Journal and News Scan

In the ISCHEMIA Trial, 5179 patients with moderate or severe myocardial ischemia were randomized equally into two groups based on initial management strategy: initial invasive strategy (angiography and revascularization when feasible) and medical therapy, or initial conservative strategy (medical therapy alone and angiography if medical therapy failed).  Primary endpoint was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest.  After a median follow-up of 3.2 years,  primary outcome events occurred in 318 of the invasive-strategy group and in 352 of the conservative-strategy group, the respective numbers of death were 145 and 144 in two groups. 

These results did not show that an initial invasive strategy of angiography and revascularization reduced the risk of ischemic cardiovascular events or all- cause death over a median of 3.2 years, as compared to an initial conservative strategy.  

Former AATS President Dr. Craig Smith updates his 'Department of Surgery family' at Columbia University each day, highlighted as "Winston Churchill's radio speeches of this war."

Useful series from the Pacific North West, main questions:

-Why four patients who had a do-not-resuscitate order on admission were included in the dead and, ultimately, why been admitted in an ITU/ICU setting?

-How come no sputum samples from nine fatalities were ever sent for bacterial culture in an ITU/ICU setting?

It has been highlighted by experts such as Ioannides of Stanford that, since we cannot/will not screen for this elusive SARS-associated virus, we cannot computate mortality nor ultimately ascribe CAUSATION. 

In a cohort of 416 patients hospitalized with COVID-19, nearly 20% had elevated troponins indicating myocardial injury.  These patients also had a host of other serum and radiographic abnormalities, were older, had more comorbidities, and more often required ventilatory support.  Their mortality rate was 51% compared to 4.5% for other hospitalized patients.  Elevated troponins were an independent predictor of mortality (HR 4.26).