theHeart.org - Interventional/Surgery

ACC/AHA publishes new performance measures for STEMI patients

Tue, 18 Nov 2008 13:30:16 EST

Differing from guidelines, the new performance measures identify aspects of care with evidence so strong, such as prescribing a statin upon discharge or delivering reperfusion in a timely manner, that every patient should be receiving the same treatment. In other words, "If you're not doing things a certain way, then you're not providing the best care," says one expert. (Masoudi FA et al. J Am Coll Cardiol, Circulation; published online before print November 10, 2008.)

OCT imaging suggests low rates of uncovered/malapposed struts following DES for AMI

Tue, 18 Nov 2008 11:30:36 EST

An OCT study conducted in a subset of HORIZONS-AMI patients suggests that exposed and malapposed stent struts in the setting of AMI are more common with drug-eluting stents than with bare-metal stents but still relatively rare. (American Heart Association 2008 Scientific Sessions.)

APPROACH: Rosiglitazone doesn't affect atherosclerosis progression in diabetics with CV disease

Thu, 13 Nov 2008 15:00:51 EST

The thiazolidinedione, given for 18 months, didn't appear to reverse or slow disease progression compared with the same duration of treatment with a sulfonylurea, according to the IVUS-based study. Investigators point to hints that that rosiglitazone may have slowed atherosclerosis in such patients with longer-established diabetes. (American Heart Association 2008 Scientific Sessions.)

Patients believe elective PCI prevents MI and saves lives, but who's to blame?

Wed, 12 Nov 2008 16:15:39 EST

Two-thirds of patients surveyed after undergoing elective PCI for angina relief said they believed the procedure would save their lives; still more believed they'd avoid a future MI. Experts say patients may not be digesting information appropriately, but doctors are also at fault. Indeed, the majority of patients also said they were not offered any therapy other than PCI. (American Heart Association 2008 Scientific Sessions.)

New meta-analysis of beta blockers in noncardiac surgery: Time to abandon their use, or not?

Wed, 12 Nov 2008 14:00:45 EST

The use of beta blockers perioperatively to prevent cardiovascular events in patients undergoing noncardiac surgery is not justified by current evidence, according to the authors of a new meta-analysis. An update to the guidelines on this issue is under way, says one member of the writing committee, who incidentally does not agree with this overall conclusion. (Bangalore S et al. Lancet; published online before print November 12, 2008. American Heart Association 2008 Scientific Sessions.)

TIMACS: Early invasive management safe in non-ST-elevation ACS, improves outcomes in high-risk cases

Tue, 11 Nov 2008 09:00:04 EST

The findings appear to mandate early intervention in high-risk cases and to support the use of either an early or delayed strategy for patients considered at low to intermediate risk. (American Heart Association 2008 Scientific Sessions.)

Tailoring clopidogrel loading on the basis of responsiveness testing reduces stent thrombosis

Mon, 10 Nov 2008 16:30:03 EST

Investigators who adjusted clopidogrel dose on the basis of VASP index found they could reduce risk of stent thrombosis as well as MACE at 30 days. (American Heart Association 2008 Scientific Sessions.)

Revascularization, MI, and mortality benefits at three years in diabetic patients treated with drug-eluting stents

Mon, 10 Nov 2008 15:45:32 EST

The results highlight the preserved efficacy of drug-eluting stents observed in other randomized trials and also point to no increased safety concerns in long-term follow-up. Investigators say drug-eluting stents should be favored over bare-metal stents on a patient-by-patient basis, with their ability to take dual antiplatelet therapy the primary caveat. (Garg P et al. Circulation; published online before print November 10, 2008. American Heart Association 2008 Scientific Sessions.)

Registry: Cardiogenic shock rates plunge over decade thanks to PCI, statins

Thu, 06 Nov 2008 16:45:15 EST

The 75% drop in how often ACS patients develop shock during hospitalization accounted for almost all the difference in a Swiss registry study; the ranks of those presenting already in shock didn't change. (Jeger RV et al. Ann Intern Med 2008; 149:618-626.)

HF up in recent decades as MI deaths fall

Tue, 04 Nov 2008 11:45:04 EST

A decline in deaths from MI in recent decades appears to have been accompanied by an increase in the incidence of heart failure, according to a new analysis from the Framingham Heart Study. The likely explanation is that sicker patients, who would have died from MI in earlier years, are now surviving but going on to develop HF, say the researchers. (Velagaleti RS et al. Circulation; published online before print October 27, 2008.)

