http://www.incirculation.net/52694_0.aspxBlogen-usThe PCI SoS trial importantly adds to the body of evidence supporting the notion that, when primary PCI for STEMI is performed in hospitals that do not have cardiac surgery on-site, the outcomes are similar to those achieved in hospitals with surgery on-site. However, as Robert Guyton discusses here, there remains some concern that the overall management of STEMI might not be as good in hospitals without cardiac surgery on-site.2010-01-05http://www.incirculation.net/52693_109229.aspxThe RAPTOR trial showed that it is possible for experienced interventional cardiologists to switch from the trans-femoral approach to the trans-radial approach for vascular access in the cardiac catheterization lab. Dr. Mina Madan discusses the trial and why you need to learn the trans-radial technique.2010-01-04http://www.incirculation.net/52693_109209.aspxThe SYNTAX and CARDia trials have shown that the gap in outcomes between coronary bypass surgery and PCI continues to narrow. David Faxon reviews the trials and stresses the need for longer follow-up. 2009-12-17http://www.incirculation.net/52693_109133.aspxThe PLATO trial enveiled ticagrelor as the first antiplatelet therapy to achieve a significant reduction in CV mortality compared with clopidogrel across the spectrum of ACS. Freek Verheugt reviews the field - CURE, COMMIT, TRITON-TIMI 38 and the CHAMPION trials. Did PLATO herald a new dawn in antiplatelet therapy? 2009-11-27http://www.incirculation.net/52693_108831.aspxThe Indian Polycap Study (TIPS), a proof-of-concept, primary prevention trial, demonstrated the potential cardiovascular and economic benefit of a multi-drug regimen including a beta blocker, an ACE inhibitor, a statin, a thiazide and aspirin. This is no ‘magic bullet’, though. As K. Srinath Reddy asserts in his Editorial, there are outstanding questions, and only further study will ascertain whether such a treatment can reduce the risk of major cardiovascular events. 2009-11-25http://www.incirculation.net/52693_108781.aspxUntil recently, the role of exercise therapy in heart failure had only been studied with small, inconclusive trials. In this article, Sidney Goldstein discusses the importance of HF-ACTION, the first randomized trial to examine the benefits and risks of exercise as a therapeutic modality for heart failure with an adequate sample size.2009-11-11http://www.incirculation.net/52693_108299.aspx‘Once on aspirin–clopidogrel, always on aspirin–clopidogrel’ is probably inappropriate, says Gregory Lip, discussing the results of ACTIVE-A, which demonstrated the benefit of the combination therapy for the prevention of stroke in patients with atrial fibrillation.2009-10-20http://www.incirculation.net/52693_107798.aspxMichel Bertrand discusses the ABOARD and TIMACS trial, which were designed to determine the optimal timing of intervention for the treatment of non ST-segment elevation acute coronary syndromes.2009-08-04http://www.incirculation.net/52693_106720.aspxIn our ageing population, calcific aortic stenosis is an increasingly common problem. Aortic valve replacement, although an effective treatment for surgically fit patients, is a high-risk strategy in very elderly patients, and yet medical therapy is ineffective and offers a very poor prognosis. In this article, Philip MacCarthy describes a novel technique, trans-catheter aortic valve implantation, an alternative treatment option for those patients who are not likely to withstand conventional surgery.2009-07-13http://www.incirculation.net/52693_105853.aspxThere is great debate about what treatment is best for multivessel coronary artery disease: PCI or CABG. The SYNTAX trial gave some new insights, but it also confirms what has been reasonable practice already. Christian Hamm reviews the topic.2009-06-15http://www.incirculation.net/52693_105399.aspxThe accurate diagnosis of acute myocardial infarction (AMI) is crucial for therapy, clinical trials and population research. But the diagnosis is in flux as new and more sensitive diagnostic measures become widely available and the presentation of AMI in hospital changes. Russell Luepker discusses these shifts and recent recommendations for the diagnosis of AMI by authoritative bodies.2009-04-28http://www.incirculation.net/52693_104619.aspxThe delivery of effective evidence-based treatments for primary and secondary prevention is now one of the key strategies in controlling coronary heart disease burden, but there is still no consensus on what is needed and what are the priorities. Martin O’Flaherty and Simon Capewell discuss the results of the EUROACTION trial, which provides insight on what could be achieved by targeting high-risk patients. 2009-01-20http://www.incirculation.net/52693_102811.aspxThe risk-reducing effect of intensive lipid-lowering therapy with rosuvastatin has recently been tested in healthy individuals without the usual guideline-derived indications for such treatment, but with elevated levels of high-sensitivity CRP. Terje Pedersen discusses the results of the JUPITER trial, which was interrupted prematurely owing to very favourable results with regards to the rate of clinical events. 2009-01-06http://www.incirculation.net/52693_102423.aspxThe GISSI-HF trial found no clinical benefit from statin therapy in patients with chronic heart failure. Despite the neutral findings, the trial provides important insights into the use of statins in heart failure, and it builds on findings from CORONA. Philip Poole-Wilson shares his views on the trial and its ramifications.2009-01-06http://www.incirculation.net/52693_102431.aspxMonitoring natriuretic-peptide levels to guide treatment of heart failure failed to improve the primary endpoint of hospitalization-free survival over 18 months in the TIME-CHF trial. However, as Theresa McDonagh mentions in her editorial, some benefits were observed in younger patients. 2008-12-02http://www.incirculation.net/52693_101865.aspxThe importance of the bradycardic effect of beta blockade in heart failure is now being tested with the development of drugs such as ivabradine that can slow the heart by inhibiting the If current in the sinoatrial node. Sidney Goldstein discusses the results of the BEAUTIfUL trial, which provides insight into the potential of these drugs in the treatment of patients with heart failure. 2008-10-28http://www.incirculation.net/52693_100990.aspxThe long-held norm for the resuscitation of cardiac arrest victims has involved both chest compressions and mouth-to-mouth ventilation. However, recent evidence has questioned whether compression-only resuscitation should be taught. Douglas Chamberlain, Honorary Professor of Resuscitation Medicine, Cardiff University, UK, reviews the arguments relevant to this controversy.2008-09-12http://www.incirculation.net/52693_99998.aspxThe results of the HYVET trial on the benefits of blood pressure lowering in the very old hypertensive (aged 80 years or older) have recently been published. Alberto Zanchetti provides in-depth discussion of the importance of this trial for the management of hypertension.2008-08-28http://www.incirculation.net/52693_99540.aspxAnticoagulation in acute coronary syndromes or during PCI is a major challenge, because bleeding and clotting have potentially disastrous consequences. Various recent trials have addressed the need to find safer alternatives to standard unfractionated heparin, and in his Editorial, InCirculation.net Editorial Board member Michel Bertrand discusses the particular efficacy and safety of two such powerful anticoagulants, bivalirudin and fondaparinux.2008-08-28http://www.incirculation.net/52693_99544.aspxISAR-REACT-3 set out to compare the performance of bivalirudin and heparin in patients who were undergoing elective PCI but who were not treated with a GbIIb/IIIa blocker. Freek Verheugt discusses the results of the trial.2008-08-22http://www.incirculation.net/52693_99434.aspx