Dear Editor
Gholap et al confirmed a surprising observation that South Asians,
compared to White British populations, have lower or similar, rather than
higher mortality, following myocardial infarction, as Fischbacher et al
first demonstrated in Scotland.(1;2) As the chief investigator of that
Scottish study I found the result perplexing given South Asians' high
prevalence of type 2 diabetes. A literature review showed...
Dear Editor
Gholap et al confirmed a surprising observation that South Asians,
compared to White British populations, have lower or similar, rather than
higher mortality, following myocardial infarction, as Fischbacher et al
first demonstrated in Scotland.(1;2) As the chief investigator of that
Scottish study I found the result perplexing given South Asians' high
prevalence of type 2 diabetes. A literature review showed the mortality
following MI in Scottish South Asians was similar to international reports
and concluded that White Scottish people had unusually high post-MI
mortality.(2) This showed how studies on minorities may, paradoxically,
throw light on health of the majority.
Possibly, compared to White Scottish people, South Asians may have
having smaller, less lethal MIs given their tendency to diffuse
atherosclerosis. We hypothesised that South Asians may reach hospitals
quicker than the White Scottish populations given they tended to live in
the inner city. Given heterogeneity in South Asian populations (Indians,
Pakistanis; men, women) we were keen to disaggregate them. We have
published our results, and they show further surprises. The survival
following MI was, compared to White Scottish people, similar in Indian men
and women, but better in Pakistanis, especially women. Our conclusions
were unaltered by adjustment for socio-economic factors, travel times,
hospitalisation for diabetes, or cardiovascular procedures. We had no
cardiovascular risk factor data but Gholap et al's data show these are not
explanatory.
The results are reassuring from a clinical and public health
perspective but they remain surprising. Possibly, they relate to lower
cardiovascular risk factors over a lifetime, as many of South Asians came
to the UK as adults having had little exposure to risk factors when young.
It will be interesting to see whether the new generations of South Asians
will also enjoy this 'protection', given their lifelong exposure to
cardiovascular risk factors and a high risk of diabetes.
In the Netherlands ethnic minority groups (defined by parental and
own birthplace) have relatively worse outcomes, with gaps increasing over
time.(4) Overall, in the UK we can be proud of these results as they
reflect, at least partially, equitable health care.
Reference List
1 Gholap NN, Khunti K, Davies MJ, Bodicoat DH, Squire IB. Survival in
South Asian and White European patients after acute myocardial infarction.
Heart 2015; 101/8: 630-636.
2 Fischbacher CM, Bhopal R, Povey C, Steiner M, Chalmers J, Mueller G et
al. Record linked retrospective cohort study of 4.6 million people
exploring ethnic variations in disease: myocardial infarction in South
Asians. BMC Public Health 2007; 7/1: 142.
3 Bansal N, Fischbacher CM, Bhopal RS, Brown H, Steiner MF, Capewell S et
al. Myocardial infarction incidence and survival by ethnic group: Scottish
Health and Ethnicity Linkage retrospective cohort study. BMJ Open 2013;
3/9.
4 van Oeffelen AAM, Agyemang C, Stronks K, Bots ML, Vaartjes I. Prognosis
after a first hospitalisation for acute myocardial infarction and
congestive heart failure by country of birth. Heart 2014; heartjnl-2013.
Medical Clinic II-Department of Cardiology, Angiology and Intensive
Care Medicine, University Heart Center Luebeck, University of Luebeck,
Luebeck, Germany
Medical Clinic II-Department of Cardiology, Angiology and Intensive
Care Medicine, University Heart Center Luebeck, University of Luebeck,
Luebeck, Germany
Corresponding author:
Georg Fuernau, M.D.
Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine)
University Heart Center Luebeck
University Hospital Schleswig-Holstein, Ratzeburger Allee 160
23538 Luebeck, Germany
Mail: georg.fuernau@gmx.at
Tel.: +49 451 500 2501; Fax: +49 451 500 6437
We read with great interest the manuscript by Park and co-workers
published epub ahead of print in Heart [1]. The authors investigated an
important and controversial issue, interventional treatment of multi-
vessel disease in patients with cardiogenic shock complicating acute
myocardial infarction. Yet, we have some concerns if the population
studied in this manuscript reflects a population with real cardiogenic
shock. Although using established definitions for cardiogenic shock
(systolic blood pressure <90 mmHg for >30 min or the need for
supportive management to maintain systolic blood pressure >90 mmHg and
evidence of end-organ hypoperfusion) the one-year mortality (~16%) in the
study by Park et al. was much lower than in all other studies
investigating cardiogenic shock. In other trials mortality rates of 50% up
to 63% after 1 year were reported [2, 3]. Therefore, we believe that the
population studied is a cohort at minor risk and the results cannot be
extrapolated to patients with severe cardiogenic shock. Furthermore, the
discussion is slightly selective with not all trials being cited comparing
multi-vessel versus culprit lesion only PCI in cardiogenic shock. The
current evidence has recently been reviewed [4]. To clarify the important
question of multi-vessel vs. culprit lesion percutaneous coronary
intervention in patients with cardiogenic shock complicating myocardial
infarction a randomized European multi-center study is currently
recruiting patients (Culprit Lesion Only PCI Versus Multivessel PCI in
Cardiogenic Shock - CULPRIT-SHOCK; ClinicalTrials.gov Identifier:
NCT01927549).
Conflict of Interest:
None declared
References
1 Park JS, Cha KS, Lee DS, et al. Culprit or multivessel
revascularisation in ST-elevation myocardial infarction with cardiogenic
shock. Heart 2015. pii: heartjnl-2014-307220. doi: 10.1136/heartjnl-2014-
307220. [Epub ahead of print].
2 Thiele H, Zeymer U, Neumann FJ, et al. Intra-aortic balloon
counterpulsation in acute myocardial infarction complicated by cardiogenic
shock (IABP-SHOCK II): final 12 month results of a randomised, open-label
trial. Lancet 2013;382:1638-45.
3 Aissaoui N, Puymirat E, Tabone X, et al. Improved outcome of
cardiogenic shock at the acute stage of myocardial infarction: a report
from the USIK 1995, USIC 2000, and FAST-MI French nationwide registries.
Eur Heart J 2012;33:2535-43.
4 Thiele H, Ohman EM, Desch S, et al. Management of cardiogenic
shock. Eur Heart J 2015. pii: ehv051. [Epub ahead of print].
I read the research by Dahl et al. with great interest (1). The
authors have suggested paradoxical low-flow low-gradient aortic stenosis
is a distinct entity, and not an advanced stage of severe aortic stenosis.
Indeed, they have observed only 5% of these patients had high-gradient
severe disease prior to the index assessment (1).
Recent studies have demonstrated that paradoxical low-flow low-
gradient is a hete...
I read the research by Dahl et al. with great interest (1). The
authors have suggested paradoxical low-flow low-gradient aortic stenosis
is a distinct entity, and not an advanced stage of severe aortic stenosis.
Indeed, they have observed only 5% of these patients had high-gradient
severe disease prior to the index assessment (1).
Recent studies have demonstrated that paradoxical low-flow low-
gradient is a heterogeneous subgroup of patients with aortic valve
calcification (based on computed tomography), echocardiographic and
cardiovascular magnetic resonance features between those observed in
concordant non-severe and severe disease (2-4). Moreover, more than 80%
of patients with paradoxical low-flow low-gradient severe aortic stenosis
experienced progression of aortic stenosis severity, with half of them to
high-gradient severe disease (5). Instead of an advanced stage of severe
disease or a distinct entity, these studies have suggested paradoxical low
-flow low-gradient severe aortic stenosis is a stage in transition from
non-severe to severe disease.
Consistent with this hypothesis, all the patients in the current
study have progressed from non-severe disease, albeit at different rates
and with different remodelling patterns (Figures 1, 2 and 3 (1)). In this
regard, paradoxical low-flow low-gradient severe aortic stenosis (and for
that matter, the other flow and gradient patterns) reflects the complex
interaction between aortic valve calcification and heterogeneous
hypertrophic response, rather than a new entity.
Longitudinal studies with multi-modality imaging approaches
(echocardiography, computed tomography and cardiovascular magnetic
resonance) will be essential to fully examine this complex interaction
between the valve and the myocardium; and to identify unique
characteristics that determine progression in the different flow-gradient
patterns.
References
1. Dahl JS, Eleid MF, Pislaru SV, Scott CG, Connolly HM, Pellikka PA.
Development of paradoxical low-flow, low-gradient severe aortic stenosis.
Heart. 2015 Mar 20 [Epub ahead of pring].
