Primary Angioplasty May Be More Effective Than Thrombolysis In Very Elderly Patients With AMI: Results From The TRIANA Trial
Primary angioplasty is superior to thrombolysis in the treatment of very old patients with acute myocardial infarction (AMI), according to results from the TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos*) study, a randomised trial sponsored by the Spanish Society of Cardiology.** The trial was designed to compare the two principal available treatments to open blocked coronary arteries in AMI patients: immediate primary PCI with angioplasty, and thrombolysis with clot-dissolving drugs. The trial was performed in 226 patients all aged 75 years or older and all with AMIs of less than six hours' evolution. They were recruited in 23 Spanish hospitals between 2005 and 2007.
PRAGUE-7 Cardiac Study Results
The outcome of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock* is generally very poor. Although early mechanical revascularisation by primary PCI has been shown as superior to medical treatment, the mortality range remains high (at about 45-60%). Registries have shown further therapeutic benefit from the administration of glycoprotein (GP) IIb/IIIa inhibitors** during PCI in AMI patients with cardiogenic shock. However, there are no randomised data to support this approach in these high risk patients. The PRAGUE-7 study was designed to determine whether the routine upfront administration of abciximab (a IIb/IIIa GP inhibitor) improves outcome when compared with conventional selective administration.
Heart Failure: More Or Less Malignant Than Cancer?
A recently completed analysis of over one million hospital cases in Sweden during the period 1988 to 2004 has revealed that heart failure, relative to most common forms of cancer specific to men and women, represents a major health burden in respect to the risk of being hospitalised for the first time, poor overall survival and the number of premature life-years lost. Heart failure is a debilitating and deadly syndrome that commonly occurs in those who have suffered high blood pressure over a long period of time and/or suffered a heart attack. As the term suggests, heart failure means that the heart is permanently damaged leading those who are affected to experience debilitating symptoms and remain at high risk of being hospitalised and/or suffer a premature death.
Failing Heart, Failing Kidney: Double Trouble?
Concomitant kidney dysfunction and/or worsening renal function in patients with heart failure is a frequent finding and is associated with a poor prognosis. Current treatment of heart failure has beneficial effects on cardiac function but does not favorably affect renal function. The possibility to improve renal function and/or obtain kidney protection with new drugs or devices is still uncertain. Heart failure remains the most important cause of hospitalisation for patients aged more than 65 years and this proportion is going to increase because of aging of the general population and improvement in outcomes of most cardiac diseases. Current treatment has improved the clinical course and prognosis of chronic heart failure.
Treatment Of Anemia With Erythropoietin May Benefit Heart Failure Patients
Heart failure patients may benefit from treatment of anaemia similarly to those with chronic kidney disease (CKD) or cancer. Anaemia is common to many diseases (chronic kidney disease, cancer, chronic heart failure) as well as a consequence of treatment for diseases such as cancer, specifically with chemotherapeutic agents. Anaemia may contribute to lethargy, reduced exercise tolerance and poor quality of life. Therefore, raising haemoglobin (Hb) in anaemic patients has long been thought to be a beneficial therapeutic goal. In contrast to CKD and cancer, attaining higher Hb targets does not appear to be associated with increased major events in early phase trials.