Dr. Christopher Cannon highlights his top 3 CV news picks for the week of November 8, 2010.
A big week in cardiology this week for the cardiology countdown we have a meta-analysis in the european heart journal looking at the benefit of routine pci following thrombolysis for st elevation mi looking at a total of six studies finding a significant reduction in death mi or recurrent ischemia in those who are sent routinely within 24 hours for cath and pci
Following thrombolysis this is driven by a nearly fifty percent reduction in recurrent mi and recurrent ischemia but not a significant difference in mortality as such this has been incorporated into the guidelines based on individual trials where a routine early strategy is recommended for high-risk patients and this meta-analysis really supports that with all
The evidence at our number two spot this week is a very hot topic of the proton pump inhibitor and clopidogrel interaction there’s an acc aaha an a cg combined guideline document that looks at the current evidence now that the one randomized trial cogent is published and they find that use of a ppi with dual antiplatelet therapy aspirin and clopidogrel is now an
Appropriate treatment for those at high risk of gi bleeding it was seen that the proton pump inhibitors will reduce gi ulcers and gi bleeding and that the evidence for cardiovascular harm and an interaction between clopidogrel and ppi has been very scattered and not consistent in the literature and actually refuted in the one direct randomized trial cogent and as
Such it the recommendation is to risk stratify and those who are at high risk for bleeding are now recommended to get a proton pump inhibitor and conversely those at very low risk of gi bleeding are not recommended necessarily to get routine use of a proton pump inhibitor and thus a big change but nice to have a consensus document on this very hot topic and if
This week’s number one spot is the paper in cholesterol treatment it’s the second cycle of the cholesterol treatment trial lists collaboration now this is more than a meta-analysis it’s a patient level data of all of the statin trials combined into one that look at the world’s literature in statin treatment now this cycle adds the five trials and co published as
The fifth the search trial of high dose versus standard oh statin therapy and what is seen in the overall meta-analysis in collaboration is that the high dose versus regular dose reduced major coronary events by fifteen percent now there’s a non-significant seven percent lower risk of death but the all the non-fatal events are significantly reduced notably mi and
Stroke and the need for coronary revascularization and then looking at the staten versus placebo and the high dose versus low dose they find very consistent findings for the degree of ldl lowering translating into the degree of benefit and as such they also find no harm with no increase in nonvascular death and no increase or decrease in the risk of cancer and so
This huge study of over a hundred and seventy thousand patients reaffirms the central role of statins and cholesterol-lowering in preventing cardiovascular events so if this week’s cardiology countdown i’m chris you you
Transcribed from video
Cardiology Countdown | PCI, PPI and Clopidogrel, Statins By American College of Cardiology Video Archive 2
