ISCHAEMIC HEART DISEASE

Concerns about off-pump cardiac surgery ▸ Off-pump surgery has become popular in recent years. It has been thought to be less invasive, and produce better outcomes. This trial randomly assigned 50 patients to undergo on-pump coronary artery bypass grafting and 54 to undergo off-pump surgery. Surgical and anaesthetic techniques were standardised for both groups. Three months later, the patients underwent coronary angiography, including quantitative analysis. The mean age of the patients was 63 years. The on-pump group received a mean of 3.4 grafts, and the off-pump group 3.1 (p  =  0.41). There were no deaths. There was no significant difference in the median postoperative length of stay between the two groups (seven days in each group). The area under the curve of troponin T concentration was higher during the first 72 hours in the on-pump group than in the off-pump group (30.96 hr•μg/litre v 19.33 hr•μg/litre, p  =  0.02). At three months, 127 of 130 grafts were patent in the on-pump group (98%), as compared with 114 of 130 in the off-pump group (88%, p  =  0.002). The patency rate was higher for all graft territories in the on-pump group than in the off-pump group, including the left internal mammary artery graft.

▴Khan NE, De Souza A, Mister R, Flather M, Clague J, Davies S, Collins P, Wang D, Sigwart U, Pepper J. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med2003;350:21–8.OpenUrl

GTN spray is not a diagnostic test for angina ▸ The belief that response of chest pain to glyceryl trinitrate (GTN) is a hard diagnostic sign is taken apart in this prospective observational study, where all patients presenting to the emergency room …