The American Heart Association held its 2009 Scientific Sessions from November 14 to 18 in Orlando. The features below highlight some of the news emerging from the meeting. For more information on these items and other research that was presented, go to www.americanheart.org.
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