TABLE OF CONTENT: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug 2009

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1. Title: A possible link between insulin glargine and malignancy : the facts : editorial
   Authors: Mollentze, W.F.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
   Published: 2009
   Pages: 216-218
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   Abstract: On 26 June 2009 Diabetologia, official mouthpiece of the European Association for the Study of Diabetes (EASD), sounded the alarm in a press release regarding a possible association between the use of insulin glargine and an increased risk for the development of certain malignancies compared to human insulin and other insulin analogs. The evidence for such an increased risk is based on a single study recently conducted in Germany and available on the Diabetologia website. Before making the results of the German study known, the editor of Diabetologia sensibly commissioned three additional studies in an effort to reach more clarity on the issue. These studies were done in Sweden, the UK and Scotland.
    
   
2. Title: A possible link between insulin glargine and malignancy : the facts : comment from Prof François Bonnici : editorial
   Authors: Bonnici, Francois
   From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
   Published: 2009
   Pages: 218
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   Abstract: The recent news alerting the diabetes world to safety concerns regarding primarily insulin glargine, in fact bring to the fore a wider debate, that of increased risk of cancer in patients with type 2 diabetes, and the treatment of diabetes with other insulins and insulin secretagogues.
    
   
3. Title: A possible link between insulin glargine and malignancy : the facts : reply from Dr Navin Singh : editorial
   Authors: Singh, Navin
   From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
   Published: 2009
   Pages: 218-219
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   Abstract: Four registry analyses were published on the website of Diabetologia, the journal of the European Association for the Study of Diabetes (EASD) on 26 June 2009, discussing a hypothetical link between treatment with insulin glargine and cancer.
    
   
4. Title: Patients' motivations for participating in cardiovascular clinical trials : a local perspective : cardiovascular topics
   Authors: Burgess, L.J.; Sulzer, N.U.; Hoosain, F.; Leverton, N.; Bliganut, S.; Emanuel, S.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
   Published: 2009
   Pages: 220-223
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   Abstract: Objective: To investigate patients' motivations for participating in cardiovascular clinical trials.
   Methods: Patients attending TREAD Research, located within Tygerberg Hospital, Parow, Western Cape, between January 2005 and May 2006 were approached to participate in the study. Consenting patients were given a validated questionnaire to complete in their home language. All questionnaires were anonymous and 250 consecutive patients completed the questionnaire. They provided basic demographic data and rated their response to 18 statements concerning factors that may or may not have influenced their decision to participate in a clinical trial.
   Results: The mean (± SD) age of subjects was 56.3 ± 10.9 years. A large percentage of the respondents were unemployed (66.5%). Access to medical care was a motivation for the majority of patients (90.5%). Ninety-six per cent of patients appreciated the regular follow up they received as trial participants; 90% of patients entered the trial to receive medication, which they could otherwise not afford. A substantial 98% of patients participated to learn more about their disease. Almost all (99%) wanted to further the scientific understanding of their condition. A reassuring 94% of subjects felt that they were not pressurised into the study; 80% of patients disagreed that participation in clinical trials was an easy way to obtain money.
   Conclusions: Access to medical care and making a contribution to scientific knowledge are two of the most common motivations for participation in cardiovascular clinical trials. The role of remuneration is relatively unimportant.
    
   
5. Title: Implantable cardioverter defibrillators after myocardial infarction : letter to the editor
   Authors: Bonny, Aime; Ditah, Ivo; Tonga, Nfor
   From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
   Published: 2009
   Pages: 223
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   Abstract: With reference to the interesting review of implantable cardioverter defibrillators (ICD) after myocardial infarction by Dr RJ Myerburg, we would like to discuss some aspects of the article.
    
