February 2nd, 2015
Selections from Richard Lehman’s Literature Review: February 2nd
CardioExchange is pleased to reprint this selection from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.
NEJM 29 January 2015 Vol 372
Less-Tight v.s Tight Control of Hypertension in Pregnancy (pg. 407): A Canadian trial tells us a bit more about how to treat raised blood pressure in pregnancy. If women already have elevated BP or acquire it before 34 weeks of gestation without proteinuria, treating to a target diastolic of 100 mm Hg produces the same result as treating to a target of 85, in terms of pregnancy loss, high level neonatal care, or overall maternal complications. Naturally, those treated less intensively show a greater tendency for their BP to rise as the pregnancy continues.
A Randomized Trial of Icatibant in ACE-Inhibitor–Induced Angioedema (pg. 418): Huge numbers of people now take angiotensin-converting enzyme inhibitors, and a few of them get angio-oedema as a result, which can happen even after years of use. As far as I could ascertain, fatalities are very rare and exclusive to people of African origin. I get mild angio-oedema now and again, though I’m not on an ACE inhibitor. I take an antihistamine and wait for it to go away. So, I guess, do most people: the treatment cost must be about 10p. Shire makes a competitor drug called icatibant, which in the USA costs between $5000 and $10 000 per shot. They have run a trial (n=27) to show that it works faster in ACEI-related angio-oedema than standard hospital treatment with intravenous prednisolone and clemastine—eight hours rather than 27. I can see this being kept in the back locker for those rare people with real airways compromise, rather than people like me with the occasional thick lip.
JAMA Intern Med January 2015
Comparative Effectiveness of Diagnostic Testing Strategies in Emergency Department Patients With Chest Pain (OL): This important study shows that people who are privately insured and attend an American hospital with chest pain, and undergo immediate investigations which are negative for myocardial infarction, still get later non-invasive testing in a third of cases. These patients had the same subsequent very low incidence of myocardial infarctions as the non-tested group, but were of course much more likely to proceed to invasive testing. “Compared with no testing, exercise electrocardiography, myocardial perfusion scintigraphy, and coronary computed tomography angiography were associated with significantly higher odds of cardiac catheterization and revascularization procedures without a concomitant improvement in the odds of experiencing an MI.” I don’t know how much of this goes on in the UK, but it is time it stopped.
Lancet 31 January 2015 Vol 385
ST-Segment Elevation Myocardial Infarction in China from 2001 to 2011 (pg. 441): China has the wealth to sort out its own health problems, but first it must know how to map them. With names like Krumholz, Spertus, and Masoudi on the case, it can hardly fail to make progress with mapping their cardiovascular outcomes, as this study of ST-segment elevation myocardial infarction in China from 2001 to 2011 illustrates. But wait a moment: after the paper had gone online, somebody discovered a miscalculation in the weight of one of the urban areas in the study. It made no substantive difference to the conclusions, but when the authors reported it to the Lancet, the journal proceeded to retract the paper rather than publish a small correction. Now that the corrected paper has appeared in print, the Lancet takes the opportunity to congratulate itself on this noble deed.