(Press-News.org) London, UK - 29 Aug 2015: For the first time, ESC Guidelines published today give the highest degree of recommendation for the radial approach over the femoral one for coronary angiography and percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS). The ACS without persistent ST-segment elevation (NSTE-ACS) guidelines, drafted by an international multidisciplinary Task Force, are published online in European Heart Journal1 and on the ESC Website.2
"New data shows that the radial approach is superior to the femoral not only in terms of vascular complications and major bleeding events but also in reducing all-cause mortality," said Professor Marco Roffi (Switzerland), Task Force Chairperson. "It is recommended that centres treating ACS patients implement a transition from transfemoral to transradial access. However, proficiency in the femoral approach should be maintained, as this access is indispensable in a variety of procedures, including intra-aortic balloon counterpulsation implantation, structural heart disease interventions, and peripheral revascularization procedures."
A new, shorter algorithm for diagnosis in patients with suspected non-ST-elevation myocardial infarction (NSTEMI) is introduced. When high-sensitivity troponin assays are available, blood tests can be done at presentation and after 1 hour instead of the current practice of 3 hours. Professor Carlo Patrono (Italy), Task Force Co-Chairperson, said: "Both algorithms are equally good and either can be used. The 1 hour protocol accelerates diagnosis and consequent treatment or rules out NSTEMI so patients can be discharged or investigated for other conditions. This should translate to shorter stays in the emergency department."
While the general recommendation of dual antiplatelet therapy (DAPT) for one year remains, a tailored duration (i.e., shortened to 3-6 months or extended up to 30 months) is now allowed in selected patients at high bleeding or ischaemic risk, respectively. "The duration of DAPT is a hot topic," said Professor Marco Roffi. "With improved drug-eluting stent technology, stent thrombosis rates have dropped dramatically and recent data suggests that shorter duration of DAPT in patients at high bleeding risk is safe and effective. In addition, new data shows that DAPT beyond one year is effective in reducing ischaemic events in selected patients at high ischaemic and low bleeding risk."
The most controversial area discussed by the Task Force was the optimal time to give P2Y12 inhibitors to NSTE-ACS patients scheduled for invasive assessment. The 2011 Guidelines3 recommended the antiplatelet drug be given as soon as a diagnosis was made, independently of when the patient would undergo coronary angiography (called pretreatment). The first study designed to test the impact of P2Y12 inhibitor pretreatment in ACS showed that prasugrel pretreatment resulted in more bleeding events compared to giving the drug at the time of coronary angiography/PCI in the absence of a reduction in ischaemic events.
"Prasugrel pretreatment is now contraindicated, which is a change of paradigm," said Professor Patrono. "In retrospect, we were over confident about the value of P2Y12 inhibitor pretreatment. With respect to ticagrelor and clopidogrel, the optimal timing of drug administration in patients scheduled for an invasive strategy has not been properly studied, so we do not give any recommendation for or against pretreatment. This is a gap in evidence that requires further research."
Guidance on the minimum duration of cardiac rhythm monitoring (none, 24 hours) in patients with NSTE-ACS is given for the first time, depending on clinical presentation. Professor Roffi said: "We give recommendations to streamline the stay of patients in monitored units. This may reduce length of stay in hospital and costs."
There is a new section on the complex issue of managing antiplatelet therapy in patients requiring chronic oral anticoagulation. Additional new sections concern the treatment of bleeding related to antithrombotic therapy, management of antiplatelet agents in patients requiring coronary bypass surgery, and NSTE-ACS patients with atrial fibrillation or undergoing noncardiac surgery.
Also published today are three companion manuscripts4 with questions and answers on diagnosis and risk assessment; antithrombotic therapy; and coronary revascularization in NSTE-ACS. "Guidelines are based on populations in large trials," said Professor Roffi. "The companion papers give detailed advice, based on the guidelines, on managing individual patients."
Professor Patrono concluded: The guidelines published today provide the most contemporary evidence-based advice for physicians on how to diagnose and treat their patients with NSTE-ACS."
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London, UK - 29 Aug 2015: ESC Guidelines published today on infective endocarditis boost the role of imaging in diagnosis of this deadly disease.
"We emphasise the need for a multimodality imaging approach to diagnosing endocarditis," said Professor Gilbert Habib, Chairperson of the guidelines Task Force. "While the 2009 guidelines1 focused on echocardiography, the 2015 guidelines show the important role of other imaging techniques such as PET-CT. These new imaging techniques are increasingly useful for the diagnosis and management of infective endocarditis and we recommend ...
