theHeart.org - Interventional/Surgery

Sen Grassley questions top medical schools about ghostwriting

Fri, 20 Nov 2009 13:15:28 EST

As part of his mission to see more financial transparency in medicine, Sen Grassley has asked eight top US medical schools about their policies on ghostwriting.

Stroke incidence related to PCI steady over 15 years

Fri, 20 Nov 2009 13:00:13 EST

Mayo Clinic researchers report that their stroke rate related to PCI has stayed steady for the last 15 years, something they interpret as good news, given that substantially older, sicker patients with more complex anatomy are now undergoing PCI.

Oral anticoagulants REDEEMed? Daily dabigatran "safe" with dual antiplatelets after MI

Thu, 19 Nov 2009 11:00:11 EST

A dose-finding study saw what were characterized as low bleeding rates associated with triple-drug antithrombotic therapy that included the oral anticoagulant dabigatran in patients with a recent ACS event and other cardiovascular risk factors.

EFFECT: Public reporting of hospital performance improves quality of care?

Thu, 19 Nov 2009 10:00:55 EST

Publicly released report cards based on hospital performance did not result in a measurably greater systemwide improvement in two composite AMI or CHF process-of-care indicators in a Canadian study. But they did appear to stimulate some important changes in delivery of care that could have led to some better outcomes.

BARI 2D cost-effectiveness analysis favors medication over PCI for less severe CVD in diabetic patients

Wed, 18 Nov 2009 15:45:07 EST

New data from the BARI 2D trial comparing medical therapy vs revascularization in diabetics shows higher up-front costs of revascularization are only partially offset by long-term savings.

Ticagrelor effects unraveled in new phase 2 trials

Wed, 18 Nov 2009 15:00:52 EST

New and unique phase 2 data add to the growing body of evidence explaining the pharmacologic effects of the new antiplatelet agent ticagrelor.

Baseline function data from STICH no help in pinpointing patients who benefit from SVR

Wed, 18 Nov 2009 10:45:20 EST

Measures of left ventricular dysfunction or wall motion identified by different imaging modalities at baseline offer no clues as to whether a subset of patients treated with surgical ventricular reconstruction might benefit from the procedure.

ACC/AHA focused update of guidelines for STEMI, PCI

Wed, 18 Nov 2009 09:00:00 EST

The latest evidence for the treatment of STEMI and PCI has been incorporated into a fast-track update of US guidelines. But questions remain about the quality of some of the evidence informing the guidelines and about the composition of the writing committees.

POPE: No benefit of diclofenac on pericardial effusion

Tue, 17 Nov 2009 10:00:33 EST

Mean pericardial effusion grade postcardiac surgery was not reduced with 14 days of treatment with the NSAID.

CASCADE: No significant benefit of clopidogrel in reducing graft disease after CABG

Tue, 17 Nov 2009 09:00:24 EST

Dual antiplatelet therapy did not significantly reduce vein graft intimal hyperplasia compared with aspirin alone over 12 months.

HeartMate II continuous-flow VAD sets new benchmark in destination-therapy trial

Tue, 17 Nov 2009 08:00:00 EST

UPDATED WITH COMMENTARY // Thoratec's HeartMate II continuous-flow VAD keeps about half of patients alive and stroke- or reintervention-free after two years in pivotal destination therapy trial.

Bypassing the blues: How simple collaborative care can help tackle depression after CABG surgery

Mon, 16 Nov 2009 18:45:23 EST

Depression after coronary artery bypass surgery is often overlooked by physicians but is associated with worse outcomes. A new US study illustrates a simple telephone-based approach to tackle this, with nurses encouraging patients to seek help from their primary-care doctors and providing ongoing feedback and review.

Postop anemia in high-CV-risk patients: No CV gains from fixed hemoglobin target in trial

Mon, 16 Nov 2009 17:45:01 EST

A randomized trial found no protection from in-hospital cardiovascular events with a strategy of blood transfusions to maintain hemoglobin above 10 g/dL, compared with a more conservative approach to transfusion therapy, in patients with CV disease or risk factors who underwent hip surgery.

Massachusetts data show similar STEMI PCI outcomes in hospitals with or without surgery

Mon, 16 Nov 2009 16:15:48 EST

Data from a Massachusetts registry add to the growing evidence that hospitals without bypass-surgery capabilities can match the acute coronary intervention outcomes of surgery-on-site centers.

Cangrelor in CHAMPION: What went wrong?

Mon, 16 Nov 2009 15:15:27 EST

Discussion is abounding on why cangrelor did not show benefit over clopidogrel despite the fact that it did inhibit platelet activity more effectively.

