Showing posts from September, 2010

Unique US trial shows bone-marrow stem cells to be safe for AMI

The first randomized, double-blind, placebo-controlled US trial of bone-marrow stem cells in patients with ST-elevation MI (STEMI) has shown the therapy to be safe and to improve left ventricular volume compared with placebo. Dr Jay H Traverse   (Minneapolis Heart Institute, MN) and colleagues report the findings in the September 2010 issue of the   American   Heart Journal . Traverse told   that this small, phase 1 trial differs in some ways from the European trials that have been performed with bone-marrow-derived stem cells in MI, which he admits are "considerably larger." This is the first time all patients have received the same number of cells—100 million—whereas in European studies, for example   REPAIR-AMI , some patients got three times as many cells as others. "Meta-analyses suggest there is a dose-response effect, so if you're giving people different numbers of cells, this introduces another variable that may affect the results," Traverse observ

Substantial bleeding hazard with combination antithrombotic treatment in AF patients

In patients with atrial fibrillation (AF), combinations of warfarin, aspirin, and clopidogrel are associated with increased risks of serious nonfatal and fatal bleeding, with dual warfarin and clopidogrel therapy and triple therapy carrying a more than three-fold higher risk than warfarin alone, a new Danish study shows. But such treatment does not appear to be associated with a significant reduction in ischemic stroke. The study, published in the September 13, 2010, issue of the   Archives   of   Internal   Medicine , was conducted by a team led by   Dr   Morten   Hansen   (University Hospital Gentofte, Copenhagen, Denmark). Hansen noted that this research is similar to a previous study conducted in MI patients, which showed almost identical   results. Hansen told   that "this bleeding risk is extremely hazardous and is leading to many deaths. Physicians need to think more carefully about the bleeding risk before prescribing another anticoagulant on top of warfarin, and c

Surgery better option than stents?

Dr. Jeff Carstens knows the reaction he'll get when he mentions open heart surgery to a patient. “They say, whoa, ‘I don't want to have that,'” said Carstens, an Omaha cardiologist. Patients may balk, but a new study indicates that heart bypass surgery may be a better option than stents for many people with heart disease. Researchers involved in the major European-American study say that tens or even hundreds of thousands of Americans are having coronary artery angioplasty and stenting every year when they should be having a bypass. Patients and cardiologists frequently prefer angioplasty and the insertion of a stent to keep arteries open because it is quicker and easier. Patients also go home sooner and return to work more quickly. But data from the study on more than 1,800 patients show that three years after the procedure, those who got stents were 28 percent more likely to suffer a major event, such as a heart attack or stroke, and 46 percent more likely to

Rare cardiac surgery performed

 Dr V Nandakumar, chief cardiac surgeon at the Kovai Medical Centre in Coimbatore has performed a rare cardiac surgery on Ramaswamy, a chronic renal patient.   "I wanted to make sure that Ramaswamy of Tirupur is perfectly normal before disclosing it to the outside world. Now, more than a month has passed after the surgery and the patient is perfectly normal," Dr Nandakumar, who had worked as a professor at the Kozhikode Medical College, told Express. "After browsing the net, I could not find a similar case anywhere in the world," Dr Nandakumar, who had also served in Melbourne for three-and-a-half years, said.   Ramaswamy, 58, was brought to the Kovai Medical Centre with excruciating back pain. He had undergone kidney transplant 25 years ago and was keeping well all these years. Investigations, including 64 slice CT Angiogram, revealed a long tear in the aorta (aortic dissection), starting from the aortic valve, causing severe valve leak and reaching to

Surgical groups rated by Consumer Reports

In Consumer Reports, alongside toasters, oven and cars, medical groups that perform heart bypass surgery are now being rated. Data-based ratings of doctors are not available to patients in most parts of the country, data-based except a few states like New York. From 42 states, ratings of 221 surgical groups were published but it should be noted that individual doctors are not rated. Based on complication and survival rates, one, two or three stars are given to the groups. These starts mean below average, average or above average. It is also taken into consideration while giving the ratings that whether the groups used the best surgical technique and whether patients were being sent home with certain medicines. The information that will be available in October is now available to those who buy the magazine or subscribed to Consumer Reports online. Dr Fred H.   Edwards , the chairman of quality and research for the society, and medical director for cardiothoracic surgery at t

