Atrial fibrillation ablation is one of the fastest growing techniques in cardiology and due to the very high number of patients that might be candidates to this procedure, a significant number of resources will have to be devoted to it to be able to treat them in the following years. Atrial Fibrillation (AF) is the most frequent cardiac arrhythmia. Its prevalence increases with age affecting more than 5% of the population older than 75 years of age. Overall it is estimated that more than 3.000.000 patients in Europe suffer from atrial fibrillation. Atrial fibrillation doubles the possibility of death mainly due to the higher incidence of thromboembolic events and occurrence of heart failure in patients suffering this arrhythmia.
Primary angioplasty (with stent implantation) is the most effective therapy for acute myocardial infarction (AMI), but it is not available to many patients, even though most European countries have sufficient resources (ie, catheterisation laboratories) for its wider use. The Stents 4 Life initiative was a study aiming to analyze the use of primary angioplasty in the treatment of AMI in 27 European countries. Data were collected from national infarction or angioplasty registries, on AMI epidemiology and treatment and on angioplasty centres and procedures in each country. Findings showed that the frequency (annual incidence) of hospital admission for any AMI varied between 90 and 312 events per 100, 000 population per year;
Data from a phase II trial of an investigational intravenous drug designed to block the formation of blood clots shows potential to reduce the risk of death, a second heart attack, or other coronary complications compared with the current standard of care in patients presenting with acute coronary syndromes (heart attacks or unstable angina ). Otamixaban inhibits the activity of Factor Xa, a key enzyme involved in the process of blood coagulation. It has already shown promising results when tested in patients undergoing elective angioplasty. In this trial, otamixaban was studied in high-risk patients with acute coronary syndromes (ACS). Otamixaban was compared with heparin, a standard and very commonly used blood thinner for acute coronary syndromes.
NORDISTEMI: first trial to study the effect of early PCI after fibrinolysis in rural areas with very long transfer delays. Results from the NORwegian study on DIstrict treatment of ST-Elevation Myocardial Infarction (NORDISTEMI) show that patients presenting with acute ST-elevation myocardial infarction (STEMI) in rural areas have a better treatment outcome with thrombolysis followed by immediate transfer for angiography than with thrombolysis and conservative, community-hospital follow-up. The latest European guidelines on the treatment of STEMI put emphasis on speedy reperfusion therapy, performed by "percutaneous coronary interventions" (PCI, with balloon angioplasty and stent) and thrombolysis.
Launched in 1999, the Global Registry of Acute Coronary Events (GRACE) is the world's largest international database tracking outcomes of patients presenting with acute coronary syndromes (ACS), including myocardial infarction or unstable angina. GRACE data are derived from 247 hospitals in North America, South America, Europe, Asia, Australia and New Zealand, and from more than 100, 000 patients with ACS. Data from 43, 018 ACS patients in the Registry were analysed to determine the optimal revascularisation strategy for unprotected left main coronary disease, which has so far been little studied. Results of the analysis showed that unprotected left main coronary disease (ULMCD) in ACS is associated with high in-hospital mortality, especially in patients presenting with STEMI (ST segment elevation myocardial infarction) and/or hemodynamic or arrhythmic instability.
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.