Good news continues for ticagrelor in PLATO STEMI subanalysis

Sun, 15 Nov 2009 19:30:00 EST

Ticagrelor, an investigational antiplatelet agent, may become a new standard of care for the management of patients with STEMI heading for primary PCI, said the lead investigator of the STEMI subset of the PLATO trial. Reporting the new findings here today, he said they were consistent with the overall PLATO results.

POPULARity contest: For platelet function assays, what works, what doesn't

Sun, 15 Nov 2009 14:15:02 EST

None of the eight platelet assays studied were able to predict bleeding, but four of the eight, based on ADP-induced platelet aggregation, produced results that correlated with adverse CV outcomes. By contrast, four tests that use shear-stress-induced adhesion-based methods were not predictive.

PEPCAD-3: Paclitaxel-coated-balloon/stent system misses mark in de novo coronary lesions

Sun, 15 Nov 2009 10:30:25 EST

Inflation of the paclitaxel-delivering balloon followed by a bare-metal stent failed a randomized noninferiority test against the Cypher sirolimus-eluting stent in previously untreated coronary lesions.

FRANCE: Transcatheter-valve registry permits "observation" of CoreValve, Sapien differences

Sun, 15 Nov 2009 09:45:44 EST

Results from one of the first registries to evaluate contemporary use of both the Edwards Sapien transcatheter valve and the CoreValve bioprosthesis show that complication rates are low and similar, following a short training period, and that mortality, at least out to six months, is "acceptable" for both types of devices.

Two-year EXPIRA results suggest mechanical aspiration with primary PCI may reduce mortality

Sun, 15 Nov 2009 09:00:03 EST

Two-year follow-up results from the EXPIRA study show mechanical thrombectomy during primary PCI improves myocardial perfusion and may reduce mortality.

Experienced operators can switch easily and rapidly to radial-access PCI: RAPTOR

Sun, 15 Nov 2009 08:30:00 EST

Experienced interventional cardiologists can rapidly shift their practice from the femoral-artery to the radial-access approach, with no increase in procedure time and radiation exposure for PCI. Also, the transradial approach leads to a more economic use of hospital resources, say researchers.

CHAMPION: Negative trials but some positive angles for cangrelor?

Sun, 15 Nov 2009 08:00:00 EST

Although neither CHAMPION-PCI nor CHAMPION-PLATFORM showed significant reductions in the primary end point with this new IV antiplatelet agent, some positive effects were seen, suggesting that the drug may yet have a future.

SGR repair bill failure could cool physician support for healthcare reform

Thu, 12 Nov 2009 15:00:58 EST

Now that the US House of Representatives has passed a healthcare reform bill, organized medicine anticipates another vote—possibly next week—on a second bill that would rewrite Medicare's controversial sustainable-growth-rate formula for physician reimbursement.

DES fractures occur more often than thought

Thu, 12 Nov 2009 13:15:57 EST

A new postmortem study using high-resolution imaging has found that fractures in drug-eluting stents may be more common than thought. However, the majority of such fractures appear to be low-grade and silent, with likely few clinical implications, say the researchers.

ASTRAL finds no benefit of revascularization over medical therapy alone for renal-artery stenosis

Wed, 11 Nov 2009 17:00:00 EST

Percutaneous revascularization of atherosclerotic renal arteries improves patency, but its benefits on renal function have been evaluated only in small studies. The 806-patient ASTRAL trial found no evidence of benefit from revascularization.

Regions with high rates of carotid-stenting adoption have poorer outcomes

Wed, 11 Nov 2009 11:15:28 EST

Results from a new study suggest that, as the use of carotid artery stenting has become more widespread following expanded Medicare coverage, overall revascularization outcomes have worsened.

What's going to be hot at AHA 2009?

Wed, 11 Nov 2009 09:00:54 EST

Anticipation is building for full trial results from ARBITER 6-HALTS, plus a better understanding of what went wrong with cangrelor in the CHAMPION trials. Also in the lineup are updates from PLATO, RE-LY, ALLHAT, BARI 2D, STICH, CASCADE, POPULAR, HEARTMATE II, and many more. Indeed, this year's "late-breaking" sessions include more than 30 trials over five days.

Clopidogrel effects in men vs women

Tue, 10 Nov 2009 16:15:59 EST

A new meta-analysis has suggested that clopidogrel reduces cardiovascular events and increases bleeding in both men and women, without significant differences between the sexes.

Class I recall of CardioVations EndoClamp catheters

Tue, 10 Nov 2009 12:45:21 EST

Edwards's September 24 recall of balloon catheters used in bypass surgery has been categorized as a class I recall by the FDA.