Alain Carpentier spearheads new total artificial heart endeavor

Fri, 31 Oct 2008 08:30:00 EDT

A French start-up company has announced it has received millions of dollars in funding, some from the defense industry, even as other replacement hearts in development globally seem stymied by disappointing long-term results or lack of funds.

Medtronic says it will sell Endeavor with rapid exchange in US

Thu, 30 Oct 2008 16:30:20 EDT

Six-month TRANSFER-AMI data show persistent benefit

Thu, 30 Oct 2008 15:00:00 EDT

Investigators observed persistent trends toward a reduction in reinfarction and say that the data support the 30-day results that showed a benefit of PCI within six hours of fibrinolytic therapy in STEMI patients. (Canadian Cardiovascular Congress 2008.)

Door-to-balloon times of less than 90 minutes possible

Thu, 30 Oct 2008 14:30:20 EDT

A new Mayo Clinic protocol resulted in sustainable and durable improvements for four years. (American College of Emergency Physicians Scientific Assembly 2008,)

Twenty-year aortic bioprosthesis data show good durability and "satisfying outcomes"

Thu, 30 Oct 2008 10:15:04 EDT

New results suggest that while the bioprosthesis may begin to degenerate at around the seven-year mark, valve-related complications are rare, even out to 20 years. (Eichinger WB et al. Ann Thorac Surg 2008; 86:1204-1211.)

Endocarditis twice as likely to kill the elderly

Wed, 29 Oct 2008 18:30:18 EDT

The largest prospective multicenter study of infective endocarditis ever conducted has found that elderly patients with the disease have distinctive characteristics compared with their younger counterparts and that they are twice as likely to die from it. (Durante-Mangoni E et al. Arch Intern Med 2008; 168:2095-2103.)

Endoscopic harvesting of radial artery: Less painful, but approach fails to reduce infections

Wed, 29 Oct 2008 08:45:00 EDT

Endoscopic harvesting of the radial artery for CABG surgery significantly reduces postoperative wound pain and improves patient satisfaction with the cosmetic results, but there was only a trend toward a reduction in wound infection, a new study has shown. (Canadian Cardiovascular Congress 2008.)

Beta blockers up risk of MI, death after noncardiac ops

Tue, 28 Oct 2008 16:00:26 EDT

A new retrospective cohort study has found that those taking beta blockers prior to noncardiac surgery had higher rates of MI and death at 30 days than those not taking beta blockers. The findings are similar to those of the landmark POISE study, says the senior author, although he acknowledges that there are some differences and that the new study has limitations. (Kaafarani HMA et al. Arch Surg 2008; 143:940-944.)

Radial-access PCI reduces major bleeding 73% compared with femoral approach

Mon, 27 Oct 2008 17:00:00 EDT

In addition to the reduction in major bleeding, there were trends toward a reduction in ischemic events, although these did not reach statistical significance. A second study also showed that radial-access PCI in STEMI patients does not compromise reperfusion times. (Canadian Cardiology Congress 2008.)

Promising percutaneous CoreValve data from Europe leave US trialists itching for green light from the FDA

Fri, 24 Oct 2008 18:00:00 EDT

New data from 18 European countries on the fully percutaneous aortic valve speak to low 30-day mortality and improved valve function sustained over the longer term. So why the holdup in the US, where nary a feasibility study has been conducted? (TCT 2008.)

Court lifts injunction that keeps Endeavor from rapid exchange: Medtronic mum on plans

Thu, 23 Oct 2008 09:30:40 EDT

Currently, Endeavor is the only DES in the US that cannot be used with the newer delivery system.

COOL-RCN: Hypothermia does not prevent contrast-induced nephropathy during cath procedures

Tue, 21 Oct 2008 18:00:24 EDT

The COOL-RCN investigators used a catheter that essentially acts as an "intravenous refrigerator," cooling the body from the inside out, but it failed to decrease the risk of acute kidney damage caused by iodinated contrast agents. (TCT 2008.)

New trial results support broader role for carotid stenting, but CMS again refuses to expand Medicare coverageUpdated

Tue, 21 Oct 2008 17:15:42 EDT

Critics say the CMS should have waited for pending publications of the SAPPHIRE, CAPTURE 2, and EXACT data before announcing its decision, especially as new results from PROTECT, EMPIRE, and EPIC indicate that stroke, death, and MI rates are continuing to decline. (TCT 2008.)

