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Aspirin alone proved as effective as aspirin plus the blood clot preventer Plavix in keeping coronary artery bypass grafts open during the first year after surgery, according to a study released on Monday.

The study was designed to see if the addition of Plavix — already a $9 billion a year seller for Bristol-Myers Squibb Co and Sanofi Aventis — to standard aspirin therapy would help further reduce vein narrowing or blockages after coronary artery bypass surgery.

“We found no significant difference in the amount of vein graft thickening, or the number of blocked bypasses, cardiovascular events or bleeding events in the 113 surgery patients treated with either aspirin and clopidogrel (Plavix) or aspirin alone,” said Dr Alexander Kulik, a cardiovascular surgeon who led the study.

The data were presented at the American Heart Association scientific meeting in Orlando.

The success rate after one year was 93.2 percent for aspirin alone and 94.3 percent for patients on aspirin plus Plavix, a difference not considered to be statistically significant.

More than 90 percent of patients in the trial were also taking cholesterol lowering statins — standard therapy for heart patients.

While the duel clot-preventing therapy of aspirin and Plavix is standard during and after artery-clearing angioplasty procedures, some surgeons have begun using the combination after bypass surgery in the belief that it might improve outcomes, Kulik explained.

This study failed to validate that theory, Kulik said.

“The good news is that patients and their doctors can expect more than 90 percent of vein grafts to remain open one year after surgery with the use of aspirin and statins,” he said.

People taking the acid reflux drugs Prilosec or Protonix in combination with blood thinners such as Plavix have a higher risk for death after angioplasty than people who don’t take the two popular antacids, a new study has found.

The people in the study, which is to be presented Monday at the American Heart Association’s annual meeting in Orlando, Fla., were undergoing what doctors call “percutaneous coronary intervention,” or PCI, a common procedure used to widen a narrowed artery. PCI typically involves balloon angioplasty followed by the insertion of a drug-emitting stent, a tiny mesh tube, to keep the vessel open.

Study author Dr. Joseph Sweeny, an assistant professor of medicine at Mount Sinai Medical Center in New York City, said that the clinical implications for users of these reflux drugs — called proton pump inhibitors (PPIs)– remain unclear.

“It’s a moving target,” Sweeny said, adding that, “although certain confounders are going to be at play that do cause limitations of the study, in my opinion the data speaks for itself. We found an overall increased mortality in this patient population that takes a PPI with clopidogrel [Plavix]. The problem was I was not able to look at specific cause of mortality.”

One expert agreed that the study, while interesting, does not prove cause-and-effect.

“All this shows is that people taking PPIs have a worse outcome than those not taking PPIs,” said Dr. Chet Rihal, director of the Mayo Clinic’s catheterization lab in Rochester, Minn. “This does not prove there’s causation. That would be like saying that carrying matches is associated with lung cancer. It is associated, but it doesn’t mean it causes lung cancer.”

“These data do not show that patients should stop taking PPIS, and, in fact, it would be dangerous for patients to stop PPIs or other medication without a physician’s advice,” Rihal said.

The mortality increase shown by the study is not surprising, he added. “People who are older are the ones who get stents and tend to get ulcers and stomach problems [warranting use of PPIs] so we would expect them to have a worse prognosis,” Rihal said. “Whether it’s due to medical problems or whether it has something to do with a drug-drug reaction is unclear.”

PPIs are frequently given with aspirin and Plavix after an angioplasty procedure to reduce the chances of gastrointestinal bleeding. Many people also take PPIs for various gastrointestinal conditions, including acid reflux, gastric ulcers and stomach bleeding.

For the study, Sweeny and colleagues looked back at records of more than 8,300 people who underwent the procedure between April 2003 and June 2007. They were followed for an average of two years.

During the study period, 17 percent of them took a PPI. All of the patients also took both aspirin and Plavix, the researchers said.

Overall, people taking a PPI had a 30 percent higher risk for dying after their PCI procedure than did people who were not taking a PPI. Two drugs in the class appeared to contribute most of the added risk: Omeprazole (Prilosec) was associated with 72 percent higher risk for death after PCI, and pantoprazole (Protonix) was linked to a 54 percent increased risk, the study found.