Interventional cardiologist Donald Baim dies

Fri, 06 Nov 2009 18:22:01 EST

UPDATED // Interventional cardiologist Dr Donald Baim, chief medical and scientific officer at Boston Scientific, has died.

Latest European and US STEMI guidelines compared and contrasted

Fri, 06 Nov 2009 17:15:26 EST

The latest recommendations for the treatment of ST-elevation MI issued by American cardiology associations and the European Society of Cardiology are compared and contrasted in a new paper.

Off-pump CABG shows no benefit over on-pump approach: ROOBY study

Wed, 04 Nov 2009 17:00:00 EST

A 2203-patient randomized trial of off-pump vs on-pump CABG surgery found no differences in neuropsychological outcomes and worse overall outcomes for the off-pump group at one-year follow-up.

VELETI in print: Plaque sealing of SVGs a strategy "ahead of its time"?

Wed, 04 Nov 2009 15:30:23 EST

The imaging study was the first to show that stenting a non-flow-limiting stenosis of an SVG may help slow or halt the accelerated atherosclerosis that takes place in these vessels. An accompanying editorial cautions that the study does little more than "infer a trend toward anatomic benefit."

No CV risk reduction with B vitamins posttransplant

Wed, 04 Nov 2009 13:15:27 EST

In keeping with all the other evidence showing no effects of homocysteine-lowering with B vitamins, the FAVORIT study now confirms that this lack of benefit is also seen in renal-transplant recipients.

Interventional cardiologist sues hospital under Whistleblower's Act

Tue, 03 Nov 2009 15:15:34 EST

Dr David Gossman has filed a lawsuit claiming that he was fired for complaining about ties between the hospital and some of its senior staff with the medical device company Medtronic.

US updates advice on perioperative beta-blocker use in noncardiac surgery

Tue, 03 Nov 2009 14:30:32 EST

A US update on the perioperative use of beta blockers for noncardiac surgery is, says the lead author, "similar" to recent European guidance on this issue.

Blood type of pig may be factor in longevity of porcine replacement heart valves

Fri, 30 Oct 2009 16:45:00 EDT

Researchers in Ottawa find that the longevity of porcine replacement heart valves may depend partly on whether the blood type of the patient matches the blood type of the valve's "original owner."

Underutilization of ICDs in CABG patients is worst in women and elderly, Halifax study shows

Wed, 28 Oct 2009 16:45:37 EDT

Only 101 of 1169 post-bypass-surgery patients eligible for an ICD got one over a 13-year period in Nova Scotia.

Bariatric surgery fails to reduce risk of MI long term

Wed, 28 Oct 2009 14:30:14 EDT

After a median follow-up of 12 years, MI rates were essentially the same among those treated with surgery and those who received conventional care for weight loss.

Contrary to common belief, women feel same heart-attack symptoms as men

Tue, 27 Oct 2009 14:30:23 EDT

Women and men have the same rates of chest pain and other classic symptoms during ACS, although women are more likely to experience some other symptoms such as jaw and neck pain.

Stent pioneer Julio Palmaz urges DES makers to "learn from mistakes of the past"

Tue, 27 Oct 2009 13:00:38 EDT

Speaking at the 30th anniversary of the GISE Congress, Palmaz said he'd never believed drug elution was the way forward for stents and outlined his theories for why coatings of any kind disrupt the healing properties of metallic coronary stents.

Blood products should be used conservatively in heart-surgery patients, trial shows

Tue, 27 Oct 2009 12:15:25 EDT

Administration of blood products to stable patients post-cardiac surgery increases their risk of death, renal failure, and sepsis, according to new research.

NRMI data raise more questions about PCI in nonsurgery centers

Mon, 26 Oct 2009 13:00:23 EDT

A new analysis of national registry data suggests that the superior outcomes of NSTEMI patients in hospitals with open-heart-surgery capabilities vs those without it are due to their size, procedure volume, and adherence to medication guidelines.

Iloprost prevents contrast-induced nephropathy in high-risk patients undergoing coronary intervention

Wed, 21 Oct 2009 13:00:34 EDT

Intravenously administered iloprost, a prostacyclin analog, may help prevent contrast-induced nephropathy in patients with renal dysfunction undergoing coronary procedures, a new pilot study suggests.

Data from 1.23 million patients confirms warfarin increases mortality in trauma patients

Tue, 20 Oct 2009 13:45:55 EDT

Warfarin use is rising in both older and younger patients. How much does the anticoagulant contribute to the risk of traumatic injuries?

