Clinical implications of switching from intensive to moderate statin therapy after acute coronary syndromes.

Int J Cardiol. 2011 Oct 6;152(1):56-60

Authors: Colivicchi F, Tubaro M, Santini M

Abstract
BACKGROUND AND AIMS: Intensive statin therapy represents an effective option after acute coronary syndromes (ACS). Despite evidence, switching to less effective statins frequently occurs in practice. Aim of this observational study was to assess the impact of switching from intensive to moderate statin therapy on clinical outcomes after ACS.
METHODS AND RESULTS: A cohort of 1321 consecutive ACS patients (886 men, age 71±.8years) discharged on atorvastatin 80mg/d in a 6.5year period was followed for 12months after discharge. During follow-up, 557 patients (42%) were switched by primary care physicians to moderate statin therapy, either for side effects (56%) or for safety concerns (44%). No major adverse reaction was reported. Increasing age (HR 1.52 per 10-year increase, 95% CI 1.23-1.78, p=0.01), and female gender (HR 1.11, 95% CI 1.06-1.23, p=0.02) were associated with a higher probability of switch. Patients following a cardiac rehabilitation program (HR 0.64 95% CI 0.49-0.86, p=0.02) and diabetic subjects (HR 0.81, 95% CI 0.67-0.92, p=0.02) were more likely to continue atorvastatin 80mg/d. During follow-up, a major adverse clinical event occurred in 331 patients (one-year probability 0.25, 95% CI 0.22-0.27). Multivariate analysis with Cox proportional hazards method, including statin switching as a time-dependent covariate, demonstrated that, after adjustment for demographic and clinical variables, reduction from intensive to moderate statin therapy was an independent predictor of adverse clinical outcomes (HR 2.7, 95% CI 1.7-5.1, p=0.004).
CONCLUSION: Switching from intensive to moderate statin therapy after ACS is associated with an increased incidence of adverse clinical events.

PMID: 20674999 [PubMed - in process]

Does modifying electrode placement of the 12 lead ECG matter in healthy subjects?

Int J Cardiol. 2011 Oct 20;152(2):184-91

Authors: Sheppard JP, Barker TA, Ranasinghe AM, Clutton-Brock TH, Frenneaux MP, Parkes MJ

Abstract
BACKGROUND: Limb electrodes for the 12 lead ECG are routinely placed on the torso during exercise stress testing or when limbs are clinically inaccessible. It is unclear whether such electrode modification produces ECG changes in healthy male or female subjects that are clinically important according to the 2009 AHA, ACCF, HRS guidelines. We therefore measured whether ECG modification produced clinically important or false positive ECG changes e.g., appearance of Q waves in leads V(1-3), ST changes greater than 0.1mV, T wave changes greater than 0.5mV (frontal plane) or 1mV (transverse plane), QRS axis shifts or alterations to QTc/P-R/QRS intervals.
METHODS: The 12 lead ECG was measured in 18 healthy and semi-recumbent subjects using the standard and Takuma modified limb placements.
RESULTS: In the frontal plane we demonstrate that the modification of limb electrode placement produces small Q, R and T wave amplitude and QRS axis changes that are statistically but not clinically significant. In the transverse plane it produces no statistically or clinically significant changes in the ECG or in ST segment morphology, P-R, QRS or QTc intervals.
CONCLUSIONS: We provide better and more robust evidence that routine modification of limb electrode placement produces only minor changes to the ECG waveform in healthy subjects. These are not clinically significant according to the 2009 guidelines and thus have no effect on the clinical specificity of the 12 lead ECG.

PMID: 20701990 [PubMed - in process]