Two other common PPIs — esomeprazole (Nexium) and lansoprazole (Prevacid) — did not show a heightened risk. There wasn’t enough data to rank a fifth drug, Aciphex (raberprazole), according to the study.

Sweeny could not say why Nexium and Prevacid were exempt from the effect. “It’s a very heterogenous interaction and depends on how a specific population metabolizes that drug,” he said.

People taking PPIs along with a blood thinner also had a small risk for developing blood clots after insertion of a stent, the team found.

The findings add to a lively back-and-forth about the dangers — or lack thereof — of combining antacids with blood thinners, with studies over the past few years coming down on both sides of the debate.

But according to Rihal, there may actually be an answer to this question, though not from the current study. He pointed to an earlier study that demonstrated an interaction between the two types of drugs, but only in a test tube.

When it came to replicating those findings in humans, however, no extra problems showed up in people taking PPIs compared with those not taking them. This was later confirmed by another study, Rihal said.

“That was actually the best-done study of them all,” he said.

One problem with the Mount Sinai study, Rihal said, is that it does not indicate why people were taking the antacids.

PPIs, used by millions of Americans, have also been linked to a number of other health risks, including an increase in hip fractures, diarrhea and community-acquired pneumonia.

Former American Heart Association (AHA) president and current spokesman Dr. Sidney Smith said that new AHA/American College of Cardiology recommendations regarding PPIs would be announced Wednesday at the Orlando conference.

While overall care of heart attack patients in the United States is good, gaps remain in the treatment of patients 80 and older, a new study suggests.

Researchers analyzed 2000-2009 data on 156,677 heart attack patients treated at 416 centers enrolled in the American Heart Association’s “Get With the Guidelines — Coronary Artery Disease” program.

The analysis revealed that 86 percent of patients aged 80 and older received early beta blocker therapy, compared with 90 percent of patients aged 64 or younger. Only 43 percent of patients 80 and older received balloon angioplasty within 90 minutes of hospital arrival, compared with 54 percent of younger patients.

Older patients had a far higher rate of in-hospital deaths (11.8 percent vs. 2.4 percent) and were less likely than younger ones to be taking statins when discharged from hospital (76 percent vs. 92 percent).

Co-existing health conditions were more common in the older patients than in the younger patients, noted Dr. Gregg C. Fonarow of the University of California, Los Angeles Medical Center and colleagues.

The study, to be presented Monday at the American Heart Association’s annual meeting in Orlando, Fla., shows there is room to improve care and outcomes in older heart attack patients, the researchers said.

A new, inexpensive screening method could help reduce the risk for sudden cardiac death among high school athletes, U.S. researchers report.

Athletic trainers at 10 high schools in Houston used a laptop system to perform electrocardiograms (EKGs) on 2,057 student athletes. The results, which were transmitted to a cardiologist, revealed 186 athletes with abnormal EKGs. All but 13 of them received subsequent echocardiograms.

Among the findings:
Three students had serious cardiac conditions, including right ventricular cardiomyopathy, which is abnormal enlargement, thickening or stiffening of heart muscle; coarctation, a narrowing, of the aorta; and non-compaction cardiomyopathy, a rare genetic condition caused by failure of myocardial development during embryo development.
Eight students had Wolff-Parkinson-White syndrome, an electrical defect that can cause arrhythmia. They were referred to pediatricians.
Mitral valve prolapse was detected in 17 students, and six were diagnosed with pulmonary hypertension.
Two students were found to have bicuspid aortic valves, and six had mild to moderate vascular regurgitation.
Three students with hypertension had concentric left ventricular hypertension and were referred for treatment.
Eleven students were told they could not participate in competitive athletics.

Performing EKGs in schools would cost less than $5 per student, and the EKG laptop equipment could be provided to school districts for about $500, according to Dr. Thomas DeBauche, of Cypress Cardiology in Houston.

Though school-based EKG screening would not eliminate sudden cardiac death among high school athletes, it could significantly reduce the risk, the researchers said.

The study was to be presented Sunday at the American Heart Association’s annual meeting, in Orlando, Fla.