Monday, September 29, 2014
Thursday, September 25, 2014
at 8:54 AM
Monday, September 22, 2014
I must say that nowadays, at clinical meeting, we are hearing reported, more negative trials.
In the recently concluded European Society of Cardiology Annual Scientific Congress,, one such trial reported was the SIGNIFY trial. This trial was to a randomised, double blinded, placebo control trial to test the benefits of Ivabradine against the placebo in patients with stable angina pectoris, without heart failure and worse heart rate was greater than 70 beats per minute. Ivabradine was a heart rate slowing drug working through the If channel n the SA node. I suppose the investigators were hoping to show that by slowing the heart rate from 70 to 60 per minute, it would make a better outcome. The PI was Dr Kim Fox of London. The paper was also published simultaneously in the New England Journal of Medicine 371:1091, 2014. They managed to enrol 19,102 patients who had stable coronary disease without heart failure and whose heart rate was more than 70 / min. It is important to note that of the 19,000 or so patients, 12,000 or so had class 2 angina or more ( Canadian classification ). The primary endpoint was CVS mortality and non fatal MI. Half the patients were given Ivabradine and the other half, a placebo.
After 27 months of follow-up. it was true that the Heart Rate was lower in the treated arm. There was however no significant difference in the primary endpoint. But in the 12,000 patients with Canadian class 2 or more angina, there were more deaths and non fatal MI. There also seemed to be a higher incidence of atrial fibrillation in the treated arm.
Now, this last two points have given rise to some concern. We now know ( 19,000 is a large number ) that there is no point using ivabradine in patients with stable angina pectoris without heart failure. Secondly, we have to be careful in those with Class 2 or more angina, as it may do harm. Why? we are not certain.
at 9:04 AM
at 7:46 AM
Wednesday, September 17, 2014
This morning I join the Kembali Negara-Ku Piknik at Taman Jaya. I reached the site at 8.20 am and found the action point, sat down and had breakfast with y friend Dr KB Ng.
at 12:33 AM
Monday, September 15, 2014
In the field of interventional cardiology ( which is plateauing ), obviously the latest stent impacting us is the Absorb bioresorbable vascular scaffolding, which reach our Malaysian shores about 4-5 years ago. Of course the initial results were excellent, Absorb cohort A, Absorb cohort B, ABSORB I trial ( we are awaiting the 5 year follow-up results ) and the ABSORB II study, the prelim 1 year FU data was just released by Patrick Serruys at TCT. From the CV, looks like Patrick, the cornerstone of ThoraxCenter, Rotterdam, for so many years, have now moved to Imperial College, London ( need to check this out ). Well, Patrick released the Absorb II interim analysis and showed that the Absorb was as good as the good "old" Xience V ( good DES ), except for some less acute lumen gain. That is a minor point according to Patrick but I think that that point cannot be simply dismissed.
Anyway, between Absorb I and Absorb II, investigators ( not from the Patrick group ), the other European investigators have published the GHOST-EU registry at Eurointervention 2014. Led by Dr Capodanno, these investigators publish their registry of 1,189 patients, across 10 European Centers, who had the Absorb bio-resorbable vascular scaffolding implanted between Nov 2011 - January 2014 ), and followed up. This seemed more real world, when compared to the "mastery" skills of Patrick and team. They found that there were significant problems. Over follow up of 6 months, there were 2.1% stent thrombosis, death rate 1.0%, target lesion MI of 2.0% and TLR of 2.5%. TVR was 4.0%. These are not small numbers. And it is only 6 months.
Of course, I have always shy away from using Absorb because Abbott Vascular's Xience Prime was working excellent in my hands and not to forget, the Xience Prime DES was much cheaper, making it more cost effective ( value for money ), except that this Xience Prime cannot disappear.
Looks like Absorb is a good stent but there are still issues to be resolved. Xience Prime is a very good stent and is much cheaper.
I hear that there is a company call Elixir, who also has a bio-resorbable vascular scaffolding. The drug is different,another -limus, called novolimus. So competition is on the way. Looks like prices will becoming down.
at 10:38 AM
Tomorrow is Malaysia Day. This should be our National Day. It was the day our Sarawak and Sabah brothers and sisters join us to form the Federation of Malaysia, 16th September 1963.
Just to remind us all.
After 51 years of Malaysia.
Borrowing a line from Charles Dickens -
It is the best of times, we have seen tremendous progress of iconic buildings and disconnected monorails / LRT services, a so called "booming economy" propped up by great household debt. A government trumpeting economic numbers that many have trouble trying to understand as things on the ground is a far cry from things declared in Putrajaya.
It is the worse of times , as we become a laughing stock to the world, with one country, two Allahs, laws meant for prosecution are used selectively to become laws for persecution. The constitution challenged with impunity with government tacit support. It is the worse of times, when clicking "like" in a facebook page can be deemed as seditious. When we have many "hot crimes" without criminals.
We must all come together and remember the Philosophy of Malaysia as stated in our Rukun Negara.
We must believe in God. Please call it whatever name you wish, but believe in God. I will respect your Allah, and you please respect mine too. I will be loyal to the king and our country and I hope that the Kings will also be loyal to king and country. The Constitution is SUPREME and so also the RULE OF LAW ( not rule by law ). We must have mutual respect for each other as fellow Malaysians and have good social behaviour.
We are all Malaysians first and only Malaysians. Let not the racist politicians divide us.
16h September 2014
8.30 am - 10 am
Taman Jaya, PJ
at 9:39 AM
Thursday, September 11, 2014
I was at UM campus yesterday to be with the students at their mini demo next to the UM bus station.
We all left after singing the Negara-Ku.
When you are there, it is heart warming to see these young ones speaking, walking and taking up the challenge against a corrupt and abusive government. I only hope that they were persevere and persist in their strive to build a new Malaysia.
They made a severe mistake detaining so many under the Sedition Act. And an even bigger mistake, charging a law lecturer, who teaches the young minds. That is a severe mistake which I am sure thay will regret.
at 8:54 AM