Archive

Archive for November, 2014

Journal Club 12 November 2014

Paper

Type 2 myocardial infarction in clinical practice

Presenter

KL

Summary

Objective

We aimed to assess differences in incidence,
clinical features, current treatment strategies and
outcome in patients with type 2 vs. type 1 acute
myocardial infarction (AMI).

Methods and results

All 20 138 hospitalisations in
Sweden with a diagnosis of AMI registered during 2011
in the Swedish Web-system for Enhancement and
Development of Evidence-based care in Heart disease
Evaluated According to Recommended Therapies were
classified into types 1–5 in accordance with the
universal definition of myocardial infarction (MI) from
2007. Type 1 AMI was present in 88.5% of the cases
while 7.1% were classified as type 2 AMI. Higher age,
female sex, comorbidities, impaired renal function,
anaemia and smaller extent of myocardial necrosis
characterised patients with type 2 AMI. While normal
coronary arteries were more frequently seen (42.4% vs.
7.4%), an invasive treatment was less common, and
antiplatelet medications were less prescribed in patients
with type 2 AMI compared with type 1 AMI. The group
with type 2 AMI had significantly higher crude 1-year
mortality compared with the group with type 1 AMI
(24.7% vs. 13.5%, p<0.001). However, after
adjustment, the HR for 1-year mortality in patients with
type 2 AMI was 1.03 (95% CI 0.86 to 1.23).

Conclusions

In this real-life study, 7.1% of myocardial
infarctions were classified as type 2 AMI. These patients
were older, predominantly women and had more
comorbidities. Invasive treatment strategies and
cardioprotective medications were less used. Patients
with type 2 AMI had higher crude mortality compared
with type 1 patients with MI. However, after adjustment,
the 1-year mortality was similar.

Advertisements

Journal Club 5 November 2014

Paper

Aspirin in Patients Undergoing Noncardiac Surgery

Presenter

SH

Summary

Background

There is substantial variability in the perioperative administration of aspirin in
patients undergoing noncardiac surgery, both among patients who are already on
an aspirin regimen and among those who are not.

Methods

Using a 2-by-2 factorial trial design, we randomly assigned 10,010 patients who were
preparing to undergo noncardiac surgery and were at risk for vascular complications
to receive aspirin or placebo and clonidine or placebo. The results of the aspirin
trial are reported here. The patients were stratified according to whether they
had not been taking aspirin before the study (initiation stratum, with 5628 patients)
or they were already on an aspirin regimen (continuation stratum, with 4382 patients).
Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery
and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum and
for 7 days in the continuation stratum, after which patients resumed their regular
aspirin regimen. The primary outcome was a composite of death or nonfatal myocardial
infarction at 30 days.

Results

The primary outcome occurred in 351 of 4998 patients (7.0%) in the aspirin group
and in 355 of 5012 patients (7.1%) in the placebo group (hazard ratio in the aspirin
group, 0.99; 95% confidence interval [CI], 0.86 to 1.15; P = 0.92). Major bleeding was
more common in the aspirin group than in the placebo group (230 patients [4.6%]
vs. 188 patients [3.8%]; hazard ratio, 1.23; 95% CI, 1.01, to 1.49; P = 0.04). The primary
and secondary outcome results were similar in the two aspirin strata.

Conclusions

Administration of aspirin before surgery and throughout the early postsurgical
period had no significant effect on the rate of a composite of death or nonfatal
myocardial infarction but increased the risk of major bleeding. (Funded by the
Canadian Institutes of Health Research and others; POISE-2 ClinicalTrials

Supplementary Material

This was assessed as important paper. The following supplementary material is provided

Journal Club 29 October 2014

Paper

Cardiac catheterization is associated with superior outcomes for survivors of out of hospital cardiac arrest: Review and meta-analysis

Presenter

PJS

Summary

Aims

Survivors of out-of-hospital cardiac arrest (OHCA) have a high rate of morbidity and mortality. Invasive cardiac assessment with coronary angiography offers the potential for improving outcomes by facilitating early revascularization. The aim of the present study was to review the published data on early coronary angiography for survivors of OHCA, and its impact on survival and neurological outcomes.

Methods

Medline, Embase and PubMed were searched with a structured search query. The primary outcome was in-hospital (or if not available, 30 day or 6 month) survival. Rates of survival with good neurological outcome were a secondary endpoint. The time period of the search was from 1 January 1980 to 1 January 2014. Data was pooled with means and 95% CI interval calculated. Meta-analysis of the main outcomes was performed using a weighted random effects model.

Results

Following review of all identified records, 105 relevant full text articles were retrieved. Fifty had adequate outcome information stratified by the use of coronary angiography for analysis. In studies where a control group was available for comparison, the overall survival in the acute angiography group was 58.8% versus 30.9% in the control group (Odds ratio 2.77, 95% CI 2.06–3.72). Survival with good neurological outcome (as per the Utstein framework) in the early angiography group was 58% versus 35.8% in the control group (Odds ratio 2.20, 95% CI 1.46–3.32).

Conclusions

Early coronary angiography in patients following OHCA is associated with improved outcome and better survival.

Note

The paper and Spaulding background paper will linked to in due course.

Categories: Journal Club Tags: