Volume 10 Issue 6, June 2013

The results of MASS COMM support the safety of performing percutaneous coronary intervention at centres without on-site cardiothoracic surgery services. To translate these findings into clinical practice, robust quality oversight programmes, with direct measurement of procedural outcomes and complications, are needed. The VA CART programme provides a model for such a strategy.

Cangrelor is an intravenous, reversibly binding, P2Y₁₂-receptor inhibitor with a rapid onset of action that yields a high level of receptor inhibition within minutes. The CHAMPION PHOENIX study has demonstrated that these pharmacodynamic properties yield superior efficacy compared with oral clopidogrel loading at the time of percutaneous coronary intervention.

Despite presenting early after symptom onset, some patients with ST-segment elevation myocardial infarction are unable to receive mechanical reperfusion within 60 min. The STREAM trial shows that, among these individuals, fibrinolysis with early angiography is associated with outcomes comparable to modestly delayed primary percutaneous coronary intervention, but with an increased risk of intracranial haemorrhage.

Three randomized clinical trials have added data to the debate about whether off-pump CABG surgery has any advantages over the on-pump approach. A growing consensus is emerging; however, understanding the conflicting results of these trials, and how they might apply to clinical practice, requires careful attention to trial design.

A key aim of personalized medicine is to optimize the prevention, diagnosis, and treatment of diseases by tailoring them to individual patient characteristics and genetics. In this Review, Henry Völzke and colleagues describe the methodological and statistical features of study design that will allow personalized medicine to be translated from a promising theoretical concept to a clinically beneficial, cost-effective reality in cardiovascular medicine.

Atrial fibrillation is a very common sustained arrhythmia, but patients' response to medical and ablation therapy is highly variable. Drs Darbar and Roden expertly review the emerging data on the underlying genetic substrate of this condition, and discuss how understanding the pathological mechanisms might help to tailor antiarrhythmic therapies to individual patients and improve the response to treatment.

Therapeutic decision-making requires integration of complex information on patient-specific and therapy-specific factors. Physicians and prescribers face the daunting task of assessing the efficacy and safety of medications relative to each patient. In this Review, Drs Woosley and Romero discuss the challenges of safe medication prescribing to prevent drug-induced adverse events, and the efforts made to improve clinical decision support systems, using examples from several new evidence-based, online resources.

The development of new therapies for heart failure has led to substantial increases in the cost of care for these patients. Cost-effectiveness analyses can help quantify the relationship between clinical outcomes and the economic implications of available therapies. In this Review, Rohde and colleagues critically appraise cost-effectiveness studies on key areas of heart failure pharmacologically and nonpharmacological treatment options, including medical devices and heart transplant.

In this opinion article, the authors discuss multicentre clinical trials in Asia. Asians have been under-represented in many clinical trials; differences in cardiovascular disease risk and drug responses between Asians and white people underscore the importance of ethnicity-specific intervention testing. Challenges specific to Asia need to be addressed before Asia can rival Europe and the USA as a location-of-choice for clinical trials.