Difference between pre-operative and cardiopulmonary bypass mean arterial pressure is independently associated with early cardiac surgery-associated acute kidney injury

Cardiac surgery-associated acute kidney injury (CSA-AKI) contributes to increased morbidity and mortality. However, its pathophysiology remains incompletely understood. We hypothesized that intra-operative mean arterial pressure (MAP) relative to pre-operative MAP would be an important predisposing factor for CSA-AKI. Methods: We performed a prospective observational study of 157 consecutive high-risk patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The primary exposure was delta MAP, defined as the pre-operative MAP minus average MAP during CPB. Secondary exposure was CPB flow. The primary outcome was early CSA-AKI, defined by a minimum RIFLE class - RISK. Univariate and multivariate logistic regression were performed to explore for association between delta MAP and CSA-AKI. Results: Mean (SD) age was 65.9+/-14.7 years, 70.1% were male, 47.8% had isolated coronary bypass graft (CABG) surgery, 24.2% had isolated valve surgery and 16.6% had combined pro

Prediabetics and Post-op Risk: Real Increase or Artifact?

Cardiac surgery patients with impaired glucose tolerance or prediabetes have long been thought to suffer more major postoperative adverse events than those with normal glucose tolerance. New evidence suggests that may not be the case. Researchers in Boston have found that the two groups of patients—prediabetics and nondiabetics—experience similar rates of myocardial infarction, renal failure, stroke and death, at least when a cutoff of hemoglobin A 1c  (HbA 1c ) of 6% or greater is used to define impaired glucose tolerance. “Patients with impaired glucose tolerance are a special group,” said Balachundhar Subramaniam, MPH, MD, assistant professor of anaesthesia at Harvard Medical School and Beth Israel Deaconess Medical Center, both in Boston. “They’re not yet diagnosed as diabetics, and [yet] may be prone to more risk than patients who are already diagnosed and well controlled.” To determine the relative adverse event rate for nondiabetics versus prediabetics, Dr. Subramaniam a

Rewarmed Blood Linked to Complications After Cold Bypass

Rewarming of blood after hypothermic cardiopulmonary bypass appears to impair autoregulation of blood flow in the brain, increasing the patient’s risk for stroke in the process, researchers have found. Investigators at Johns Hopkins University in Baltimore found that patients with impaired autoregulation of cerebral blood during rewarming were four times as likely to experience a stroke or transient ischemic attack as patients without the problem (95% confidence interval, 1.8-9.5;  P <0.001). “Hypoperfusion is an important cause of brain injury during cardiac surgery with cardiopulmonary bypass,” said Charles Hogue, MD, associate professor of anesthesiology and critical care medicine at Johns Hopkins, who led the study. “In looking at previous research, we’ve observed that some patients seem to get really dysregulated during rewarming and have a high incidence of stroke. It suggests that the rewarming period is one of vulnerability to the brain.” Clinicians empirically manag

Price, Not Performance, Separate Two Blood-sparing Drugs

  Since the removal of aprotinin from the market in late 2007, tranexamic acid and ε-aminocaproic acid have been used interchangeably. Yet clinicians have had little data comparing the relative safety and effectiveness of the two drugs on which to base their choice of blood-loss agent.  Results from two studies, one ongoing, should help.   Interim analysis of the continuing trial, by researchers in New York City, has revealed that tranexamic acid (Cyklokapron) and ε-aminocaproic acid (Amicar), both made by Pfizer, have similar outcomes in terms of chest tube output, creatinine values, speed of clot formation and clot strength and firmness. There was a nonsignificant trend toward lower transfusion rates in one group, although the study was not unblinded to reveal which group this may be.   Meanwhile, a separate study by Massachusetts researchers has found that ε-aminocaproic acid offers comparable safety and efficacy to tranexamic acid, but at a fraction of the cost. “Th

Health Ministry still await DTAB report on safety of some widely sold drugs to initiate action

