ISCHAEMIC HEART DISEASE

Maybe an angiogram with a risk of 1 in 1000 is not such a bad idea? ▸

The Euro Heart survey set out to investigate the prognosis associated with stable angina in a contemporary population as seen in clinical practice, to identify the key prognostic features, and from this to construct a simple score to assist risk prediction. A total of 3031 patients were included on the basis of a new clinical diagnosis by a cardiologist of stable angina with follow up at one year. The rate of death and non-fatal myocardial infarction (MI) in the first year was 2.3 per 100 patient years; the rate was 3.9 per 100 patient years in the subgroup (n  =  994) with angiographic confirmation of coronary disease (this was performed in 41% of all patients). The clinical and investigative factors most predictive of adverse outcome were co-morbidity, diabetes, shorter duration of symptoms, increasing severity of symptoms, abnormal ventricular function, resting electro-cardiographic changes, or not having any stress test done. Results of non-invasive stress tests did not significantly predict outcome in the population who had tests done. A score was constructed using the parameters predictive of outcome to estimate the probability of death or MI within one year of presentation with stable angina. A score based on the presence of simple, objective clinical and investigative variables makes it possible to discriminate effectively between very low risk and very high risk patients and to estimate the probability of death or non-fatal MI over one year.

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Aspirin for primary prevention: more sex-specific data ▸

A meta-analysis of all randomised controlled trials of aspirin treatment in patients without cardiovascular disease published between 1966 and 2005 identified six trials that enrolled 51 342 women and 44 114 men. Mean duration of treatment was 6.4 years, and aspirin doses ranged from 100 mg every other day to 500 mg daily. Among women in these trials there were 1285 major cardiovascular events: 625 strokes, …