   
6. Title: A cross-sectional study of blood pressure control in hypertensive patients in general practice (the I-TARGET study) : cardiovascular topics
   Authors: Rayner, Brian; Schoeman, Hermanus S.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
   Published: 2009
   Pages: 224-227
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   Abstract: Introduction: Despite the availability of multiple effective antihypertensive drugs, hypertension control rates remain poor. The reasons for this are complex, but increasingly, physician inertia has been identified as a crucial factor. In this study we attempted to define the level of blood pressure (BP) control and reasons for not achieving control in a survey of selected general practices within South Africa.
   Methods: This was a multi-centre, cross-sectional disease study involving 15 selected general practices throughout South Africa. Treated hypertensive patients over 18 years old were eligible for inclusion. The study was approved by Pharma Ethics, and after informed consent, consecutive hypertensive patients at the participating general practice centres were included, with each centre enrolling 30 patients.
   Results: A total of 451 patients, from 15 sites in South Africa, were entered in the study. The mean age of the patients was 60.7 years, 56.3% were female and 15.7% were current smokers. The BP was reduced by 26.4/17.6 mmHg (p < 0.001) in 220 patients with a documented initial BP. Co-morbidities were present in 322 (71.4%) patients and overall, 37.9% had more than one co-morbidity. Lifestyle modification was not uniformly applied, with only 46.1, 59.6 and 56.8% receiving advice about weight loss, exercise and diet, respectively. Less than a third (30.7%) of patients were on monotherapy, 42.8% were on two drugs (25.9% on fixed-drug combination and 16.9% on free combination) and 26.5% were on more than two agents. Most (86.9%) practitioners used either international or local guidelines to determine target BP. Overall, 61.2% of patients were at goal (BP < 140/90 mmHg). If a stricter target BP (BP ≤ 130/80 mmHg) is applied to patients with co-morbidities, as recommended by the guidelines, 60.6% of patients did not reach goal. Of the 175 patients not at target BP, there was no action plan in 22.9%, while 39.4% were advised to undertake lifestyle changes only.
   Conclusions: Control rates were quite good in comparison with other surveys within and outside South Africa. However we were able to define several important deficiencies: there was evidence of physician inertia and also practitioners need to be more cognisant of local and international guidelines to optimise treatment.
    
   
7. Title: Intracoronary autologous bone marrow cell transfer for myocardial infarction : a safe procedure? : letter to the editor
   Authors: Wiwanitkit, Viroj
   From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
   Published: 2009
   Pages: 227
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   Abstract: Due to the advancement of stem cell research, stem cell therapy is now widely seen as a treatment for many diseases. Intracoronary autologous bone marrow cell transfer is an application of stem cell therapy for the treatment of myocardial infarction. Some articles report favourably on this procedure, whereas the others do not. Apart from its efficacy, consideration of its safety is necessary.
    
   
8. Title: Invasive and anticoagulant treatment for coronary ectasia : a single operator's experience in a tertiary hospital in South Africa : cardiovascular topics
   Authors: Grigorov, V.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
   Published: 2009
   Pages: 229-232
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   Abstract: Introduction: Coronary artery ectasia (CAE) is a rare but well-recognised condition involving dilatation of a coronary artery to more than 1.5 times the diameter of the adjacent portion of the artery. As far as we are aware, the disease has not been described in any local literature and no other research has been conducted in Africa. We carried out this research in order to establish the incidence of the condition in South Africa, as well as the possible preferred method of treatment.
   Methods: Cases were identified from the database of the practice. The study involved only patients who were classified to have Markis type I, II and III disease. From a total of approximately 2 000 angiographies performed during the study period, CAE types I, II and III were diagnosed in 20 patients. Patients with type IV CAE were excluded from the group. Nineteen patients were male and were in their fourth or fifth decade of life, and one was female. Three of the patients were Indian, one was black, and the rest were white.
   Results: Four patients in the group had diabetes, 13 were smokers and eight had hypertension. Dyslipidaemia was observed in seven patients. The most commonly affected area of the coronary artery was the RCA-19 (isolated, or in combination). Patients were treated mainly with anticoagulation and, when necessary, with angioplasty and stent implantation. Morbidity was seen in 5% of the patients and no mortality was observed.
   Conclusion: Most of the patients were male, and the occlusion involved mostly the right coronary artery. The cause of occlusion is still unknown, but it is thought to be due to slow blood flow, damaged endothelium, or a combination of the two. The best therapeutic approach is not known as yet.
    
