“It's getting better all the time,” sang the fab four in their 1967 hit Getting Better. Like the Beatles song, this week, the cardiology industry is following suit, finding positive strategies and approaches that may help improve procedural outcomes.
In fact, positive news this week from the New England Journal of Medicine showed that patients with left main coronary disease or three vessel disease saw a greater relief from angina with CABG compared with PCI, six and 12 months after procedure.
However, researchers from St. Luke’s Mid America Heart Institute concluded that these benefits achieved with CABG were small and were counterbalanced by the more rapid recovery times and improved health status of patients who underwent PCI.
Additionally this week, researchers from Massachusetts General found that coronary CT angiography (CCTA)-based triage of low-risk acute chest pain patients in the emergency department could reduce invasive catheterizations, save money and improve survival.
The study published in the American Journal of Roentgenology showed that after using a microsimulation model that compared standard of care to CCTA-based care, the CCTA-based approach reduced the number of patients referred for invasive coronary angiography or stress echocardiography. Additionally, this approach reduced the number of “missed” cases of acute coronary syndrome.
On the pharmaceutical side, Actos, of the controversial drug class thiazolidinedione, was found to have an astounding benefit for pre-diabetics in this week's New England Journal of Medicine, with preventing full-blown diabetes for 72 percent of pre-diabetic patient population in the study. "This is the largest decrease in the conversion rate of pre-diabetes to diabetes ever demonstrated by any intervention including diet, exercise or medication," study author Dr. Devjit Tripathy told Cardiovascular Business News.
In other news this week, a study in the American Heart Journal suggests that primary PCI be used as the first choice reperfusion strategy, when available. The authors found that compared with fibrinolytic therapy, primary PCI reduced 30-day mortality, no matter a patient’s baseline risk.
The meta-analysis, which assessed 22 randomized controlled trials, showed that patients who underwent primary PCI realized an almost 3 percent reduction in mortality compared to those who underwent fibrinolysis. However, researchers noted that fibrinolysis should still be a legitimate option if access to PCI is greater than two hours.
The news this week offers strategies that may help free patients from, or at least alleviate chest pain. Additionally, the news shows that PCI can improve recovery time and health status. Like the Beatles, news outlining beneficial strategies in cardiology is getting better, " i've got to admit it's getting better, a little better all the time.” On these topics or others please feel free to contact me.