2. Chin C, Khaw J, Luo E, Tan SW, White A, Newby DE, et al.
Echocardiography Underestimates Stroke Volume and Aortic Valve Area:
Implications for Patients With Small-Area Low-Gradient Aortic Stenosis.
Can J Cardiol. 2014;30(9):1064-72.
3. Barone-Rochette G, Pi?rard S, Seldrum S, de Meester de Ravenstein C,
Melchior J, Maes F, et al. Aortic Valve Area, Stroke Volume, Left
Ventricular Hypertrophy, Remodeling, and Fibrosis in Aortic Stenosis
Assessed by Cardiac Magnetic Resonance Imaging: Comparison Between High
and Low Gradient and Normal and Low Flow Aortic Stenosis. Circ Cardiovasc
Imaging. 2013;6(6):1009-17.
4. Clavel M-A, Messika-Zeitoun D, Pibarot P, Aggarwal S, Malouf JF, Araoz
P, et al. The complex nature of discordant severe calcified aortic valve
disease grading. J Am Coll Cardiol. 2013;62(24):2329-38.
5. Maes F, Boulif J, Pi?rard S, de Meester C, Melchior J, Gerber B, et al.
Natural History of Paradoxical Low-Gradient Severe Aortic Stenosis. Circ
Cardiovasc Imaging. 2014;7(4):714-22.
We thank Buteau and colleague (Buteau et al. 2014) for their
interest in our meta-analysis on Heart Rate Variability (HRV) and air
pollution (Pieters et al. 2012). Their concern about combining studies
from different types of regression models ignores the strength of our meta
-analysis to combine all the available evidence on HRV and air pollution
published before February 2012. Combining the available evidence is
criti...
We thank Buteau and colleague (Buteau et al. 2014) for their
interest in our meta-analysis on Heart Rate Variability (HRV) and air
pollution (Pieters et al. 2012). Their concern about combining studies
from different types of regression models ignores the strength of our meta
-analysis to combine all the available evidence on HRV and air pollution
published before February 2012. Combining the available evidence is
critically important for the goal of computing a summary effect.
Nevertheless, Buteau is right that the percentage change calculated from
linear and logarithmic models are not exactly the same. However, we
disagree that the use of linear models impacted the overall estimates of
our meta-analysis based on both logarithmic and linear models. We re-ran
our analysis with exclusion of the linear studies (n=6). In this
sensitivity analysis, using only studies with logarithmic models (n=23),
the combined estimate for an increase of 10 ?g/m? in PM2.5 was associated
with significant reduction in the frequency domain parameters including
low frequency (-1.77%, 95% CI: -2.82 to -0.72%), high frequency (-2.46%,
95% CI: -3.79 to -1.12%) and time domain parameters SDNN (-0.98%, 95% CI:
-1.44 to -0.52%) and RMSSD (-2.62%, 95% CI: -3.65 to -1.61%). These
overall estimates did not differ meaningfully from the originally reported
estimates combining both linear and logarithmic estimates.
We agree that meta-analysis should be interpreted in the context of
their limitations. Meta-analysis which are based on the information given
in the publication, cannot provide the same detail as combining the
original data of all studies. Being too stringent to leave out studies
based on the models used may also introduce a potential bias towards the
overall evidence. However, sensitivity of the findings as presented now,
is indeed useful.
References:
Stephane Buteau, Mark S. Goldberg Comment on: An epidemiological appraisal
of the association between heart rate variability and particulate air
pollution: a meta-analysis Heart published online December 29, 2014
Pieters N, Plusquin M, Cox B, Kicinski M, Vangronsveld J, Nawrot TS.
An epidemiological appraisal of the association between heart rate
variability and particulate air pollution: a meta-analysis.
Heart. 2012;98:1127-35.
Choi and colleagues describe an association between moderate coffee
consumption and lower prevalence of subclinical coronary atherosclerosis
[1]. This is consistent with a growing body of evidence that supports this
finding. A similar large prospective study of over 400 000 participants,
demonstrated that coffee consumption was inversley associated with both
total and cause-specific mortality, specifically heart disease [...
