852 e-Letters

  • Time metrics for reperfusion therapy and failure to achieve Guideline mandated times with P-PCI

    We read with interest the article by Varcoe et al (Heart Jan 15 th 20917) “Impact of call-to-balloon time on 30-day mortality in contemporary practice” We were not surprised by the results which indicate yet again that patients with delays to reperfusion suffer worse mortality rates - the concept of timely reperfusion in STEMI has been previously very well documented, and its importance recognised for some time. Thus de Lucca (1), Cannon (2) and others (3) reported data >10 years ago which supported the concept that mortality rates increase when important time metrics are not achieved. Time dependent infarct size is considered the cause (4)
    When the National Infarct Angioplasty Project (NIAP) was established in 2008 with the explicit aim of rolling out P-PCI in the UK, everyone involved in care of STEMI patients thought it was a good idea to go with a policy of one STEMI management strategy, for simplicity. No-one doubted that P-PCI should become the standard of care. Some (including the authors of this letter - one of whom served on NIAP) voiced concerns however that, based on the published data, achieving guideline mandated times was essential, and that this might be difficult to achieve with P-PCI in patients transferred from more rural regions. There was assurance from Department of Health that >95% of patients were “within distance” of a P-PCI centre. We tried to point out that being “within distance”, and being within the mandated times were very differe...

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  • Re:A Case for Palliative PCI
    James Cockburn

    We would like to thank Sarah Blake et al, for their thoughtful and insightful comments.

    Firstly, we agree that "palliative PCI" can be a very useful treatment in this elderly patient population. Locally at our institution, via our heart team meeting, we can offer an elderly symptomatic patient with multiple co-morbidities percutaneous coronary intervention (PCI), which often fails to achieve complete re-vasculari...

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  • Cautious anticoagulation strategy in patients with dialysis-requiring end-stage kidney disease.
    Jonathan M Behar

    We read with interest this manuscript which demonstrated in a large clinical registry that patients with chronic kidney disease with indications for anticoagulation were often treated sub-therapeutically (1). A more aggressive approach was therefore advocated.

    We would like to point out that, while this study should be commended for including a large number of patients, it did not show data on the key clinical...

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  • Considering genomic variants for cardiovascular disease prediction
    Sherry-Ann N. Brown

    Dear Editor,

    I read with great interest the article by Morris et al entitled, "Marginal role for 53 common genetic variants in cardiovascular disease prediction" (1). The article analyzed a large sample of 11, 851 individuals from 7 prospective studies aimed at primary prevention of fatal or non-fatal coronary heart disease (CHD) or stroke.

    The study incorporated susceptibility variants for CHD and str...

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  • "Definite Diagnosis of Spontaneous Coronary Artery Dissection: An Unsettled Issue"
    Adriano Caixeta

    We read with great interest the manuscript by Faden et al. (1) entitled "A nationwide evaluation of spontaneous coronary artery dissection in pregnancy and the puerperium" when it was published online July 13. Using the Healthcare Cost and Utilization Project national database, the authors evaluated over 4 million pregnancy-related discharges, looking at the prevalence and outcomes of pregnancy-associated spontaneous cor...

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  • A Case for Palliative PCI
    Sarah R Blake

    Dear Editor

    On reading the review on coronary revascularisation in the elderly by Cockburn et al (1) I must agree that more trials are needed to focus on the benefit of PCI in elderly populations.

    When assessing these patients, clinicians should consider the impact of symptom relief versus procedural risk. If a patient is experiencing recurrent and debilitating chest pain requiring frequent hospital a...

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  • Oxygen is toxic during reoxygenation in STEMI patients as well as in other clinical conditions
    Ola Didrik Saugstad

    Nehme and coworkers tested out the effect of air versus oxygen on myocardial injury in ST-elevation myocardial infarction (STEMI).1 When administered in the first 12 hours after STEMI oxygen was associated with a dose-dependent increase in troponin and creatine kinase. In 2015 the same group of investigators published a study in Circulation showing that air instead of oxygen supplementation in STEMI led to improved outco...

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  • Signficance of Inverse Prognostic Value of Post-PCI FFR in Patients with NSTEMI
    Adnan Nadir

    I read the article by Kasula and colleagues with great interest. I firmly believe that this is a novel finding and of great clinical significance (1).

    Utility of Fractional flow reserve (FFR) is firmly established in stable coronary artery disease but has been widely debated in patients with acute MI particularly in the culprit vessel (2, 3). FFR measurements require maximal coronary hyperaemia which may be les...

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  • Inverse Prognostic Value of Post-PCI FFR in Patients with NSTEMI
    Marco Canepa

    We thank Ripley and colleagues for their interest in our paper and agree that T1 mapping with CMR is an emerging imaging biomarker that is increasingly being investigated for its potential role in hypertrophic cardiomyopathy and cardiac hypertrophy in general. Convincing data have been published concerning hypertensive heart disease(Hinojar et al., 2015), hypertrophic and dilated cardiomyopathy (Puntmann et al., 2013),...

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  • Expediating the pathway to SVT ablation
    Claire E.P. Brough

    Honarbakhsh et al should be congratulated upon their innovative research in improving the care for patients with arrhythmias. Their paper not only demonstrates an effective community treatment strategy but importantly is cost effective during the current austerity. Potential further cost savings and enhanced patient experiences could be anticipated by encouraging General Practitioners to subsequently refer patients wishi...

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