Statin drugs lower costs and complications of aortic surgery

Tue, 20 Oct 2009 11:30:57 EDT

There are significant cost savings with statin therapy before abdominal aortic aneurysm repair, and the complication rate is less than half that of patients who do not receive preop statins.

TYCOON: One year of dual-antiplatelet therapy with DES isn't enough

Mon, 19 Oct 2009 12:45:34 EDT

New results from an Italian registry reopen the question of how long drug-eluting stent recipients should stay on a dual antiplatelet regimen to prevent late thrombosis.

Zero CAC score not 100% reassuring in those presenting to ER with chest pain

Fri, 16 Oct 2009 12:45:08 EDT

In those presenting to the ER with chest pain, a prior zero calcium score cannot completely rule out a coronary obstruction, a new analysis of the MESA study has shown. This is likely due to the presence of soft plaques not detected by calcium screening, the researchers say.

Endovascular repair of aortic aneurysm reduces short-term mortality

Thu, 15 Oct 2009 14:15:51 EDT

The OVER study of abdominal aortic aneurysm shows that endovascular grafting has a lower mortality rate at 30 days than traditional open surgery.

Expert council focuses on left main PCI: Guideline changes suggested

Wed, 14 Oct 2009 14:45:22 EDT

The group argues that the data are substantive enough for left main PCI to be a class IIb indication or even a class IIa indication in selected patients without coexisting multivessel disease. In contrast, the current ACC/AHA guidelines make left main PCI a class III indication unless patients are ineligible for CABG surgery.

Scripps starts routine genetic testing for clopidogrel responsiveness

Wed, 14 Oct 2009 11:00:05 EDT

Scripps Health has announced that it is now offering patients undergoing elective stenting a test for the gene variants associated with an inability to convert clopidogrel to its active metabolite so that antiplatelet therapy can be individualized.

Experts debate bariatric surgery as a cure for diabetes

Thu, 08 Oct 2009 13:15:54 EDT

Under the some-say-misguided term "metabolic" surgery, gastric bypass is now being used in some instances to treat diabetics who are not considered morbidly obese. Experts say the mostly circumstantial evidence on this is intriguing, but prospective data are desperately needed in this group of patients.

Counseling and education fail to reduce prehospital delays in ACS

Tue, 06 Oct 2009 16:00:00 EDT

Even among patients with documented ischemic heart disease, an intensive program of education and counseling about the importance of seeking treatment quickly does not lead to reductions in prehospital delays or increased ambulance use among those experiencing the signs and symptoms of an ACS, a new study shows.

20�000-patient DAPT clinical trial starts enrolling with eight industry sponsors on board

Mon, 05 Oct 2009 16:45:09 EDT

The trial, rumored to cost more than $100 million, is a first for collaboration: eight drug and device companies are backing the trial, along with the FDA. The study is powered to detect a difference in stent thrombosis and major adverse events between patients taking 12 or 30 months of aspirin plus clopidogrel or prasugrel.

Next up: Drug-eluting stents for erectile dysfunction

Fri, 02 Oct 2009 17:45:26 EDT

In what may be the first clinical trial to test a DES in the pudendal artery, investigators at nine sites are looking at whether pudendal stenting is safe and effective in men who have failed PDE-5 inhibitors.

New "principles" on authorship and COI from PhRMA get mixed response

Fri, 02 Oct 2009 12:00:10 EDT

The "Principles on Conduct of Clinical Trials and Communication of Clinical Trial Results" echo recent standards set by medical journal editors, but some observers say the document, which has no penalty component, lacks real teeth.

HORIZONS analysis: 600-mg clopidogrel load preferable in primary PCI

Thu, 01 Oct 2009 16:00:46 EDT

The higher dose was associated with a reduced rate of ischemic events without an increase in bleeding in patients with STEMI undergoing primary PCI.

Pump may not be the culprit in "pump head" after CABG

Wed, 30 Sep 2009 11:15:57 EDT

The decline in cognitive function that is often seen after CABG may not be related to the use of cardiopulmonary bypass or to embolic debris in the bloodstream from the bypass pump, Chinese researchers say.

Kissing-balloon dilatation of side branch not needed with one-stent bifurcation approach

Tue, 29 Sep 2009 16:15:30 EDT

With the one-stent technique for the treatment of bifurcation lesions, the use of routine kissing-balloon dilatation of the side branch does not improve six-month clinical outcomes.

BCIS-1 trial: "Bailout" intra-aortic balloon pump beats elective use in low EF/high-risk patients

Tue, 29 Sep 2009 10:45:47 EDT

The study provides an important answer to a question that has divided some interventionalists. Those who "swear" by IABP use for all high-risk, low-EF patients should rethink their practice. In hypotensive patients and those with cardiogenic shock, IABPs play a key role.

