theHeart.org - Interventional/Surgery

Interventional cardiologist Donald Baim dies

Fri, 06 Nov 2009 18:22:01 EST

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.

Should patients go directly to a PCI-capable hospital? Two studies, different results

Wed, 23 Sep 2009 10:45:51 EDT

One trial showed that despite a mean treatment delay of 67 minutes, STEMI patients undergoing primary PCI taken first to an emergency department before transfer had equivalent rates of major adverse cardiac events when compared with those who presented directly to a PCI facility. A smaller study showed that taking patients directly to the cardiac center resulted in significantly better survival when compared with patients who were transported to an emergency department.

Changing PARTNER: Program tweaks overshadow updates from transcatheter-valve studies

Wed, 23 Sep 2009 09:15:00 EDT

A packed session of interventionalists eager to hear more about long-term safety and efficacy were caught off-guard by news that a new co-primary end point has been added to cohort B.

Senators question Dr Martin Leon's financial links to industry

Tue, 22 Sep 2009 17:15:30 EDT

UPDATED // The letter, from Sens Herb Kohl and Charles Grassley, states that Leon did not fully disclose much of the money he has received from outside companies.

Enoxaparin cheaper than UFH in STEMI patients undergoing thrombolysis?

Tue, 22 Sep 2009 17:15:18 EDT

A new analysis of the EXTRACT-TIMI 25 trial concludes that enoxaparin is slightly cheaper in the long term than unfractionated heparin for STEMI patients undergoing thrombolysis. But there are questions as to why 30-day data and not one-year results were used to model long-term cost-effectiveness.

Mixed start to planned MARVEL trial of post-MI autologous skeletal-myoblast therapy

Tue, 22 Sep 2009 14:00:42 EDT

A pilot analysis suggests the cell therapy can improve functional capacity, but amiodarone may be needed to prevent ventricular arrhythmias; its investigators say they plan to switch gears on the remainder of the study.

Should left main PCI be a class IIa indication?

Tue, 22 Sep 2009 13:15:44 EDT

TCT 2009 kicked off with a discussion on revascularization strategies for left main PCI. Interventionalist Dr Paul Teirstein argues the data are sufficient for left main PCI to be a class IIa indication, upgrading it from the current class III recommendation, but surgeon Dr David Taggart says that CABG is still the preferred revascularization option in the majority of left main patients.

Three-year SPIRIT III results show enduring edge for Xience V over Taxus

Tue, 22 Sep 2009 11:45:00 EDT

Three-year target vessel failure remained statistically lower for the everolimus-eluting Xience V stent (which is also marketed as the Promus) than for the paclitaxel-eluting Taxus stent.

ENDEAVOR IV: Revascularization rates similar for Endeavor and Taxus at three years, with Endeavor "pulling ahead" for safety

Tue, 22 Sep 2009 09:45:47 EDT

Rates of cardiac death and MI actually statistically favor the Endeavor stent at three years, new data show. Stent thrombosis occurred just once after one year for Endeavor, as compared with 11 cases after the one-year mark in the Taxus-treated patients.

Flu vaccine may protect against MI

Mon, 21 Sep 2009 18:30:00 EDT

A protective effect was seen in patients with established cardiovascular disease. Whether vaccination is protective in people with no vascular disease is less clear, a new review suggests.

Coumarin derivatives affect clopidogrel action

Thu, 17 Sep 2009 12:00:47 EDT

Another interaction that may affect the response to clopidogrel has been reported, this time with the coumarin derivative phenprocoumon, an anticoagulant commonly used in Europe.

Yet again, CMS declines to expand carotid-stenting coverage

Thu, 17 Sep 2009 10:00:52 EDT

Hopes for expanded Medicare coverage of carotid-stenting procedures beyond patients at high risk for carotid endarterectomy who have symptomatic carotid artery stenosis >70% have been swatted down by the CMS.

