Elective intra-aortic balloon pump did not reduce adverse event rate after PCI
Perera D. JAMA. 2010;304:867-874.
Major adverse cardiac and CV events were not reduced in patients with severe left ventricular dysfunction and extensive coronary disease who had an intra-aortic balloon inserted before percutaneous coronary intervention, study results indicated.
The prospective, open, multicenter, randomized controlled trial was conducted in 17 tertiary referral cardiac centers in the United Kingdom between December 2005 and January 2009. Patients (n=301) had severe LV dysfunction (ejection fraction ≤30%) and extensive coronary disease (jeopardy score ≥8/12). The primary endpoint was major adverse cardiac and CV events defined as death, acute MI, cerebrovascular event or further revascularization at hospital discharge.
Of the study population, 151 received PCI with elective intra-aortic balloon pump (IABP) and 150 received PCI without IABP insertion. Major adverse cardiac and CV events occurred at hospital discharge in 15.2% (23/151) of patients with elective IABP and 16% (24/150) of those with no planned IABP. All-cause mortality at 6 months was 4.6% in the IABP group and 7.4% in the non-IABP group, with noticeably fewer major procedural complications in those with elective IABP insertion (1.3% vs. 10.7%; OR=0.11; 95% CI, 0.01-0.49).
“The study did not demonstrate a difference in [major adverse cardiac and CV events] at hospital discharge and therefore does not support routine elective IABP insertion before high-risk PCI,” the researchers said in the concluding statement of their study. “However, 12% of patients who underwent PCI without elective IABP insertion required rescue IABP support, which highlights the importance of adopting a standby IABP strategy when undertaking high-risk PCI.”
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Moderate, consistent consumption of chocolate lowered HF incidence in older women
Mostofsky E. Circ Heart Fail. 2010;doi:10.1161/circheartfailure.110.944025.
Study results published in Circulation: Heart Failure have linked moderate, habitual chocolate intake with a lower rate of HF hospitalization or death in a population of older women. However, this correlation was not observed with chocolate intake of one or more servings a day.
The study consisted of women (n=31,823) from the Swedish Mammography Cohort aged 48 to 83 years who were without diabetes or a history of HF or MI. They answered health and lifestyle questions, completed a food-frequency questionnaire and were followed for 9 years (1998 through 2006) for HF hospitalization or death.
During the follow-up, there were 379 incident HFs and 40 HF-related deaths. Compared with those with no regular chocolate consumption, multivariate-adjusted rate ratio HF for women consuming one to three servings of chocolate per month was 0.74 (95% CI, 0.58-0.95), for one to two servings per week, it was 0.68 (95% CI, 0.50-0.93) and for three to six servings a week, it was 1.09 (95% CI, 0.74-1.62). However, for women consuming one or more servings of chocolate per day, the rate ratio was 1.23 (95% CI, 0.73-2.08). The P value for the quadratic trend was .0005.
“In this population of middle-aged and elderly Swedish women, moderate, habitual chocolate intake was associated with a lower rate of HF hospitalization or death, but the protective association was not observed with intake of one or more servings per day,” researchers concluded. “Further studies are needed to confirm or refute these findings and to determine the optimal dose and type of chocolate and to clarify the mechanisms involved.”
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