   
9. Title: Corticosteroid therapy for primary treatment of Kawasaki disease - weight of evidence : a meta-analysis and systematic review of the literature : cardiovascular topics
   Authors: Athappan, Ganesh; Gale, Seth; Ponniah, T.
   From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
   Published: 2009
   Pages: 233-236
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   Abstract: Objective: Corticosteroids are the treatment of choice in most forms of vasculitis. However, their role in the primary treatment of Kawasaki disease (KD) is controversial. Our aim was to conduct a meta-analysis to assess the clinical course and coronary artery outcome of adding corticosteroids to standard therapy [intravenous immunoglobulin (IVIG) + aspirin] in patients with acute KD.
   Methods: We included randomised trials comparing the addition of corticosteroids to conventional primary therapy for Kawasaki disease.
   Results: A total of four studies were identified, which included 447 patients. The meta-analysis revealed a significant reduction in re-treatments with IVIG in patients receiving corticosteroid plus standard therapy compared with standard therapy alone [odds ratio (OR) 0.48; 95% confidence interval (CI): 0.24- 0.95]. There was however no significant reduction in the incidence of coronary artery aneurysms among patients who received corticosteroid therapy plus standard therapy, compared with standard therapy alone for either up to a month (OR 0.74; 95% CI: 0.23-2.40) or over one month ([OR 0.74; 95% CI: 0.37-1.51). Similarly no significant differences between treatment groups were noted in incidence of adverse events (OR 0.81; 95% CI: 0.05-0.88).
   Conclusion: The inclusion of corticosteroids in regimens for the initial treatment of Kawasaki disease decreased rates of re-treatment with intravenous immunoglobulin. However the addition of corticosteroids to standard therapy did not decrease the incidence of coronary aneurysms or adverse events.
    
   
10. Title: Carotid intima-media thickness is a predictor of coronary artery disease in South African black patients : cardiovascular topics
    Authors: Holland, Zaiboonnisa; Ntyintyane, Lucas; Gill, Geoffrey; Raal, Frederick
    From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
    Published: 2009
    Pages: 237-239
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    Abstract: Background: Several studies have shown that increased carotid intima-media thickness (CIMT) confers risk of future coronary artery disease (CAD) and stroke. The present study aimed at investigating whether CIMT is a predictor of CAD in South African black patients.
    Methods and Results: This was a prospective study of 53 patients, 41 men and 12 women, with ages ranging from 30 to 70 years. All patients had undergone coronary angiography for suspected CAD. B-mode ultrasound measurement of the carotid intima-media thickness was carried out in all patients, the operator being blinded to the coronary angiography findings. Twenty-nine of the 38 (76%) subjects with established CAD had increased CIMT, with an average mean CIMT of 1.13 mm. Single-vessel disease was present in 12 people, double-vessel disease in 11 and triple-vessel disease in 12. There was a significant positive linear trend between CIMT and the number of involved coronary vessels (p < 0.0001, r = 0.44).
    Conclusions: Increased CIMT correlated with evidence of angiographically proven CAD. The median percentile scores showed a progressive increase as the number of vessels involved increased. CIMT could be useful as a screening tool for the presence of CAD in the South African black population.
     