CAD hospitalizations decline, but HF admissions increase

Wed, 16 Sep 2009 15:15:04 EDT

Newly initiated statin therapy after ACS reduces plaque burden within six weeks

Tue, 15 Sep 2009 16:45:07 EDT

Initiating statin therapy following an acute coronary syndrome resulted in a significant reduction in coronary atheroma volume after just six weeks, showing that the lipid-lowering drugs act quickly on atherosclerotic plaques.

Conflicts of interest affect best practices in both industry-funded and non-industry-funded trials

Tue, 15 Sep 2009 12:00:19 EDT

Clinicians and researchers need to be more aware before signing on to studies about what potential conflicts might arise with the sponsor and set the ground rules for such areas as access to data, manuscript preparation, and right to publish.

Omeprazole, but not pantoprazole, inhibits clopidogrel's platelet response

Tue, 15 Sep 2009 11:15:53 EDT

The use of omeprazole significantly reduced the antiplatelet activity of clopidogrel, even with a high maintenance dose of the drug, and other PPIs, such as pantoprazole, should be preferred in clopidogrel-treated patients, according to investigators.

Sponsorship of med-school textbooks in Denmark exposes vulnerable minds to commercial bias

Mon, 14 Sep 2009 11:45:00 EDT

Results of a new survey showed that a surprising 15% of textbooks had one or more drug or device sponsors and, in two cases, those sponsors had tried to influence the content of the textbooks.

Spin not uncommon in negative RCTs, study shows

Mon, 14 Sep 2009 11:30:00 EDT

French researchers who systematically quantified the prevalence of spin across 72 negative randomized controlled trials say half of the studies put a positive spin on the negative findings in the conclusion sections of the papers.

US cardiologists in short supply; problem could get worse

Fri, 11 Sep 2009 13:15:22 EDT

The US is short roughly 1600 general cardiologists and 2000 interventional cardiologists. The problem is expected to get worse unless the shortage is addressed, according to an ACC task force.

Homocysteine lowering cuts mortality in early-onset CAD patients

Fri, 11 Sep 2009 12:00:04 EDT

A new Israeli study finds that treatment with folic acid/B vitamins long term did significantly reduce mortality, but only in those with elevated homocysteine levels at baseline.

Ghost authorship on the wane, but guest authorship still common

Fri, 11 Sep 2009 11:00:38 EDT

UPDATED // Compared with a 1996 survey by JAMA editors, a 2008 survey indicates that the practice of having ghost writers pen papers, then not appear as authors, is down to 8%, from 12% in 1996. The practice of inviting a prominent name to appear in the list of authors, without requiring that person to contribute to the research, has held steady at roughly 20%.

Cardiac CT protocol identifies perfusion defects, stenoses

Thu, 10 Sep 2009 15:30:20 EDT

The combined protocol is still considered investigational but suggests that cardiac CT has a potential role in myocardial perfusion imaging for the detection of myocardial ischemia as well as providing information on coronary stenoses.

MIST correction published; no new information on disputed echo review for PFO/migraine trial

Wed, 09 Sep 2009 14:30:44 EDT

UPDATED // The correction in Circulation runs over 700 words long, with a four-page data supplement, but includes no details on residual-shunt data allegedly obtained with an "off-protocol" review of the echocardiographic results.

New ESC guidelines on infective endocarditis

Wed, 09 Sep 2009 09:45:03 EDT

The ESC issues new recommendations on the prevention, diagnosis, and treatment of infective endocarditis—"an old but changing disease." The guidance with respect to antibiotic prophylaxis is similar to US advice, experts say.

UK NICE recommends limited role for prasugrel

Tue, 08 Sep 2009 14:00:15 EDT

The UK agency that governs reimbursement advises that prasugrel can be used in those ACS patients undergoing PCI who have STEMI, who are diabetic, or who have had a stent thrombosis on clopidogrel.

Manual thrombectomy during PCI for STEMI improves survival: ATTEMPT

Tue, 08 Sep 2009 10:30:51 EDT

Thrombectomy with manual thrombus-aspirating catheters significantly improved one-year survival in STEMI patients undergoing PCI in a pooled analysis of 11 randomized trials.