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Atrial fibrillation from old website

Clopidogrel and CYP2C19

Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2C19 Genotype and Clopidogrel Therapy

2022 Update

Echopedia

ref: 2025081103b

Colchicine in Pericarditis

The Role of Colchicine in Recent Clinical Trials - A Focused Review on Pericardial Disease
American College of Cardiology

Aug 13, 2020 | Nadia Bouabdallaoui, MD, PHD; Jean Claude Tardif, MD, FACCExpert Analysis

Note- after first episode colchicine used for 3 or 6 months, but reporting outcome to 18 months

ICAP. A Randomized Trial of Colchicine for Acute Pericarditis, NEJM

Colchicine in pericarditis

Recent clinical trials have demonstrated that colchicine is effective in reducing symptoms and recurrence rates in patients with pericarditis, making it a recommended treatment option.

Key Clinical Trials Involving Colchicine for Pericarditis

COPE Trial:

The COPE (COlchicine for acute PEricarditis) trial showed that colchicine, when added to conventional anti-inflammatory therapy, significantly reduced symptoms at 72 hours (11.7% vs. 36.7%; p=0.003) and recurrence rates at 18 months (10.7% vs. 32.3%; p=0.004).

ICAP Trial: The ICAP (Investigation on Colchicine for Acute Pericarditis) trial found that colchicine reduced the risk of recurrent pericarditis at 18 months compared to placebo (16.7% vs. 37.5%, P<0.001). It also decreased symptom persistence at 72 hours (19.2% vs. 40.0%, p=0.001) and hospitalization rates (5.0% vs. 14.2%, p=0.02).

CORE Trial:

The CORE (COlchicine for REcurrent Pericarditis) study indicated that adding colchicine to aspirin therapy significantly reduced recurrence rates at 18 months (24.0% vs. 50.6%; p=0.02).

CORP Study:

The CORP (Colchicine for Recurrent Pericarditis) study confirmed that colchicine combined with NSAIDs led to a significant reduction in recurrent events compared to NSAIDs alone (relative risk reduction of 0.56).

COPPS Study:

The COPPS (COlchicine for the Prevention of the Post-pericardiotomy Syndrome) trial demonstrated that colchicine therapy significantly reduced the incidence of post-pericardiotomy syndrome at 12 months compared to placebo (8.9% vs. 21.1%; p=0.002).

Conclusion

Colchicine has emerged as a first-line therapy for both acute and recurrent pericarditis, showing significant benefits in reducing symptoms and recurrence rates. The European Society of Cardiology now recommends colchicine as an adjunct to conventional anti-inflammatory therapy for managing pericarditis, highlighting its effectiveness based on recent clinical trial data.

ref: 2025081103

Ischaemic Heart Disease: NSTEMI

Invasive Treatment Strategy for Older Patients with Myocardial Infarction

NEJM 2024

Journal club August 2025

Invasive Treatment Strategy for Older Patients with Myocardial Infarction

In older adults with NSTEMI, an invasive strategy did not result in a significantly lower risk of cardiovascular death or nonfatal myocardial infarction (the composite primary outcome) than a conservative strategy over a median follow-up of 4.1 years. (Funded by the British Heart Foundation; BHF SENIOR-RITA ISRCTN Registry number, ISRCTN11343602.)

A total of 376 patients (49.9%) in the invasive-strategy group underwent a revascularization procedure: 46.6% of the patients underwent PCI, with multivessel PCI performed in 29.9% of the patients, including 4.9% who received balloon angioplasty only, and 3.3% underwent CABG (Table 2 and Table S10).

We had assumed even in the elderly intervention did not reduce reinfarction.

Amongst this group is a good precentage with prior MI and prior PCI and previous CABG.

Might this be because we don't know the culprit lesion because these are patient with very high plaque burden? The ISCHAEMIA trial was with stable patients, showing outcome relates to plaque burden, so do these very elderly patients behave more like the ISCHAEMIA trial patients since it is difficult to identify the culprit lesion. Only tiny percent had CABG- the trial itself does not rule out the possibility of benefit is this subgroup that were considered candidates for CABG, that is well enough etc.

Links below are from original and not updated website

Information could be out of date. Viewpoints change with newer data. Not friendly for mobile devices with smaller screens!

ACE-inhibitors may reduce the risk of recurrent PAF in those with lone PAF
Further analysis of the ACTIVE-W trial emphasises the importance of maintaining the INR in the therapeutic range in chronic atrial fibrillation.
The ACTIVE-A trial results indicate that Aspirin with Clopidogrel is better than Aspirin alone in patients with atrial fibrillation that can not or will not take Warfarin.
Notes from ASEANZ 2009: Management of angina
Notes from ASEANZ 2009: Diabetes- new targets for management
Notes from ASEANZ 2009: Value of Apo-B
Notes from ASEANZ 2009: Comments on value of revascularisation for stable coronary disease
CASPER study investigation of frequency of inducible coronary artery spasm in those with unstable angina or myocardial infarction

Report from the European Society of Cardiology Congress, 2008. ECG abnormalities in athletes
Report from the European Society of Cardiology Congress, 2008. Meet the experts session on resistant hypetension.
Beta-blockers no longer first or second line agents for treatment of hypertension for all patients.

