Pre-procedural fasting for coronary interventions: is it time to change practice?

INTRODUCTION: Traditionally, patients are kept nil-per-os/nil-by-mouth (NPO/NBM) prior to invasive cardiac procedures, yet there exists neither evidence nor clear guidance about the benefits of this practice. OBJECTIVES: To demonstrate that percutaneous cardiac catheterisation does not require prior fasting. METHODS: The data source is a retrospective analysis of data registry of consecutive patients who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and stable angina at two district general hospitals in the UK with no on-site cardiac surgery services. RESULTS: A total of 1916 PCI procedures were performed over a 3-year period. None of the patients were kept NPO/NBM prior to their coronary procedures. The mean age was 67±16 years. 1349 (70%) were men; 38.5% (738/1916) had chronic stable angina, while the rest had ACS. 21% (398/1916) were diabetics while 53% (1017/1916) were hypertensive. PCI was technically successful in 95% (1821/1916) patients. 88.5% (1697/1916) had transradial approach. 77% (570/738) of elective PCI patients were discharged within 6 h postprocedure. No patients required emergency endotracheal intubation and there were no occurrences of intraprocedural or postprocedural aspiration pneumonia. CONCLUSIONS: Our observational study demonstrates that patients undergoing PCI do not need to be fasted prior to their procedures.

Myocardial bridging with a coronary artery aneurysm and left ventricular stunning.

The authors present a case demonstrating the unusual combination of myocardial bridging with a coronary artery aneurysm complicated by acute transient left ventricular dysfunction due to myocardial stunning. The pathophysiology and current insights into myocardial bridging, coronary aneurysms and myocardial stunning are briefly discussed. The literature reveals only one other reported case of coronary aneurysms associated with myocardial bridging. In addition, although there are several reports of angina and myocardial infarction complicating bridging, there is only 1 other report of myocardial stunning specifically.

Coronary angioplasty via the radial approach in an individual with dextrocardia.

We present the first published case of coronary angioplasty via the radial artery approach in an individual with situs inversus. The technical issues involved are discussed.

Effect of spironolactone on C-reactive protein levels in patients with heart disease.

Animal evidence shows that aldosterone is pro-inflammatory and that aldosterone blockade is anti-inflammatory. Therefore part of the beneficial effect of aldosterone blockade that might contribute to it reducing mortality could be an anti-inflammatory effect. However, there are no previous data on whether aldosterone blockade is anti-inflammatory in man. We performed 4 separate studies to investigate whether spironolactone treatment would reduce levels of C-reactive protein (CRP), a marker of inflammation, in serum samples taken from patients suffering from different degrees of heart failure. We found in all 4 studies that spironolactone had no significant effect compared with placebo, on CRP levels in these patients. These studies provide evidence against the hypothesis that the clinical benefits produced by aldosterone blockade are due to it having anti-inflammatory effects.

What is the optimal serum potassium level in cardiovascular patients?

Humans are prone to sodium overload and potassium depletion. This electrolyte imbalance is important in the pathogenesis of cardiovascular disease and sudden cardiac death. Avoiding hypokalemia is beneficial in several cardiovascular disease states including acute myocardial infarction, heart failure, and hypertension. The evidence highlighting the importance of potassium homeostasis in cardiovascular disease and possible mechanisms explaining potassium's benefits are reviewed. Targets for serum potassium concentration are suggested.