    
11. Title: Effect of percutaneous transluminal coronary angioplasty on QT dispersion and heart rate variability parameters : cardiovascular topics
    Authors: Aydinlar, Ali; Senturk, Tunay; Ozdemir, Bulent; Kaderli, Aysel Aydin; Aydin, Ozlem
    From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
    Published: 2009
    Pages: 240-244
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    Abstract: Background: The aim of the study was to analyse parameters reflecting the sympathovagal control of ventricular depolarisation and repolarisation [heart rate variability (HRV) and QT interval dispersion (QTd)] in patients undergoing elective percutaneous transluminal coronary angioplasty (PTCA), and determine whether HRV correlates with QT dispersion parameters.
    Methods: The study consisted of 26 consecutive patients (16 men, 10 women) with single-vessel coronary artery disease (CAD) who underwent elective coronary angioplasty. HRV analyses of all subjects were obtained with the time- and frequency-domain methods. For frequency-domain analysis, low-frequency HRV (LF), high-frequency HRV (HF) and the LF:HF ratio were measured. For time-domain analysis, standard deviations of the normal-to-normal QRS intervals (SDNN) and square roots of the mean squared differences of successive N-N intervals (rMSSD) were obtained. QT intervals were also corrected for heart rate using the Bazett's formula, and the corrected QT interval dispersion (QTcd) was then calculated. All measurements (HRV parameters and QTcd) were made before and immediately after PTCA.
    Results: QTcd was significantly decreased after PTCA (52.2 ± 3.5 vs 42 ± 3.9 ms). SDNN (94.1 ± 22 vs 123.9 ± 35.2 ms), rMSSD (43.7 ± 20.1 vs 73.4 ± 14.5 ms) and HF (51.1 ± 48.8 vs 64.2 ± 28.6 ms2) were significantly higher after PTCA, whereas LF (142 ± 41.5 vs 157.2 ± 25.9 ms2) and the ratio of LF:HF (3.3 ± 1.9 vs 2.1 ± 1.2) were significantly decreased after PTCA. We observed a significant negative correlation after PTCA between QTcd and LF (r = -0.87, p = 0.01) and between QTcd and the ratio of LF:HF (r = -056, p < 0.05).
    Conclusion: Among the patients with CAD undergoing PTCA, QTcd significantly decreased after PTCA, and negatively correlated with LF, the parameter reflecting the sympathetic system.
     
    
12. Title: Impact of anaemia on the prognosis of myocardial infarction in black Africans
    (Impact de l'anemie sur le pronostic de l'infarctus du myocarde chez le noir Africain) : cardiovascular topics
    Authors: Konin, C.; Adoh, M.; Koffi, J.; Anzouan-Kacou, J.B.; Adoubi, A.; Kramoh, E.; Ake-Traboulsy, E.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
    Published: 2009
    Pages: 245-250
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    Abstract: Objective: Anaemia is increasingly being described as a negative predictor of outcome after myocardial infarction. The objective of our study was to assess the prognosis post myocardial infarction in the short and medium term in black Africans with chronic anaemia.
    Methods: We carried out a comparative case-control study on 272 patients (93 anaemic and 179 non-anaemic) hospitalised for myocardial infarction at the Cardiology Institute of Abidjan. One group included 93 patients who presented with anaemia concurrent with the myocardial infarction (haemoglobin level low: 13 g/dl for males and 12 g/dl for females, respectively). The other group comprised 172 patients who presented without anaemia during the acute phase of myocardial infarction. The haemoglobin rate was measured at admission, as were the biological markers of myocardial infarction.
    Results: The mean age was 53.5 years for the anaemic patients and 52.6 years for the non-anaemic patients. We noticed a clear male predominance in both populations (81.7 vs 78.8%; p = 0.56). The mean haemoglobin level was lower in the anaemic patients compared to that in the non-anaemic patients (10.2 vs 15 g/dl). The anaemic patients were eight times more at risk for an unfavourable outcome (complications or death) compared to the non-anaemic patients (91.4 vs 57%; OR = 8.02; 95% CI: 3.5-19.07; chi2 = 33.74; p < 0.0001). The anaemic patients were 3.7 times more at risk for right ventricular failure (NYHA class II and III) compared to the control population (69.9 vs 38.5%; OR = 3.7; 95% CI: 08-6.60; chi2 = 24.06; p < 0.0001) and six times more at risk for cardiogenic shock (24.7 vs 5.3%; OR = 6.21; 95% CI: 2.56–15.43; chi2 = 22.89; p < 0.0001). The mortality rate was significantly higher in the anaemic than the non-anaemic patients (35.5 vs 12.8%; OR = 3.73; 95% CI: 1.94-7.19; chi2 = 19.18; p < 0.0001).
    Conclusion: Anaemia is an independent risk factor for a poor prognosis during the acute phase of myocardial infarction in black Africans.
    