Report from the European Society of Cardiology Congress, 2008. Beta-blockers may be inferior to other agents in reducing left ventricular hypertrophy.
Report from the European Society of Cardiology Congress, 2008. The COURAGE Trial- quality of life gains do not make this a cost-effective treatment.

The COURAGE Trial- this prospective randomised examined the potential benefits from percutaneous intervention. The study found no evidence for reduction in non-fatal myocardial infarction or death from routine PCI in those with stable coronary disease.

Coenzyme Q10 not proven to reduce myalgia in patients on statin therapy

Use proven agents to raise HDL choleserol

Folic acid supplementation to reduce homocysteine levels does not reduce cardiovascular events.

INTERHEART- BMI measurement leads to underestimation of obesity. The Waist-hip ratio is superior to BMI calculations. There is an increased risk of myocardial infarction with increasing waist-hip ratios even within a BMI range of 20-25.

Coronary Calcium Scoring: The Dallas Heart Study. This study found that one in fifteen men aged between thirty and sixty-five years, assessed as being at "moderate risk" using the Framingham risk equation, were in fact at "high risk" on the basis of a calcium score greater than 400.

Stable Coronary Artery Disease: The COURAGE trial confirms previous meta-analysis findings- percutaneous intervention with coronary artery stenting to stable lesions does not reduce the rates of myocardial infarction or death. This trial will provide further support for continued medical therapy with intensive risk factor modification for patients whose anginal symptoms can be easily controlled with medical therapy.
Atrial Fibrillation: Anticoagulant therapy was found to be superior to the combination of aspirin with clopidogrel in the ACTIVE-W trial. However, the differences in primary event rates between the two groups was not as large as in older studies that compared anticoagulation with aspirin.
The CHADS2 score is being promoted as a means to assess the risk of stroke in patients with atrial fibrillation.
Prospective data showing calcium screening helps improve prediction of future cardiovascular events. The St Francis Heart Study. Prominent Cardiologist in the USA reported to agree that the test has a role for risk stratification in intermediate risk patients.
Patent Foramen Ovale have been associated with cryptogenic stroke, decompression sickness, altitude sickness and also migrane headaches.

SAFE-T. A trial comparing amiodarone, sotalol and placebo to maintain sinus rhythm in patients in NYHA Class I or II.

Acute and severe reversible cardiomyopathy secondary to severe psychological stress.

Definition of the metabolic syndrome.
IHD. CABG and PCI for patients with IHD

Myocardial Infarction.Q waves on ECG and extent of infarction

Hypertension. Impact of Lifestyle measures
Hypertension. Selected information from the new JNC 7 guidelines from the USA

In late 2004 the American Heart Association released an update to its guidelines promoting the use of out of office blood pressure measurements.

The ASCOT trial was stopped early because of lower mortality in hypertensives treated with amlodipine/peridopril than with atenolol/thiazide diuretic. What are the implications for beta-blocker therapy in hypertension?

Review of hypertension trials and controversies published prior to preliminary presentation of data from the ASCOT trial.

Atenolol in hypertension: is it a wise choice? An interesting meta-analysis on effectiveness of atenolol in hypertension. Undoubtedly, not the last word on this question.

The lipid substudy of the ASCOT trial compared with the TNT trial. What is more cost-effective, primary prevention in high risk hypertensives or lowering the target LDL cholesterol for secondary prevention?

The TNT and PROVE-IT trials support even lower LDL cholesterol targets for secondary prevention

PROVE IT and CRP levels- CRP levels were lower in those treated with very high dose atorvastatin, further analysis suggests that lowering CRP levels provides additional benefit to lowering of LDL cholesterol levels.

The DEFINITE trial reveals lower than expected mortality in those with severe cardiomyopathy and this presumably reflects the benefits of use of beta-blockers and ace-inhibitors. The study also found a benefit from implantable defibrillators

Angiotensin blockers instead of or in addition to ace-inhibitor therapy for those with heart failure, particularly those with systolic dysfunction.

Introduction to diastolic heart failure.

Addition of patient information section.

UPDATE. PEACE trial: this study suggests that, unlike the EUROPA and HOPE trials, ACE-inhibitors need not be prescribed to all patients with coronary artery disease.

Quebec Cardiovascular Study: value of Apo-B measurement

UPDATE. NZ Guidelines- adjusting calculated risk. The NZ Guidelines seem to be relatively conservative. Until the threshold for pharmacological therapy is reduced, we should try to identify those at higher risk by measurement of emerging risk factors.

The INTERHEART study on atherosclerotic risk factors

The INTERHEART study findings in Asians

The ATP III guidelines from the USA on treatment of dyslipidaemia

Measurments of Apo-B and Apo-A1 to improve risk stratification

Non-HDL cholesterol as a target for treatment after LDL cholesterol

REVISED- AFFIRM trial information to include additional mortality data

MINOR REVISIONS. Pages on atrial fibrillation

Information