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  1. Iqbal Malik, Editor

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    ISCHAEMIC HEART DISEASE

    Blocking complement to reduce perioperative risk ▸

    To investigate whether inhibiting the pro-inflammatory effects of cytokines might decrease the risk of postoperative events, Verrier et al looked at the effect of a single dose of pexelizumab (a C5 complement inhibitor) on the rates of death or myocardial infarction (MI) 30 days after surgery. In those who had coronary artery bypass graft (CABG) surgery only (2732 patients), no significant difference was found in the rate of events in those receiving pexelizumab (9.8%) versus those receiving placebo (11.8%). However, in the larger population of those who received CABG and artificial valves (3099 patients), 11.5% of those receiving the drug versus 14% of those receiving placebo died or experienced MI (p  =  0.03). This effect persisted through to day 180 of follow up. The authors propose that the reduction in events may be mediated by an amelioration of ischaemia–reperfusion injury induced inflammation via terminal complement inhibition.

    ▴ Verrier ED, Shernan SK, Taylor KM, Van de Werf F, Newman MF, Chen JC et al. Terminal complement blockade with pexelizumab during coronary artery bypass graft surgery requiring cardiopulmonary bypass. JAMA2004;291:2319–27.
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    Statins reduce perioperative risk in non-cardiac surgery ▸

    Approximately one million of non-cardiac operations in the USA each year are complicated by a perioperative cardiovascular event. In light of the known effects of statins on plaque stabilisation and endothelial function, this study set out to examine retrospectively the relation between statin use and postoperative mortality in non-cardiac surgery. In the 780 591 patients studied, treatment with lipid lowering agents from at least two days before surgery was associated with a lower crude in-hospital mortality (2.13% v 3.05%, p < 0.001). This relation also held true when patients were stratified according to their other risk factors for perioperative cardiac events. However, the authors acknowledge that the length of preoperative statin treatment needed to establish this advantage was not elaborated by their study.

    ▴ Lindenauer PK, Pekow P, Wang K, Gutierrez B, Benjamin EM. Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery. JAMA2002;291:2092–9.

    Clopidogrel is cost effective in PVD and stroke ▸

    Based on the lifetime treatment of a 63 year old patient facing event probabilities derived from the CAPRIE (clopidogrel versus aspirin in patients at risk of ischemic events) trial as the …

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