The crucial decision on banning a number of controversial drugs, which have been either restricted or withdrawn in many countries, continues to be delayed inordinately with the Drug Technical Advisory Board (DTAB) still sitting on the matter and the health ministry ruling out any action without a recommendation from the DTAB.   The Health Ministry sources told that the matter was still with the DTAB and a final decision on these controversial drugs would be taken depending on the recommendation of the DTAB and the report was still awaited. The ministry also said it had received many representations especially from some public interest groups over the matter in the past, but would not take any action based on these complaints. On the other hand, it is learnt from the DCGI office that the DTAB was yet to make a final call on these matters as many sub-committees have been made to look into the matters relating to different drugs under question. The sources refused to give a deadline

8% of households push below poverty line each year due to health expenditure: CII Report

About 7 to 8 per cent of households in the country are pushed below the poverty line every year because of expenses incurred on healthcare, according to India Health Report 2010 prepared by Confederation of Indian Industry (CII) and Indicus Analytics. The India health Report, released recently, also said that the contribution of the private sector in terms of the availability of hospital beds has gradually increased from about 28 per cent in 1973 to about 61 per cent in 1996. Indicus estimates this to have reached about 78 per cent in 2009. Indians have inadequate access to quality healthcare, and this is particularly true for the poor, those residing in rural areas, STs and women. According to the Report, about 7–8 per cent of households are pushed below the poverty line because of expenses incurred on healthcare. There are critical gaps in infrastructure especially with respect to the presence of healthcare centres and well-trained staff.

CRT durability showcased in CARE-HF long-term analysis

The significant survival gains from cardiac resynchronization therapy (CRT) seen within the first year or two of   Cardiac Resynchronization in Heart Failure   (CARE-HF), one of the seminal randomized trials that established the heart-failure device therapy as mainstream, persisted for seven years or more, according to a long-term follow-up of the trial, one of the longest of its kind. Nearly all of those originally assigned to the trial's no-CRT control group ultimately received CRT after about three years, and although their survival thereafter improved, it didn't catch up with the survival of those who received CRT in the first place, reported  Dr John GF Cleland  (University of Hull, Kingston-upon-Hull, UK) when presenting the CARE-HF long-term analysis at the European Society of Cardiology 2010 Congress. He said that the findings "suggest that the benefits of CRT observed in the main [CARE-HF] trial are preserved during the long-term follow-up." Median survi

Experts debate merits of DES for acute MI

Drug-eluting stents (DES) for primary intervention in acute-MI patients appear to remain unpopular, although at least one expert believes the evidence favors them over bare-metal stents for this indication. In a formal debate here at the   European Society of Cardiology (ESC) 2010 Congress ,   Dr Manel Sabate   (Hospital de Sant Pau, Barcelona, Spain) argued that DES should be used routinely for primary PCI. His opponent in the debate,   Dr Gabriel Steg   (Hôpital Bichat-Claude Bernard, Paris, France), argued that the evidence of additional risk of stent thrombosis with DES is not worth the benefit of reducing restenosis in this patient population. By a show-of-hands poll, the cardiologists assembled to hear the debate showed they were skeptical of Sabate's position. Very few showed that they routinely use DES in AMI patients, and nobody raised their hand after the debate when asked whether the debate had changed their minds on the issue. Sabate conceded that few AMI patien

Another Maryland cardiologist in hot water over unnecessary procedures

Another cardiologist in Maryland has been accused of performing unwarranted procedures on multiple patients over a number of years.   Dr John R McClean   has been indicted on fraud charges by a federal grand jury in Baltimore; he allegedly placed hundreds of stents that were not needed and carried out unnecessary ECGs, echoes, and nuclear stress tests worth millions in combined Medicare   payments, according to an article in the   Baltimore Sun . McClean is charged with one count of fraud and six counts of making false statements to insurers and patients, whose records he is said to have falsified. If convicted on all counts, he could face up to 40 years in prison, says the newspaper. McClean surrendered practice privileges at his Eastern Shore hospital three years ago following an internal investigation at Peninsula Regional Medical Center about uncalled-for stenting procedures. The accusations of unnecessary diagnostic procedures were made later, by federal investigators. &qu