Cardiac CT & MRI Literature

NEJM -- Long-Term Outcomes of Coronary-Artery Bypass Grafting versus Stent Implantation

This article looks at patients from the New York registry and shows that in patients with two-vessel disease or more, CABG is better than PCI (stent implantation) as far as long-term, overall survival is concerned. The accompanying editorial helps explain this better as well.

Link: NEJM -- Long-Term Outcomes of Coronary-Artery Bypass Grafting versus Stent Implantation.

Mediterranean diet and risk of coronary artery disease

Two studies this month have focussed on the importance of the Mediterranean diet in reducing the risk of coronary artery disease. The first in the British Medical Journal (BMJ) by Trichopoulou A shows an approxx. 8% reduction in mortality whereas the other, by Panagiotakos DB in the International Journal of Cardiology, shows a significant reduction in the incidence of acute coronary syndromes, though with a regional variation.

In effect, a Mediterranean diet consisting of fruits, vegetables, legumes, ethanol (usually as wine), fish and low amounts of meat, with olive oil used as the primary oil, seems to be a great way of reducing coronary artery disease risk.

Assessment of the radial artery and hand circulation by computed tomography angiography: a pilot study.

This is a pilot study on the use of CT angiography in the assessment of patients who are to go for a cardiac bypass surgery using the radial artery. Color Doppler currently is the modality of choice, but it is likely that CTA could become a modality of choice, due to its inherent superiority in demonstrating the anatomy and calcification as well as other pathologies.

Decreased intermediate term patency of automated proximal anastomoses evaluated by sequential ultrafast CT

You know that a modality is coming of age, when it is used to differentiate different clinical issues. In this study by Dietrich M et al in the European Journal of Cardiothoracic Surgery, ultra-fast CT was used to look for early restenosis in two different groups of patients going in for saphenous vein graft bypass surgery, one group having regular handsewn anastomosis and the other group having a new automatic clamper with a nitinol implant. More and more now we can use MRI and CT being used as gold standards or methods for assessing and answering clinical issues...this is a "coming of age phenomenon"

Cardiac CT in assessing chronic total occlusions for stent placement

Continuing from yesterday with understanding possible indications of cardiac CT, is an article from Mollet NR et al from Erasmus University, Rotterdam, published in the January issue of the American Journal of Cardiology.

This article is an initial study on 15 patients, studying the factors that affect the outcome of stent placement in chronic total occlusions. "Multivariate analysis identified a blunt stump (by conventional angiography), occlusion length >15 mm, and severe calcification (by multislice computed tomographic coronary angiography) as independent predictors of procedural failure."

This should be one more potential indication for cardiac CT. Patients with chronic total occlusions identified on coronary angiography, prior to stent placement could get a CT done to assess the length of the stenosis and the extent of calcification.

Meta-analysis of data for the use of HDL-C increasing drugs

The January issue of JACC carries a meta-analysis of trials from 1996 to 2004, by Birjmohun R et al, on the efficacy of fibrates and niacin in increasing HDL-C levels and their effect on future major coronary events.

The data listed in the article shows a significant improvement in HDL-C levels and reduction in the rates of major coronary events with the use of fibrates and niacin, without significant toxicity.

These however are still not as commonly used in practice as statins are, and it is unclear what the effect of combination therapy of LDL-lowering and HDL-C increasing drugs would be.