FAUST: Ultrasound guidance improves femoral access in cases of high bifurcation, reduces risk of complication

Tue, 29 Sep 2009 09:45:25 EDT

CORRECTED // A study has found that although ultrasound imaging doesn't seem to improve upon the overall success rate of fluoroscopy-assisted femoral-access PCI, it does seem to facilitate the procedure, reducing the risk of access complications by 59% and doubling the first-pass success rate.

CHARISMA Genomics Substudy links loss-of-function allele and bleeding

Mon, 28 Sep 2009 14:15:11 EDT

Patients who are homozygous for the CYP2C19*2 allele are at increased risk of ischemia but less likely to bleed. Routine genotyping for the variant still isn't recommended.

No relationship between significant carotid stenosis and stroke after cardiac surgery

Mon, 28 Sep 2009 10:00:08 EDT

A large single-center retrospective study finds no association between carotid stenosis and stroke after cardiac surgery. The findings may finally answer the question of whether carotid endarterectomy prior to or during heart surgery provides any benefit.

Reduced bleeding and comparable stent thrombosis with DES and bare-metal stents: HORIZONS-AMI at two years

Fri, 25 Sep 2009 17:55:17 EDT

Two-year data showed significant reductions in bleeding and cardiac mortality in patients treated with bivalirudin when compared with those treated with heparin plus a GP IIb/IIIa inhibitor. In the stent arm of the trial, researchers showed that stent thrombosis rates were equivalent between DES and bare-metal stents, although both rates were high, at 4.1%.

PLATO-Invasive: Impressive ticagrelor results mirror overall trial findings

Fri, 25 Sep 2009 17:30:21 EDT

The prespecified subset analysis helps clarify the performance of the drug in patients managed invasively, including adding new insights into its benefits over both the 300-mg and 600-mg loading doses of clopidogrel.

PROSPECT: Vulnerable lesions lead to unstable angina rather than MI or death

Fri, 25 Sep 2009 14:15:11 EDT

After successful PCI, 20% of patients go on to have a MACE at three years and 12% of patients develop events from nonculprit lesions. PROSPECT investigators say, however, that events from these nonculprit lesions are more likely to be unstable angina or progressive angina, rather than harder events such as MI or cardiac death.

COMPARE: "Real-world" randomized trial favors Xience V over Taxus Libert�

Fri, 25 Sep 2009 08:30:19 EDT

COMPARE is the second of two large randomized controlled trials comparing a Taxus stent with Xience V to show a clear benefit of the newer stent.

Doubling dose of clopidogrel benefits STEMI patients without risk of bleeding

Thu, 24 Sep 2009 17:45:49 EDT

Doubling the dose of clopidogrel reduced the risk of MI and stent thrombosis in STEMI patients without increasing the risk of bleeding. The benefit extended to patients who received a bare-metal stent or a drug-eluting stent.

COGENT: No CV events but significant GI benefits of PPI omeprazole

Thu, 24 Sep 2009 16:30:07 EDT

The randomized controlled trial results should put a stop to alarmist headlines about PPIs blunting efficacy of antiplatelet drugs, experts say. By withholding PPIs, physicians are doing more harm than good, the results suggest.

FAME lives on: FFR results durable at two years

Thu, 24 Sep 2009 14:45:38 EDT

The past few cardiology meetings have included data on the FAME study, and TCT 2009 was no exception. Investigators showed that the one-year and 18-month results were durable out to two years, although some researchers would like to see the study replicated to conclusively prove the added value of fractional flow reserve testing.

SIRTAX LATE: No differences in MACE for first-generation stents at five years

Thu, 24 Sep 2009 08:30:17 EDT

After one year, Cypher had lower rates of death, MI, or repeat PCIs than Taxus in the SIRTAX trial. But four years later, investigators say all differences between the two have disappeared, in part due to more late "catch-up" with the Cypher.

Stent sandwich: First-generation stents equal for Cypher in-stent restenosis

Thu, 24 Sep 2009 07:45:13 EDT

Late lumen loss at one year, the primary end point, was equivalent between the Cypher and Taxus stent at one year among patients with restenosis after initial treatment with the Cypher stent.

SPIRIT IV: Xience V trumps Taxus for clinically driven end points, although diabetic questions linger

Wed, 23 Sep 2009 16:15:24 EDT

UPDATED // Rates of target lesion failure were significantly lower for the everolimus-eluting Xience V stent for the trial as a whole. In diabetic patients only, however, no differences were seen between the two stents.