    But: L'anémie est de plus en plus décrite comme un facteur de pronostic péjoratif de l'infarctus du myocarde. Le but était d'évaluer le pronostic à court et moyen terme de l'infarctus du myocarde chez le Noir Africain porteur d'une anémie chronique.
    Methode: Nous avons effectué une étude rétrospective comparative concernant 272 patients (93 anémiés et 179 nonanémiés) hospitalisés à l'Institut de Cardiologie d'Abidjan pour infarctus du myocarde. Le premier groupe était constitué de patients qui ont présenté concomitamment à l'infarctus du myocarde une anémie (taux d'hémoglobine inférieur respectivement à 13 g/dl pour le sexe masculin et 12 g/dl pour le sexe féminin). Ils étaient au nombre de 93. Le deuxième groupe était constitué de patients qui n'ont pas présenté d'anémie à la phase aigue de l'infarctus du myocarde. Ils étaient au nombre de 179. Le taux d'hémoglobine a été dosé à l'inclusion en même temps que les marqueurs biologiques de l'infarctus du myocarde.
    Resultats: La moyenne d'âge était de 53.5 ans pour les anémiés et 52.6 ans pour les non anémiés. Nous avons observé une nette prédominance masculine dans l'ensemble des deux populations (81.7 vs 78.8%; p = 0.56). La moyenne du taux d'hémoglobine était plus basse chez les anémiés par rapport aux non anémiés (10.2 vs 15 g/dl)). Les anémiés ont eu huit fois plus de risque d'avoir une évolution défavorable (complication ou décès) par rapport aux non anémiés (91.4 vs 57%; OR = 8.02; IC 95%: 3.5-19.07; Khi2 = 33.74; p < 0.0001). Les anémiés ont eu 3.7 plus de risque de présenter une insuffisance ventriculaire gauche (KILLIP II et III) par rapport aux témoins (69.9 vs 38.5%; OR = 3.7; IC 95%: 2.08-6.60; Khi2 = 24.06; p < 0.0001) et six fois plus de risque pour le choc cardiogénique (24.7 vs 5.3%; OR = 6.21; IC 95%: 2.56-15.43; Khi2 = 22.89; p < 0.0001). La mortalité a été significativement plus élevée chez les anémiés que chez les non anémiés (35.5 vs 12.8%; OR = 3.73; IC 95%: 1.94-7.19; Khi2 = 19.18; p < 0,0001).
    Conclusion: l'anémie a représenté un facteur indépendant de mauvais pronostic à la phase aiguë de l'infarctus du myocarde chez le noir Africain.
     
    
13. Title: Impact of income on the profile of cardiovascular risk factors among hypertensives in a Nigerian tertiary health centre: a cross-sectional study : cardiovascular topics
    Authors: Karaye, K.M.; Okeahialam, B.N.; Wali, S.S.
    From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
    Published: 2009
    Pages: 251-255
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    Abstract: Background: In most developed countries, risk factors for cardiovascular diseases (CVD) are more prevalent in low socioeconomic classes. However, the pattern in developing countries appears to be different. This study sought to evaluate and compare risk factors for CVD as well as absolute CVD risk in hypertensive subjects grouped by income in Kano, Nigeria.
    Methods: The study was cross-sectional in design and carried out in Aminu Kano Teaching Hospital, Kano, Nigeria. Seventy treatment-naÏve hypertensives and an equal number of hypertensives on treatment were recruited by balloting from the outpatient clinics, and then regrouped into low- and high-income earners. These two groups were then compared in terms of their profile of CVD risk factors and absolute CVD risk. All the assessed CVD risk factors are recognised in standard guidelines for the management of persons with systemic hypertension.
    Results: The low-income group comprised 45 patients (32.1%) while the remaining 95 (67.9%) had a high income. The most prevalent CVD risk factor was dyslipidaemia, found in 77.8 and 71.6% of low- and high-income earners, respectively (p = 0.437). The prevalence of proteinuria was significantly higher among low-income earners (42.2%) compared with high-income earners (15.8%) (p = 0.001). Mean serum creatinine was also higher among low-income earners but the difference did not reach statistical significance (p = 0.154). Very high CVD risk was found in 75.6 and 70.5% of low- and high-income earners, respectively (p = 0.535).
    Conclusion: Dyslipidaemia and very high CVD risk were found in over 71% of the patients regardless of their level of income. Low-income earners had a higher prevalence of indices of renal damage. These findings pose a great challenge to the present and future management of all subjects, particularly those in the low-income group, given that in Nigeria, healthcare is largely paid for directly out of their pockets.
     
