Archive

Archive for March, 2016

DAPT Score: A Promising Tool to Guide Duration of Dual Antiplatelet Therapy Post PCI

Yeh et al report a risk score (derived from DAPT trial and validated) to guide clinicians in decisions regarding duration of dual antiplatelet therapy post percutaneous coronary intervention. It provides estimates of thrombotic and bleeding events. Risk stratification:

  • patients with higher thrombotic risk than bleeding: consider for 30 month duration of dual antiplatelet therapy (alternate intervention in DAPT study).
  • patients with lower thrombotic risk than bleeding could be considered for cessation of dual antiplatelet therapy at 12 months.

Investigators from other clinical trials with similar populations aim to test the score on their data. These publications are awaited with interest.

There is an online calculator. There is a link to it on the Risk Scores page.

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Controlled Release Metoprolol in Moderate to Severe Aortic Regurgitation

Broch et al report a randomized placebo controlled clinical trial of use of controlled release metoprolol  in patients with moderate to severe aortic regurgitation. The primary end-point was change in LV volumes assessed by serial cardiac MRI (and echocardiography: 6 month interval). The study was neutral. Secondary end-points suggested the treatment was safe (if concomitant indication for beta-blockers). It is noteworthy that the beta-blocker group higher NT-pro BNP. The authors speculate with respect to changes in ejection fraction (increase) v elevated BP.

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To Sit or Not to Sit

Sedentary lifestyle and sitting, in particular, has been identified as a cardiovascular risk factor.  A Cochrane review examined the effectiveness of workplace measures to reduce sitting. The conclusions: The quality of evidence was very low to low for most interventions mainly because studies were very poorly designed and because they had very few participants. We conclude that at present there is very low quality evidence that sit-stand desks can reduce sitting at work at the short term. There is no evidence for other types of interventions. We need research to assess the effectiveness of different types of interventions for decreasing sitting at workplaces in the long term.

The hyperlink is the full review. It is instructive with respect to  the assessment of clinical trial quality (biases etc) in addition to the primary question. There was no data on the hard cardiovascular end point of interventions.

 

REVEAL Registry Risk Score for Pulmonary Arterial Hypertension

The REVEAL registry has provided a useful prognostic score for pulmonary arterial hypertension.

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I year Survival

I year Survival

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I could not find an online calculator with a cursory view.

A simple interface is possible but at current time I have not deployed on web.

 

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Vulnerable Plaque

Bourantas et al review the status of imaging (invasive and non-invasive)  techniques for detection of the vulnerable plaque and their clinical utility. The progress is discussed. The modest predictive value of various techniques is explored (see supplement). The challenges are reviewed.

Summary of prognostic trials of "vulnerable plaque"

Summary of prognostic trials of “vulnerable plaque”

 

 

Historical perspective

Historical perspective

 

The debate. The right side summarizes evidence addressing cons.

The debate. The right side summarizes evidence addressing cons

Coronary Artery Disease Genetic Network

Talukdar et al report on the regulatory genetic network for coronary artery disease. The relationship between well known risk  factors. Genome wide association studies within and across  vascular and metabolic tissues allowed mapping  the regulatory genetic network.

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The Victorian Auditor General review of bullying in the health sector has been released. It is extremely unlikely that this is a problem unique to Victoria. It is also not confined to surgery.

The findings are sobering. It remains to be seen whether meaningful action will arise.

 

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