Choi and colleagues describe an association between moderate coffee
consumption and lower prevalence of subclinical coronary atherosclerosis
[1]. This is consistent with a growing body of evidence that supports this
finding. A similar large prospective study of over 400 000 participants,
demonstrated that coffee consumption was inversley associated with both
total and cause-specific mortality, specifically heart disease [2]. These
findings were independent of the caffeine content of the coffee,
suggesting that other compounds might be important. Coffee contains many
other compounds that might be responsible for the observations of these
studies, including antioxidants, but the naturally occurring diterpenes,
cafestol and kahweol, are of significant interest. Both are found in
Arabica beans and released during the brewing process of regular and
decaffeinated coffee. The amount in coffee preparations varies enormously
depending on the brewing method used. Instant and drip-filtered coffee
contains insignificant quantities of diterpenes, which are removed by
industrial processing and the lipid binding properties of filter paper
respectively. In contrast, high concentrations occur in French press,
Scandinavian boiled and Turkish-style coffees [3]. Diterpenes have
pleiotropic effects including elevating serum lipids, anti-oxidant, anti-
inflammatory, pro-apoptotic, and anti-angiogenic properties [2-4]. Whilst
this work contributes to the evidence that coffee may confer health
benefits, future studies need to account for coffee brewing technique as a
significant confounding variable.
1 Choi Y, Chang Y, Ryu S, et al. Heart Published Online First: 2
March 2015 doi:10.1136/heartjnl-2014- 306663.
2 Freedman ND, Park Y, Abnet CC, et al. Association of coffee
drinking with total and cause-specific mortality. N Engl J Med
2012;366:1891-904.
3 Urgert R, van der Weg G, Kosmeijer-Schuil TG, et al. Levels of the
cholesterol-elevating diterpenes cafestol and kahweol in various coffee
brews. J Agric Food Chem 1995;43:2167-2172.
4 C?rdenas C, Quesada AR, Medina MA. Anti-angiogenic and anti-
inflammatory properties of kahweol, a coffee diterpene. PLoS One.
2011;6(8):e23407.
I read a paper by Xie et al. with interest (1). There is also a
review article in the same issue by Chin on the mechanism on the
relationship between air pollution and cardiovascular events (2), and
expert position paper was also published (3). Xie et al. handled large
samples in Beijing and conducted their survey with special emphasis on
fine particulate matter (PM2.5) concentration and ischaemic heart disease
(IHD) mo...
I read a paper by Xie et al. with interest (1). There is also a
review article in the same issue by Chin on the mechanism on the
relationship between air pollution and cardiovascular events (2), and
expert position paper was also published (3). Xie et al. handled large
samples in Beijing and conducted their survey with special emphasis on
fine particulate matter (PM2.5) concentration and ischaemic heart disease
(IHD) morbidity and mortality. The authors clarified that a 10
microgram/cubic meter increase in PM2.5 was associated with a 0.27%
increase in IHD morbidity and a 0.25% increase in mortality on the same
day. In addition, they estimated that 7703 cases and 1475 deaths were
observed during the 3 years by exceeding environmental criteria by WHO on
M2.5. I have some comments on this relationship.
Beelen et al. (4) reported a meta-analysis for the effect of long-
term exposure to air pollution on cardiovascular mortality (overall and
cause-specific), and concluded that there was no significant association.
Yamamoto et al. (5) reported a systematic review on the association
between air pollution and cardiovascular disease in South Asia, and they
could not elucidate air pollution as a significant risk factor for
cardiovascular disease (CVD). Heinrich et al. (6) mentioned that each
study of meta-analysis showed different number of samples and sex
distribution, which was related to the study outcomes. In addition to
difference of follow-up period and ethnicity, indicators of air pollution
are speculated to become a key factor on the relationship.
CVD is composed of specific causes such as cerebrovascular disease,
IHD and myocardial infarction, and sub-analysis with enough number of
samples are needed to confirm the causality of the association. Namely, a
systematic review should be conducted by specifying the types of air
pollution and classification of CVD.
References
1. Xie W, Li G, Zhao D, et al. Relationship between fine particulate
air pollution and ischaemic heart disease morbidity and mortality. Heart
2015;101:257-63.
2. Chin MT. Basic mechanisms for adverse cardiovascular events
associated with air pollution. Heart 2015;101:253-6.
3. Newby DE, Mannucci PM, Tell GS, et al. Expert position paper on
air pollution and cardiovascular disease. Eur Heart J 2015;36:83-93.
4. Beelen R, Stafoggia M, Raaschou-Nielsen O, et al. Long-term
exposure to air pollution and cardiovascular mortality: an analysis of 22
European cohorts. Epidemiology 2014;25:368-78.
