ISCHAEMIC HEART DISEASE

Another new risk marker in coronary heart disease ▸

After a spate of new inflammatory markers that appear to predict risk, this study of a very high risk population of patients (8% death rate at 12 months) having coronary angiography, suggests that having low levels of endothelial progenitor cells in your blood elevates cardiovascular risk. After adjustment for age, sex, vascular risk factors, and other relevant variables, increased levels of endothelial progenitor cells were associated with a reduced risk of death from cardiovascular causes (hazard ratio (HR) 0.31, 95% confidence interval (CI) 0.16 to 0.63; p  =  0.001), a first major cardiovascular event (HR 0.74, 95% CI 0.62 to 0.89; p  =  0.002), revascularisation (HR 0.77; 95% CI 0.62 to 0.95; p  =  0.02), and hospitalisation (HR 0.76, 95% CI 0.63 to 0.94; p  =  0.01). Endothelial progenitor cell levels were not predictive of MI or of death from all causes. This marker is not yet ready for “prime time”.

An invasive strategy for ACS produces better long term health ▸

A total of 1810 patients (from 45 hospitals in England and Scotland, UK) with non-ST elevation acute coronary syndrome (ACS) were randomly assigned to receive an early intervention (n  =  895) or a conservative strategy (n  =  915) within 48 hours of the index episode of cardiac pain. In each group, the aim was to provide the best medical treatment, and also to undertake coronary arteriography within 72 hours in the interventional strategy with subsequent management guided by the angiographic findings. At one year follow up, rates of death or non-fatal myocardial infarction (MI) were similar. However, at a median of five years’ follow up, 142 (16.6%) patients with intervention treatment and 178 (20.0%) with conservative treatment died or had non-fatal MI (odds ratio (OR) 0.78, 95% CI 0.61 to 0.99; p  =  0.044), with a similar benefit for cardiovascular death or MI (0.74, 95% CI 0.56 to 0.97; …