    
14. Title: The U wave and papillary muscle variants : revisiting an old association : case report
    Authors: Ker, James
    From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
    Published: 2009
    Pages: 256-257
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    Abstract: One of the earliest hypotheses on the origin of the U wave was that these waves represent repolarisation of the papillary muscles and their neighboring structures. Various U-wave and TU-segment abnormalities have been described and ascribed to certain cardiac pathological conditions.
    In this case report it is hypothesised that prominent U waves in the inferior leads are caused by an accessory papillary muscle. Any possible long-term consequences are not known.
     
    
15. Title: Siemens' Artis zeego brings surgery and industry together : cardiovascular imaging
    From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
    Published: 2009
    Pages: 258
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    Abstract: In a development that offers greater operating versatility for minimally invasive surgical procedures, advanced imaging and improved patient comfort, Siemens Healthcare recently introduced the Artis zeego. This is a floor-mounted robotic X-ray angiography system that maximises the benefits of using hybrid operating rooms.
     
    
16. Title: Lessons from the BEAUTIfUL trial : advertorial
    From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
    Published: 2009
    Pages: 261-262
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    Abstract: The BEAUTIfUL trial tested whether HR lowering with ivabradine (Coralan®) reduced CV events in coronary patients with left ventricular dysfunction (LVD). Ivabradine, recently launched as Coralan® in South Africa, specifically inhibits the If current in the sino-atrial node to lower HR without negatively affecting other aspects of cardiac function.
     
    
17. Title: Bayer symposium : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
    Published: 2009
    Pages: 263-264
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    Abstract: Generic substitution has its place, with careful attention to dose and duration, but is not without medico-legal pitfalls. The best interest of the patient should dictate the ultimate drug choice made by the physician. This view was expressed by Dr Jeff King, Sunninghill Hospital, Johannesburg at a recent Bayer Cardio-Academy lecture series in Franschoek. Encouraging doctors to take control of their practices, Dr King also called for a regulatory ombudsman to monitor quality-of-care issues in South Africa.
     
    
18. Title: Primary prevention using losartan in type 1 diabetic patients significantly reduces retinopathy : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
    Published: 2009
    Pages: 265
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    Abstract: This five-year RASS study on the effect of blockade of the renin-angiotensin system with an ACE inhibitor (enalapril) or an ARB (losartan) was not able to show that primary prevention protects kidney function in normotensive, normo-albuminuric type 1 diabetic patients. This therapy did however achieve significant beneficial effects on diabetic retinopathy.
     
    
19. Title: Need for new hypertension guidelines for high-risk patients : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
    Published: 2009
    Pages: 267
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    Abstract: Specific preventative and hypertension management guidelines for the patient who is at very high risk are now needed, following the results of recent trials in this population group. This group of patients is defined as those with a greater than 20% risk of experiencing a cardiovascular event in the next 10 years. This view was expressed in a recent issue of the Journal of Hypertension, the official journal of the European Society of Hypertension (ESH).
     
    
20. Title: Earlier administration of high-dose bolus tirofiban in STEMI increases benefit without increasing bleeding complications : drug trends in cardiology
    From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
    Published: 2009
    Pages: 268
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    Abstract: The most recently announced multi-strategy trial also supported the view that the high-dose bolus regimen of tirofiban was as efficacious as abciximab, while resulting in a numerically lower incidence of complications and significantly lower incidences of thrombocytopenia.
     
    
21. Title: African doctors to receive sustained training in cardiovascular intervention : cardio news
    From: Cardiovascular Journal of Africa, Vol 20, Issue 4, Jul / Aug
    Published: 2009
    Pages: 272
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    Abstract: Doctors operating in sub-Saharan African countries will soon be benefiting from advanced, state-of-the art training in cardio- and endovascular intervention.