5. Yamamoto SS, Phalkey R, Malik AA. A systematic review of air
pollution as a risk factor for cardiovascular disease in South Asia:
limited evidence from India and Pakistan. Int J Hyg Environ Health
2014;217:133-44.
6. Heinrich J, Thiering E, Rzehak P,et al. Long-term exposure to NO2
and PM10 and all-cause and cause-specific mortality in a prospective
cohort of women. Occup Environ Med 2013;70:179-86.
Since the study shows a lower heart rate in paroxysmal or persistent
AF is associated with lesser chance of progression to permanent AF, would
rigorous treatment of heart rate with beta blockers in paroxysmal or
persistent AF reduce the chance of their progression to permanent AF ?
We have read with great interest the article written by Zhang et
al[1] and we want to congratulate the authors on his contribution in this
relevant issue. Since the first publication in 1995 by Pijls et al,
fractional flow reserve has constantly progressed with undoubted success.
After initially being validated as alternative to the non-invasive tests,
the DEFER trial showed that a strategy of PCI based in FFR achieves b...
We have read with great interest the article written by Zhang et
al[1] and we want to congratulate the authors on his contribution in this
relevant issue. Since the first publication in 1995 by Pijls et al,
fractional flow reserve has constantly progressed with undoubted success.
After initially being validated as alternative to the non-invasive tests,
the DEFER trial showed that a strategy of PCI based in FFR achieves better
outcomes than the PCI guided by angiography in stable patients with one-
vessel disease. In the following years this hypothesis was also confirmed
in multivessel disease with the FAME and FAME-2 trials and even in non-ST
elevation acute coronary syndromes with the subgroup of patients of the
FAME and the recently published FAMOUS-NSTEMI trial. Finally, in FAME the
possibility of differing between the angiographic and functional concepts
of multivessel disease was also demonstrated. The article written by Zhang
resumes perfectly the advantages of this technique. However, despite the
robust evidence supporting its value and after having received the highest
level of recommendation in the European and ACC/AHA guidelines, its
utilization is still low and in many centres even anecdotal. It has also
been recently published a disappointing median time lag of 14 years needed
between guideline recommendation to 90 % practice uptake for class I
therapies in acute coronary syndromes[2]. Although issues associated with
reimbursement have been argued, there exist additional reasons which play
an important role in the low percentage of FFR: as an example in Spain
where most of the activity is performed in public hospitals without
difficulties associated to reimbursement, in 2013 only 4.097 cases were
reported, which represented 2,9% of the coronary angiographies and 6,2% of
the PCIs[3]. We believe that fractional flow reserve has changed the
conception of the cardiac catheterization laboratory and nowadays a
complete diagnosis, risk stratification and adequate treatment in a one-
stage manner can be offer to the still high number of patients with stable
caronary disease who have not been adequately studied before the
catheterization and to most of the non-ST elevation acute coronary
syndromes, avoiding in many cases a second visit to the lab satisfying
their expectancies
and reducing unnecessary delays and costs.
Reference List
(1) Zhang D, Lv S, Song X, Yuan F, Xu F, Zhang M, Yan S, Cao X.
Fractional flow reserve versus angiography for guiding percutaneous
coronary intervention: a meta-analysis. Heart 2015.
(2) Putera M, Roark R, Lopes RD, Udayakumar K, Peterson ED, Califf
RM, Shah BR. Translation of acute coronary syndrome therapies: From
evidence to routine clinical practice. Am Heart J 2015; 169(2):266-273.
(3) Garcia dB, Hernandez HF, Rumoroso C, Jr., Trillo NR. Spanish
Cardiac Catheterization and Coronary Intervention Registry. 23rd official
report of the Spanish Society of Cardiology Working Group on Cardiac
Catheterization and Interventional Cardiology (1990-2013). Rev Esp Cardiol
(Engl Ed) 2014; 67(12):1013-1023.
We would like to thank Dr Y-Hassan for his valuable comments [1] on
our manuscript on type 2 myocardial infarction (AMI) [2].
As pointed out in our article we share Dr Y-Hassan?s criticism against the
vague diagnostic criteria for type 2 AMI in the Universal Definition of
Myocardial Infarction [3,4] It may be difficult in many cases to
distinguish type 2 AMI from type 1 AMI and other non-ischaemic conditions
associated...
We would like to thank Dr Y-Hassan for his valuable comments [1] on
our manuscript on type 2 myocardial infarction (AMI) [2].
As pointed out in our article we share Dr Y-Hassan?s criticism against the
vague diagnostic criteria for type 2 AMI in the Universal Definition of
Myocardial Infarction [3,4] It may be difficult in many cases to
distinguish type 2 AMI from type 1 AMI and other non-ischaemic conditions
associated with myocardial damage (which includes Tako-Tsubo
cardiomyopathy (TC)). Complementary imaging studies are often necessary
for the correct classification and in our study echocardiography and
coronary angiography were performed in 73.9% and 75.1% of patients,
respectively. Nevertheless, as Dr Y-Hassan suggests, TC may have been
missed in a certain number of cases classified as myocardial infarction
and we believe, that TC, especially the apical sparing variants, probably
are more common than has been previously thought. However, the current
diagnostic criteria for TC are neither clear nor evidence based and the
real prevalence of TC mimicking AMI remains fairly unknown [5]. A
substantial proportion of type 2 AMI has minor troponin elevations and no
or only very minor visible impact on left ventricular function, which is
not compatible with a TC diagnosis. Therefore, we disagree with Dr Y-
Hassan that it is likely that most of the cases classified as type 2 AMI
would in fact be TC.
To date, the differentiation between type 2 AMI and other non-ischemic
conditions remains challenging and might be improved by more frequent use
of more advanced imaging techniques such as CMR or PET, but their
availability in real life is limited. Furthermore, it is still unclear
whether such differentiation has any therapeutic or prognostic impact or
is just more of an academic interest.
Almost all evidence on how to manage AMI are based on studies on classical
type 1 AMI. Therefore, we think that the attempt to distinguish type 1 AMI
from other forms of myocardial infarction/injury is a major step forward.
However, we fully agree with Dr Y-Hassan that there is an urgent need of
more stringent, evidence based, and clinically applicable diagnostic
criteria.
References:
1. Y-Hassan S. "Type 2" myocardial infarction: Evidence-based or guesswork
diagnosis. E-letter
1. Baron T, Hambraeus K, Sundstr?m J, Erlinge D, Jernberg T, Lindahl B.
Type 2 myocardial infarction in clinical practice. Heart 2015;101:101-6
3. Thygesen K, Alpert JS, White HD.; Joint ESC/ACCF/AHA/WHF Task Force for
the Redefinition of Myocardial Infarction. Universal definition of
myocardial infarction. Eur Heart J 2007;28:2525-38.
4. Thygesen K, Alpert JS, Jaffe AS, et al.; JointESC/ACCF/AHA/WHF Task
Force for Universal Definition of Myocardial Infarction. Third universal
definition of myocardial infarction. J Am Coll Cardiol 2012;60:1581-98.
5. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or
stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart
J. 2008;155:408-17.
The introduction of a Patient Safety Checklist is a welcome addition
for interventional cardiologists and is a concept practiced by surgeons in
all disciplines for a number of years since the original WHO Patient
Safety Checklist was proven to be of benefit in a global and
multidisciplinary setting (1). The European Association for Cardiothoracic
Surgery embraced this ideal in 2012 (1) with the publication of safety
check...
The introduction of a Patient Safety Checklist is a welcome addition
for interventional cardiologists and is a concept practiced by surgeons in
all disciplines for a number of years since the original WHO Patient
Safety Checklist was proven to be of benefit in a global and
multidisciplinary setting (1). The European Association for Cardiothoracic
Surgery embraced this ideal in 2012 (1) with the publication of safety
checklists which were specific to the nature of surgery undertaken,
comprehensive and failsafe.
The purpose of checklists is to ensure patient safety, confirming that the
team is prepared for the procedure ahead and that all are ready for any
eventuality.
The checklist published by Cahill et al has an obvious omission in this
regard - ensuring that those involved in the procedure are aware of the
contact details and availability of a cardiac surgeon if needed. While
less important (but sometimes needed) in coronary interventions where
surgical complications are rare, TAVI and other procedures such as pacing
lead extraction may require the attendance of the cardiac surgical team
more frequently in the event of major issues arising and preparedness is
crucial in emergency situations. The BCIS/SCTS Position Statement on TAVI
(2009) mandates the need for surgical cover on site and immediate access
to cardiopulmonary bypass. There is an opportunity in the checklist for
the cardiology team to check that they have current contact and
availability details for the cardiac surgical team so that if required
help can be summoned without delay. With more and more TAVI procedures
being performed transfemorally cardiac surgeons are not always physically
present during procedures and robust cover arrangements need to be in
place and details of cover confirmed. The checklist is the ideal
opportunity for this to be done and avoids unnecessary delays when minutes
count. The omission of a specific place on the checklist to ensure that
such details are known misses an essential step in ensuring patient
safety.
