Dr Amardeep Ghosh Dastidar

Invasive Treatment Strategy for Older Patients with Myocardial Infarction

In older adults with heart attack an invasive strategy(angiography guided) did not result in a significantly lower risk of cardiovascular death or nonfatal myocardial infarction (the composite primary outcome) than a conservative strategy over a median follow-up of 4.1 years. However the patients in the invasive-treatment group had fewer nonfatal during the follow up.

Immune checkpoint inhibitors: Unravelling atherosclerotic cardiovascular risk

Highlights •Immune checkpoint inhibitors have become the standard of care in the treatment of many malignancies. •Immune checkpoint proteins, which are targeted by current immune checkpoint inhibitor therapies (CTLA-4, PD-1 and PD-L1) are also critical negative regulators of atherosclerosis. •There is now growing preclinical, imaging and clinical evidence suggesting that immune checkpoint inhibitors may accelerate atherosclerosis and lead to an increased risk of atherosclerotic cardiovascular events. •Increasing the awareness of immune checkpoint inhibitor associated atherosclerotic events alongside myocarditis among clinicians is an important first step. Patients presenting with chest pain, troponin elevation, or ST/T wave changes on 12 lead ECG after initiation of immune checkpoint inhibitor therapy should be provisionally diagnosed with myocarditis, however both myocarditis and acute coronary syndrome should be considered. •All cancer patients who are candidates for immune checkpoint inhibitor therapy should undergo baseline CV risk assessment and be optimised for known cardiovascular risk factors to try and prevent atherosclerotic cardiovascular events.