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By medpagetoday.com

Head-to-head evaluation of three stroke classification systems showed that all did fairly well, with the major stroke subtypes distinct irrespective of the system used, researchers reported in a study appearing in JAMA Neurology.

The Causative Classification of Stroke (CCS), Trial of Org 10172 in Acute Stroke Treatment (TOAST), and ASCO (A for atherosclerosis, S for small-vessel disease, C for cardiac source, and O for other cause) classification systems had area under the receiver operating characteristic curves for 90-day recurrence of 0.71, 0.61, and 0.66, respectively.

While all had similar discrimination for 90-day mortality, CCS "generates discrete etiologic categories with more diverse clinical, imaging, and prognostic characteristics than either TOAST or ASCO," the researchers noted.

Nevertheless, this validation study says the scales perform "fairly well" overall, so it's reasonable to stick with any of the three, commented Philip Gorelick, MD, MPH, of Michigan State University in Grand Rapids.

Statins Flop As Cancer Tx

Statins' pleiotropic benefits don't extend to cancer, according to the phase III LUNGSTAR trial showing that adding pravastatin to standard chemotherapy didn't improve survival or secondary outcomes in small cell lung cancer.

Despite promising preclinical and observational findings, this is the fifth placebo-controlled trial of statin use in patients with cancer to show no benefit.

"Given the findings from our trial and the other published, double-blind, randomized controlled trials, independent monitoring committees of studies that are still recruiting or in follow-up should examine interim analyses of clinical endpoints and stop early if there is sufficient evidence for futility, thus saving resources," the authors concluded in their paper online in the Journal of Clinical Oncology.

See MedPage Today's coverage here.

A Better Aneurysm Coil

Novel next-generation endovascular coils for treating medium-sized intracranial aneurysms reduced adverse outcomes among patients, according to the randomized GREAT trial reported at the International Stroke Conference.

MicroVention's HydroSoft or HydroFrame coils, filled with a hydrogel that expands upon contact with liquid to increase packing density, reduced the composite rate of major aneurysm recurrence at 18 months, retreatment for major recurrences within 18 months, morbidity that prevented angiographic follow-up, or death by an absolute 8.4% compared with standard platinum coils.

"In the U.S., most patients get the classic coil or the clip," commented Mark Alberts, MD, of Hartford Healthcare in Connecticut. "But this could potentially be an advance."

See the full MedPage Today story here.

Arthritic Heart Woes

Heart attack and rheumatoid arthritis are well known partners in crime, but other types of arthritis are culprits as well, a 25-study meta-analysis reported in the Annals of the Rheumatic Diseases.

MI risk was elevated most with rheumatoid arthritis but also significant for gout (HR 1.47), psoriatic arthritis (HR 1.41), and osteoarthritis (HR 1.31), with a trend seen for ankylosing spondylitis (HR 1.24, 95% CI 0.93-1.65) as well.

"The study findings support more integrated cardiovascular prevention strategies for arthritis populations that target both reducing inflammation and enhancing management of traditional cardiovascular risk factors," the researchers concluded, suggesting that gout and osteoarthritis patients should be monitored and risk factors targeted as is already recommended in the other types of arthritis.

Source: http://www.medpagetoday.com/cardiology/prevention/63560