PREPARE: Proximal embolic protection with aspiration improves immediate ST-segment resolution

Mon, 20 Oct 2008 17:15:04 EDT

An embolic-protection and aspiration device delivered proximally to the lesion in primary PCI results in better immediate microvascular flow in STEMI patients compared with primary PCI alone. Although the immediate benefits did not hold up over time, investigators believe the early reperfusion will translate into better outcomes. (TCT 2008.)

BBC ONE: Fewer MACE with provisional T-stenting for bifurcations

Fri, 17 Oct 2008 17:30:29 EDT

Provisional T-stenting using the Taxus stent, instead of the crush or culotte techniques, is associated with a lower rate of death, MI, and target vessel failure at one year, results from the BBC ONE trial show. (TCT 2008.)

The devil in the details: Sponsors still mulling nuts and bolts of DAPTUpdated

Fri, 17 Oct 2008 12:30:03 EDT

Device companies contacted by heartwire about their role in the Dual Antiplatelet Therapy Trial say nothing has yet been finalized about trial funding or "in-kind" sponsorship. Hammering out these details may yet jeopardize the $100M DES trial. (TCT 2008.)

Senate committees seek specifics on industry payments to CRF physicians

Fri, 17 Oct 2008 11:30:16 EDT

The request came during the Cardiology Research Foundation's flagship event in the nation's capital, held mere blocks from the Senate offices.

European data raise safety questions about Endeavor stentUpdated

Thu, 16 Oct 2008 16:30:02 EDT

In a comparison with the Cypher stent, SORT-OUT III showed an increased risk of MI and stent thrombosis with the Endeavor zotarolimus-eluting stent at nine months, while two-year registry data suggest an increase risk in all-cause mortality. While everybody urged caution in interpreting the findings, experts say the results are a warning signal. (TCT 2008.)

HORIZONS AMI: Drug-eluting stent safe and effective in the setting of STEMI

Wed, 15 Oct 2008 18:00:00 EDT

In addition to reducing TLR rates at 12 months, the Taxus stent was equivalent to its bare-metal counterpart in terms of major cardiovascular adverse events, including death, MI, stroke, and stent thrombosis, report investigators. (TCT 2008.)

$100M DAPT supplants CODA: Massive DES/dual antiplatelet therapy trial announced at TCT

Wed, 15 Oct 2008 17:00:00 EDT

Eight companies have agreed to sponsor the study, selecting the Harvard Clinical Research Institute to command the 33-month, $100-million dollar study. The announcement effectively shelves CODA, the dual antiplatelet study first proposed by Duke but rejected by the necessary industry funders. (TCT 2008.)

Cheney's AF recurs, electrical defibrillation scheduled

Wed, 15 Oct 2008 13:00:03 EDT

Left main and three-vessel disease subsets from SYNTAX: New answers, more questions

Wed, 15 Oct 2008 12:00:00 EDT

The analyses can be viewed only as "hypothesis generating," since SYNTAX was negative. But the data suggest that in low- or intermediate-risk patients with left main disease, DES and CABG are both "reasonable" options, but in three-vessel disease, only the lowest-risk patients should be considered as candidates for DES instead of surgery. (TCT 2008.)

More than half of stable CAD patients go straight to PCI without stress test

Tue, 14 Oct 2008 18:30:00 EDT

The findings imply not only that some physicians are ignoring guidelines and subjecting patients to a higher-risk treatment than warranted but also that Medicare is spending too much on invasive therapies without first knowing whether an interventional approach is needed, investigators say. (Lin GA et al. JAMA 2008; 300:1765-1773.)

FAME! FFR-guided PCI significantly reduces clinical events

Tue, 14 Oct 2008 17:45:13 EDT

Investigators report that fractional flow reserve-guided PCI reduced the risk of death, MI, or repeat revascularization by 30% and death or MI by 35%, when compared with the current practice of using angiography to guide stenting decisions. (TCT 2008.)

Cypher, Taxus equal in left main disease: ISAR LM

Tue, 14 Oct 2008 14:30:35 EDT

Both types of drug-eluting stents performed similarly in left main subjects, leading to two-year outcomes comparable to those from CABG registries. (TCT 2008.)