London, UK - 29 Aug 2015: New ESC Guidelines on pericardial diseases are published today. Until now there was insufficient evidence for strong recommendations in this group of conditions which can severely restrict quality of life.
"Pericardial diseases include different clinical presentations and various aetiologies that require appropriate management," said Professor Yehuda Adler, Co-Chairperson of the guidelines Task Force. "We hope these new recommendations will help clinicians to manage these diseases with resulting improvements in outcomes and quality of life."
The ...
London, UK - 29 Aug 2015: A novel treatment algorithm for pulmonary arterial hypertension is launched today in new pulmonary hypertension guidelines from the European Society of Cardiology (ESC) and European Respiratory Society (ERS). The protocol aims to give patients the best chance of a good clinical outcome in a condition with dismal prognosis which puts severe limitations on patient choices including avoiding pregnancy, excessive physical activity and certain types of travel.
The 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension are ...
London, UK - 29 Aug 2015: ESC Guidelines published today recommend DNA analysis as a fundamental component of post mortem assessment in young sudden death victims. Identification of a genetic cause helps to quickly diagnose and protect relatives.
The Guidelines are published online in European Heart Journal1 and on the ESC Website2 and are the European update to the 2006 European/American guidelines.3 They focus on preventing sudden cardiac death in patients with ventricular arrhythmias.
"For the first time these guidelines have incorporated the concept proposed by ...
Are some people immune to hangovers, and can eating or drinking water after heavy drinking prevent a hangover? The answers appear to be 'no' and 'no' according to new research presented the ECNP conference in Amsterdam.
Excessive alcohol consumption has familiar consequences, many of them quite damaging. If a person does not experience a hangover - and 25% to 30% of drinkers regularly claim this - they may be more likely to continue drinking, so good research into the outcomes of drinking to excess is needed.
A group of international researchers from the Netherlands ...
Tropical Storm Erika was centered in the Eastern Caribbean Sea and affecting Puerto Rico and Hispaniola when NASA's Terra satellite passed overhead mid-day on Friday, August 28, 2015. Two hours after Terra passed, NOAA's GOES-East satellite saw Erika's western side over the Dominican Republic.
At 15:05 UTC (11:05 a.m. EDT) the Moderate Resolution Imaging Spectroradiometer instrument aboard NASA's Terra satellite captured a visible light image Tropical Storm Erika approaching Hispaniola. Erika's center was in the eastern Caribbean Sea, and the northern quadrant of the ...
To understand how confidence in parenting may predict parenting behaviors in women who were abused as children, psychologists at the University of Rochester have found that mothers who experienced more types of maltreatment as children are more critical of their ability to parent successfully. Intervention programs for moms at-risk, therefore, should focus on bolstering mothers' self-confidence--not just teach parenting skills, the researchers said.
"We know that maltreated children can have really low self-esteem," said Louisa Michl, a doctoral student in the department ...
A simple change in the wording of a traffic sign - from "Share the Road" to "Bicycles May Use Full Lane" - could help clarify the rules of the road for bicyclists and motorists, according to a North Carolina State University study.
"'Share the Road' signs are common but what that means in terms of how drivers and bicycle riders should interact can be ambiguous," says George Hess, natural resources professor and co-author of the study in PLOS One. Some bicyclists complain that motorists consider them to be in the way, while some motorists accuse bicyclists of hogging ...
Consider the pendulum of a grandfather clock. If you forget to wind it, you will eventually find the pendulum at rest, unmoving. However, this simple observation is only valid at the level of classical physics--the laws and principles that appear to explain the physics of relatively large objects at human scale. However, quantum mechanics, the underlying physical rules that govern the fundamental behavior of matter and light at the atomic scale, state that nothing can quite be completely at rest.
For the first time, a team of Caltech researchers and collaborators has ...
Washington DC - August 28, 2015 - Oysters not only transmit human norovirus; they also serve as a major reservoir for these pathogens, according to research published August 28 in Applied and Environmental Microbiology, a journal of the American Society for Microbiology. "More than 80 percent of human norovirus genotypes were detected in oyster samples or oyster-related outbreaks," said corresponding author Yongjie Wang, PhD.
"The results highlight oysters' important role in the persistence of norovirus in the environment, and its transmission to humans, and they demonstrate ...
