Latest news with #angina
Medscape
15-07-2025
- Health
- Medscape
Silent Graft Occlusion After CABG Complicates Heart Care
TOPLINE: In-hospital silent asymptomatic graft occlusion following coronary artery bypass grafting (CABG) was associated with an increased incidence of angina-related rehospitalisations and reinterventions after 1 year of follow-up. METHODOLOGY: Silent CABG occlusion occurs in 5%-17% of patients after surgery and often goes undetected due to the absence of any classic signs of myocardial infarction, posing major challenges for diagnosis and management. Researchers analysed data from a prospective cohort study including 292 patients (mean age, 67 years; 85% men) who underwent isolated CABG between July 2021 and December 2023 to assess mid-term outcomes in those with early silent CABG occlusion. Silent CABG occlusion was defined as occlusion detected using coronary CT before discharge from the hospital and without any clinical signs of perioperative myocardial infarction. Patients received standard care, including anticoagulation and dual antiplatelet therapy, after operation and completed follow-up of at least 1 year. The primary endpoint was the incidence of angina-related rehospitalisations and coronary revascularisations over a mean follow-up duration of 14.5 months. TAKEAWAY: Silent in-hospital CABG occlusion was identified in 8.5% of patients, and these patients had a longer hospital stay than those without silent CABG occlusion (median, 10 vs 8 days; P < .001). Patients with silent CABG occlusion had a higher incidence of angina-related rehospitalisations (28% vs 4.1%; P < .01) and reinterventions (28% vs 2.6%; P < .01) than those without silent CABG occlusion. Graft occlusion was associated with a nearly 8.5-fold higher risk for rehospitalisation and a 15-fold higher risk for reintervention (P < .001 for both). Overall mortality or rates of major adverse cardiovascular and cerebrovascular events did not differ significantly between patients with and without silent CABG occlusion. IN PRACTICE: "Our findings support the routine use of postoperative cCT [coronary CT] angiography to identify silent graft occlusions, which are frequently underdiagnosed with symptom-driven follow-up alone; early detection enables tailored risk stratification, facilitates ischaemia testing when indicated and informs closer surveillance rather than reflexive intervention," the researchers noted. SOURCE: This study was led by Islam Salikhanov, MD, PhD, University Hospital Basel, Basel, Switzerland. It was published online on July 07, 2025, in Open Heart. LIMITATIONS: This study was conducted at a single centre. The incidence of silent graft occlusion was 8.5%, which limited the statistical power for subgroup analyses. The exclusion of patients with severe renal issues or iodine-contrast allergies limited the generalisability of the findings. DISCLOSURES: This study received funding from the Immanuel and Ilse Straub Foundation. The authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
29-05-2025
- General
- Medscape
Rapid Rx Quiz: Calcium-Channel Blockers
Calcium-channel blockers (CCBs) play a central role in the treatment of hypertension, angina, and certain cardiac arrhythmias and are among the most commonly prescribed drugs in the United States. Beyond their US Food and Drug Administration–approved uses, CCBs have found a place in treating several off-label conditions. With their widespread use, however, comes the responsibility of understanding their pharmacodynamics, drug-drug interactions, and potential toxicities. How much do you know about CCBs? Test yourself with this short quiz. Off-label uses for CCBs include Raynaud phenomenon, migraines, and subarachnoid hemorrhage. CCBs do not treat depression; in fact, their use has been associated with depression. Verapamil might reduce diastolic dysfunction, but this is not a mainstream use. The most common CCBs are relatively weight neutral. Learn more about Raynaud phenomenon. Including lightheadedness, specific adverse and serious adverse events from CCB use are bradycardia, constipation, headaches, flushing, worsening cardiac output, and peripheral edema, possibly from fluid redistributing from the intravascular space. Learn more about dizziness and vertigo. A recent study found that amlodipine was involved in the majority of overdose cases, accounting for 62% of all CCB overdoses. This far surpasses other agents such as lercanidipine (12%), diltiazem (11%), verapamil (10%), and felodipine (5%). The lower incidence of overdoses involving lercanidipine, diltiazem, verapamil, and felodipine corresponds with their declining presence in current hypertension treatment guidelines. Although amlodipine is involved in more overdose cases overall, the study underscores that the severity of overdose varies significantly by CCB class. Nondihydropyridines, such as diltiazem and verapamil, were associated with markedly higher rates of life-threatening complications, including dysrhythmias (33-35% of cases) and intensive care unit (ICU) admissions (52% and 30%, respectively). In contrast, amlodipine showed much lower rates of dysrhythmias (1%) and ICU admissions (18%). Learn more about CCB toxicity. Many of the signs and symptoms of CCB toxicity are similar to normal CCB adverse events, making diagnosis challenging. A blood test can aid in diagnosis; abnormal findings that suggest CCB toxicity include acidosis, hyperglycemia, and hypokalemia. Neutrophilia has no established connection. Learn more about CCB toxicity. Combining diltiazem or verapamil with direct oral anticoagulants might increase risk for bleeding or clotting complications, though previous research has shown mixed results. A recent study found no evidence of increased risk when direct oral anticoagulants were used alongside diltiazem or verapamil. However, patients who began direct oral anticoagulant therapy while already taking diltiazem had higher rates of overall mortality and cardiovascular-related death within 30 days, compared with those taking anticoagulants alone. Learn more about diltiazem.
