Migraine Headaches Increase Stroke Risk
The Particulars: Identifying people at highest risk of ischemic stroke is crucial to preventing disabling strokes. Many articles about the relationship between migraine and ischemic stroke have been published, but this relationship has not been well characterized.
Data Breakdown: Researchers pooled results from 21 studies involving 622,381 men and women, assessing migraine and subsequent risk for ischemic stroke. Study participants were between the ages of 18 and 70, and none had suffered a stroke prior to enrollment. The risk of ischemic stroke for those with migraines was 2.3 times that of those without migraine. For those who experienced aura, the risk of ischemic stroke was 2.5 times higher. In women who experienced aura, the risk of ischemic stroke was 2.9 times as high as those without migraine with aura.
Take Home Pearls: Migraine headaches appear to be associated with more than a two-fold higher risk of ischemic stroke. Physicians should consider addressing stroke risk factors in patients with a history or signs of light aura associated with severe migraine headaches.
Benefits of Mechanical Thrombectomy in Primary PCI
The Particulars: Previous studies have shown that myocardial perfusion after primary PCI is a strong predictor of mortality, independent from infarct-related coronary artery reopening. The EXPIRA (Thrombectomy With Export Catheter in Infarct-Related Artery During Primary Percutaneous Coronary Intervention) trial randomized 175 STEMI patients to either standard PCI or to PCI plus manual thrombectomy (using Export, Medtronic, Inc.).
Data Breakdown: Primary outcomes of EXPIRA were the percentage of patients whose myocardial blush grade reached at least 3 (complete perfusion) and the percentage of patients whose ST-segment resolution was greater than 70% after 90 minutes. At 24 months, 76.3% of patients in the thrombectomy group had a myocardial blush grade of 3, compared with 32% in the conventional-PCI group. About 80% of the thrombectomy group had at least a 70% decrease in ST-segment resolution, compared with 37.5% rate for the control group. The thrombectomy group also had fewer adverse events than the control group.
Take Home Pearls: Mechanical thrombectomy during PCI for STEMI appears to improve myocardial perfusion and reduce infarct size. Thrombectomy prevented thrombus embolization and preserved microvascular integrity in the myocardium. Larger trials are needed to determine if thrombectomy can reduce mortality in this patient population.
Active Video Gaming Increases Physical Activity
The Particulars: About one-third of American adults are overweight and another third are obese. Using a metabolic chamber to measure the energy expenditure of 12 men and women (ages 25 to 44) as they played Wii Sports and Wii Fit video games, investigators assessed metabolic equivalent (MET) values to estimate energy expenditures. An energy expenditure of 3.0 METs or more was considered moderate-intensity exercise.
Data Breakdown: The average intensities of each video game were distributed over a wide range (1.3 METs to 5.6 METs). One-third of the virtual physical activities required an energy expenditure of 3.0 METs or more. Wii Boxing was the most effective activity to increase energy expenditure (4.5 METs). Golf, bowling, tennis, and baseball had MET values of 2.0, 2.6, 3.0, and 3.0, respectively. The most effective Wii Fit exercise was the single-arm stand (5.6 METs). The intensities of Wii Fit yoga and balance exercises were significantly lower than those of resistance and aerobic exercise, but these exercises effectively improved flexibility and fall prevention.
Take Home Pearls: Active Wii Sports video games and some Wii Fit activities appear to increase adults’ energy expenditure as much as moderately intense exercise. The range of energy expenditure in these active games appears to be sufficient to prevent or improve obesity and lifestyle-related disease.
Assessing PCI Success Rates by Hospital Capabilities
The Particulars: Primary PCI is the preferred treatment of a STEMI, but it is not widely available. Performing PCI at community hospitals without cardiac surgery on site (No SOS) could increase the number of STEMI patients with timely access to the procedure compared with performing PCI at hospitals with cardiac surgery on site (SOS). Primary PCI at hospitals with No SOS is not routinely done, but many states have approved its use at hospitals that meet certain guidelines for procedure volume.
Data Breakdown: A study of 3,018 STEMI patients who underwent primary PCI was performed to determine if patients fared better after having primary PCI at hospitals with cardiac SOS compared with those having PCI at community hospitals with No SOS. The mortality rate at 30 days and 1-year follow-up was no different following primary PCI at either type of facility (9.41% with SOS vs 8.58% with No SOS). Little difference was observed among patients needing a repeat PCI to reopen the originally blocked cardiac vessel. At 1 year, the rate of recurrent heart attack was 6.66% at hospitals with No SOS compared with 5.06% at those with on-cardiac SOS.
Take Home Pearls: One-year mortality appears to be similar at hospitals with or without cardiac SOS for patients undergoing primary PCI for treatment of a STEMI. Patients undergoing primary PCI at hospitals with No SOS had a slightly higher incidence of recurrent heart attack at 30 days for reasons that are unclear and require further study.
PCI-Related Stroke Incidence Stabilizes
The Particulars: Physicians must recognize patients at higher risk of stroke or transient ischemic attack (TIA). If patients have a stroke or TIA related to PCI, technologies are more readily available to use clot-busting drugs or remove the clot. Recognition of patients at higher risk may benefit physicians treating these patients, especially as more are performing PCI on older, sicker patients and in those in need of more complicated treatment.
Data Breakdown: A retrospective study of 17,249 patients who had 21,502 PCIs was conducted. Some patients suffered a PCI-related cerebrovascular accident (CVA), defined as a stroke or a TIA. Researchers compared outcomes with the remainder of the study population. Few patients who underwent PCI suffered a stroke; 84 patients had a stroke or TIA, 23% of which were TIAs. Patients with CVA were more likely to be older, female, have moderate-to-severe renal disease, and have a history of stroke unrelated to prior PCI.
Take Home Pearls: The incidence of stroke or TIA related to PCI appears to have remained steady over 15 years. Other factors appear to be predictors of CVA, including the number of diseased coronary arteries, the presence of intracoronary thrombus, an increased number of vessels treated, and the need for emergency PCI.
[Back to Top] |
Stay Updated
More