Ischaemic heart disease

“High take off” ST segments do not carry an adverse prognosis ▸ First described in 1936, this study confirms that early repolarisation (high take-off) is more common in men, blacks (48% v 26% with a normal ECG), and in people who take more exercise (10.4 hours per week of activity v 6.4 hours). It is not associated with any increase in mortality, and patients with this pattern appear to have fewer arrhythmias. The danger lies in this normal variant being interpreted as acute myocardial infarction in the era of 30 minute door-to-needle thrombolysis targets.

Primary angioplasty is better than thrombolysis ▸ A total of 1572 patients with acute myocardial infarction were randomised with angioplasty or accelerated treatment with intravenous alteplase. Among patients who underwent randomisation at referral hospitals, the primary end point of death/myocardial infarction/cerebrovascular accident was reached in 8.5% of the patients in the angioplasty group, as compared with 14.2 % of those in the fibrinolysis group (p = 0.002). Among all patients, the better outcome after angioplasty was driven primarily by a reduction in the rate of reinfarction (1.6% in the angioplasty group v 6.3% in the fibrinolysis group; p < 0.001); no significant differences were observed in the rate of death (6.6% v 7.8%; p = 0.35) or the rate of stroke (1.1% v 2.0%, p = 0.15). Ninety six per cent of patients were transferred from referral hospitals to an invasive treatment centre within two hours. Of note, a recent meta-analysis confirmed significant mortality reduction in addition to the above benefits.

Combined low dose aspirin and ACE inhibitor treatment is not harmful ▸ In patients on angiotensin converting enzyme (ACE) inhibitors for heart failure, treatment included no aspirin in 235 (group 1), a low dose (⩽ 160 mg) in 45 (group 2), and a high dose …