Archive for April, 2016

Ten year prognostic model for patients presenting with chest pain

Sekhri et al report a prospective cohort study of patients with suspected angina presenting to a chest pain clinic. An internally validated prognostic model was developed and added discriminating power to the Diamond-Forrester estimates. The online calculator has been added to the risk score calculator page.






Eicosapentanoic Acid in Hypercholesterolemic Patients

The JELIS trial was a prospective randomized clinical trial examining the addition of purified eicosapentanoic acid (EPA: 2 x 300 mg three times=1800 mg per day) in Japanese patients with hypercholesterolemia. 18645  patients were randomized.  There were secondary prevention and primary prevention subgroups.

The trial revealed a reduction in the composite end-point of major coronary events overall in the trial. The primary prevention arm effect size was similar but did not reach significance. The secondary prevention group did reach significance.


The effect on lipids is shown below:


and subgroup analysis:


An analysis of the primary prevention arm was subsequently published.  There was a dose response relationship between risk factors and cardiac events. Patients with high triglycerides and low HDL appeared to have a significant benefit with effect size similar to overall trial.




CTCA Guided Therapy for Patients with Suspected Angina

Williams et al report a prospective randomized clinical trial (SCOT-HEART) comparing standard care with standard care + CTCA in 4146 patients with suspected angina. The effect on time to preventive strategies was shorter in the CTCA guided arm. Cumulative fatal and non-fatal cardiac events were lower in the CTCA arm. The comparative costs were also presented.


Updated Modified Jones Criteria for Acute Rheumatic Fever

HeartOne has 2 modules on acute rheumatic fever and rheumatic heart disease. The 2015 modified Jones criteria for diagnosis is available here.
There is a very instructive app from Rheumatic Heart Disease Australia.


The HOPE3 investigators published the results of the randomized clinical trial of blood pressure lowering (candesartan-hydrochlorothiazide), cholesterol lowering (with rosuvastatin) or both in patients with intermediate risk but no cardiovascular disease. The combined treatment and the cholesterol lowering therapy were associated with reduction in the primary end-point and component adverse cardiovascular events. Blood pressure alone was not associate with reduction in cardiovascular events. Subgroup analysis suggested there may be a beneficial effect in patients with baseline hypertension.


Blood Pressure Lowering and Cholesterol Lowering





Blood Pressure Lowering 


Cholesterol Lowering


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Post Cardiac Surgery Atrial Fibrillation: Rate versus Rhythm

Gillinov  et al report a randomized clinical trial of rate v rhythm control for post operative atrial fibrillation (AF) after cardiac surgery. Amiodarone was used for rhythm control. If AF persisted to 24 to 48 hours electrical cardioversion was recommended. The rate control arm aimed for a heart rate < 100/minute. There was crossover to amiodarone if clinician thought this was indicated.The primary end point was the total number of days of hospitalization within 60 days after randomization. No significant differences were found between the two strategies: primary end-point, adverse events.


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Cryoablation versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation

Kuck et al report (for the FIRE and ICE investigators) the results of a randomized clinical trial comparing cryoablation with radiofrequency ablation for drug refractory paroxysmal atrial fibrillation. Cryoablation was found to be non-inferior in terms of the primary efficacy end-point and there was no significant difference in overall safety between the technique.



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