However, as is clear from the introduction of safety checklists in the
surgical arena the most significant hurdle to overcome is one of apathy
following their introduction. If this can be overcome and the motivation
of those using it maintained through strong leadership then this will
surely be an effective contribution to patient safety.
1. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger
EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K,
Reznick RK, Taylor B, Gawande AA. A surgical safety checklist to reduce
morbidity and mortality in a global population. N Engl J Med 2009;360:491-
499.
2. Clark S.C., Dunning J., Alfieri O.R., Elia S., Hamilton L.R., Kappetein
A.P., Lockowandt U., Sarris G.E., Kolh P.H.
EACTS Guidelines for the Use of Patient Safety Checklists.
European Journal of Cardiothoracic Surgery 2012; 41 (5): 993-1004
Dear Editor Gholap et al confirmed a surprising observation that South Asians, compared to White British populations, have lower or similar, rather than higher mortality, following myocardial infarction, as Fischbacher et al first demonstrated in Scotland.(1;2) As the chief investigator of that Scottish study I found the result perplexing given South Asians' high prevalence of type 2 diabetes. A literature review showed...
Georg Fuernau, Holger Thiele
Medical Clinic II-Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Center Luebeck, University of Luebeck, Luebeck, Germany
Keywords: acute myocardial infarction, cardiogenic shock, multivessel percutaneous coronary intervention
Corresponding author: Georg Fuernau, M.D. Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine)...
I read the research by Dahl et al. with great interest (1). The authors have suggested paradoxical low-flow low-gradient aortic stenosis is a distinct entity, and not an advanced stage of severe aortic stenosis. Indeed, they have observed only 5% of these patients had high-gradient severe disease prior to the index assessment (1).
Recent studies have demonstrated that paradoxical low-flow low- gradient is a hete...
We thank Buteau and colleague (Buteau et al. 2014) for their interest in our meta-analysis on Heart Rate Variability (HRV) and air pollution (Pieters et al. 2012). Their concern about combining studies from different types of regression models ignores the strength of our meta -analysis to combine all the available evidence on HRV and air pollution published before February 2012. Combining the available evidence is criti...
Choi and colleagues describe an association between moderate coffee consumption and lower prevalence of subclinical coronary atherosclerosis [1]. This is consistent with a growing body of evidence that supports this finding. A similar large prospective study of over 400 000 participants, demonstrated that coffee consumption was inversley associated with both total and cause-specific mortality, specifically heart disease [...
I read a paper by Xie et al. with interest (1). There is also a review article in the same issue by Chin on the mechanism on the relationship between air pollution and cardiovascular events (2), and expert position paper was also published (3). Xie et al. handled large samples in Beijing and conducted their survey with special emphasis on fine particulate matter (PM2.5) concentration and ischaemic heart disease (IHD) mo...
Since the study shows a lower heart rate in paroxysmal or persistent AF is associated with lesser chance of progression to permanent AF, would rigorous treatment of heart rate with beta blockers in paroxysmal or persistent AF reduce the chance of their progression to permanent AF ?
Conflict of Interest:
None declared
We have read with great interest the article written by Zhang et al[1] and we want to congratulate the authors on his contribution in this relevant issue. Since the first publication in 1995 by Pijls et al, fractional flow reserve has constantly progressed with undoubted success. After initially being validated as alternative to the non-invasive tests, the DEFER trial showed that a strategy of PCI based in FFR achieves b...
We would like to thank Dr Y-Hassan for his valuable comments [1] on our manuscript on type 2 myocardial infarction (AMI) [2]. As pointed out in our article we share Dr Y-Hassan?s criticism against the vague diagnostic criteria for type 2 AMI in the Universal Definition of Myocardial Infarction [3,4] It may be difficult in many cases to distinguish type 2 AMI from type 1 AMI and other non-ischaemic conditions associated...
The introduction of a Patient Safety Checklist is a welcome addition for interventional cardiologists and is a concept practiced by surgeons in all disciplines for a number of years since the original WHO Patient Safety Checklist was proven to be of benefit in a global and multidisciplinary setting (1). The European Association for Cardiothoracic Surgery embraced this ideal in 2012 (1) with the publication of safety check...
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