Archive for March, 2014


The ORBIT AF trial provides important and useful information in relation to concomitant use of aspirin and oral anticoagulation. It is associated with increased risk of bleeding complications. The trial characterises and quantifies risk in ‘real world’ population.

It is available here.

Categories: Uncategorized

Mortality Morbidity Meeting 12 March 2014

This is a placeholder documenting the occurrence of this meeting.

Categories: Mortality Morbidity

Valvular Heart Disease Guidelines (ACC/AHA)

The ACC/AHA guidelines for management of patients with valvular heart disease is available here.

Journal Club 26 February 2014


Short-term rosuvastatin therapy for prevention of contrast-induced acute kidney injury in patients with diabetes and chronic kidney disease.





This study sought to evaluate the safety and efficacy of rosuvastatin in preventing contrast-induced acute kidney injury (CI-AKI) in patients with diabetes mellitus (DM) and chronic kidney disease (CKD).


CI-AKI is an important complication after contrast medium injection. While small studies have shown positive results with statin therapy, the role of statin therapy in prevention of CI-AKI remains unknown.


We randomized 2,998 patients with type 2 DM and concomitant CKD who were undergoing coronary/peripheral arterial angiography with or without percutaneous intervention to receive rosuvastatin, 10 mg/day (n = 1,498), for 5 days (2 days before, and 3 days after procedure) or standard-of-care (n = 1,500). Patients’ renal function was assessed at baseline, 48 h, and 72 h after exposure to contrast medium. The primary endpoint of the study was the development of CI-AKI, which was defined as an increase in serum creatinine concentration ≥0.5 mg/dl (44.2 μmol/l) or 0.25% above baseline at 72 h after exposure to contrast medium.


Patients randomized to the rosuvastatin group had a significantly lower incidence of CI-AKI than controls (2.3% vs. 3.9%, respectively; p = 0.01). During 30 days’ follow-up, the rate of worsening heart failure was significantly lower in the patients treated with rosuvastatin than that in the control group (2.6% vs. 4.3%, respectively; p = 0.02).


Rosuvastatin significantly reduced the risk of CI-AKI in patients with DM and CKD undergoing arterial contrast medium injection. (Rosuvastatin Prevent Contrast Induced Acute Kidney Injury in Patients With Diabetes [TRACK-D]

Journal Club 19 February 2014


The Yield of Downstream Tests after Exercise Treadmill Testing: A Prospective Cohort Study





To estimate the frequency and results of downstream testing following exercise treadmill tests (ETT).


The utility of additional diagnostic testing following ETT is not well characterized.


We followed consecutive individuals without known CAD referred for clinical ETT at a large medical center. We measured the frequency and results of downstream imaging tests and invasive angiography within six months of ETT, and the combined endpoint of survival free from cardiovascular death, myocardial infarction, and coronary revascularization.


Among 3,345 consecutive subjects who were followed for a mean of 2.5±1.1 years, 332 (9.0%) underwent noninvasive imaging while 84 (2.3%) were referred directly to invasive angiography after ETT. The combined endpoint occurred in 76 (2.2%) patients. The annual incidence of the combined endpoint following negative, inconclusive and positive ETT was 0.2%, 1.3% and 12.4% respectively (P<0.001). Rapid recovery of ECG changes during ETT was associated with negative downstream test results and excellent prognosis while typical angina despite negative ECG was associated with positive downstream tests and adverse prognosis (P<0.001). Younger age, female gender, higher METs achieved and rapid recovery of ECG changes were predictors of negative downstream tests.


Among patients referred for additional testing after ETT, the lowest yield was observed among individuals with rapid recovery of ECG changes or negative ETT while the highest yield was observed among those with typical angina despite negative ECG or a positive ETT. These findings may be used to identify patients who are most and least likely to benefit from additional testing.

Categories: General Cardiology