Low 30-day and six-month mortality for transfemoral valve implantation in PARTNERS EU and SOURCE

Tue, 14 Oct 2008 09:30:06 EDT

High survival following transcatheter valve placement via the transfemoral approach reflects increased operator skill and lower-risk patients than the transapical arms of the study, experts say. (TCT 2008.)

First-in-human data with novel polymer-coated stent: No thrombosis at 12 months

Mon, 13 Oct 2008 17:15:31 EDT

Investigators reported no cases of stent thrombosis at 12 months in patients implanted with the stent, as well as no adverse clinical events, despite stopping dual antiplatelet therapy at 30 days. (TCT 2008.)

No increased risk, but no MI/mortality benefit with DES, experts cautiously conclude

Mon, 13 Oct 2008 11:45:30 EDT

Leaders of some of the more provocative DES studies in recent years seem to agree that other factors may be contributing to the apparent survival benefit with DES seen in recent registries but that it is at least safe to conclude that risk of death or MI is not increased with their use. But many also argue for a bigger role for bare-metal stents. (TCT 2008.)

Carotid stenting safe and effective with experienced operators, European registry suggests

Mon, 13 Oct 2008 09:15:09 EDT

Investigators caution that the data are preliminary, but the 30-day risk of stroke and death observed in clinical trials is lower when more experienced operators perform the procedure. (TCT 2008.)

New DES on the block: TAXUS Liberté receives FDA approval

Fri, 10 Oct 2008 16:45:00 EDT

NOMAS: Just a 2% overlap for PFO and migraine; St Jude shuts down ESCAPE trial

Thu, 09 Oct 2008 14:30:12 EDT

While both migraine and PFO occurred in roughly 15% of the NOMAS participants, the two were rarely found together. Experts agree: hopes are dimming that PFO closure may help migraineurs. Indeed, only one company is still testing this hypothesis in randomized trials. (Rundek T et al. Circulation 2008; 118:1419-1424.)

Stem cells for AMI: New review finds same old story

Tue, 07 Oct 2008 19:00:00 EDT

A familiar message has emerged from a new review of stem-cell therapy for acute MI—a moderate improvement was seen, but much more research is needed. (Martin-Rendon E et al. Cochrane Database Syst Rev 2008; 4: CD006536. Eur Heart J 2008; 29:1807-1818.)

Questions raised about Northwestern use of valve device; prominent surgeon denies wrongdoing

Tue, 07 Oct 2008 15:30:20 EDT

Dr Patrick McCarthy and Edwards Lifesciences insist that the Myxo ETlogix annuloplasty ring 5100 that McCarthy invented was commercially available at the time it was used in a study describing the "initial experience" with the ring. The circumstances are now the subject of an FDA investigation and the focus of a lawsuit from a patient who says she was never told that McCarthy had invented the device.

Societies confront GI risks of antiplatelets, NSAIDs in consensus document

Tue, 07 Oct 2008 10:00:38 EDT

It addresses a common clinical problem for which there is little clinical-trial-quality data for guidance and gives a starring role to proton-pump inhibitors in treating GI ulcers and bleeding and, in high-risk groups, in their prevention. (Bhatt DL et al. J Am Coll Cardiol; Circulation; published online before print October 3, 2008.)

Elective PCI possible without "safety net" of anticoagulation

Mon, 06 Oct 2008 17:00:00 EDT

Low-risk patients with uncomplicated lesions can have elective PCI safely performed using dual antiplatelet therapy without systemic anticoagulation, according to a new randomized study. An accompanying editorial begs to differ, however. (Stabile E et al. J Am Coll Cardiol 2008; 1293-1298.)

Endovascular AAA repair cost-effective in high-risk patients

Mon, 06 Oct 2008 14:30:05 EDT

The average one-year costs for EVAR and open surgery were nearly identical, despite the significantly more expensive endovascular procedural costs. Patients undergoing endovascular repair spent less time in the hospital, and this reduced morbidity translated into lower nonprocedural costs. (Tarride JE et al. J Vasc Surg 2008; 48:779-787.)

Transapical valve data: Climbing survival rates speak to improved skill, technology, and patient selection

Thu, 02 Oct 2008 11:30:00 EDT

Surgeons say the bleak six-month survival rate of 55% in the preapproval PARTNER EU data set reflects the learning-curve period. Refinements to the technology, growing expertise, and better patient selection are captured in the later SOURCE data set and those of single European centers, where 30-day survival approaches 90%. (European Association for Cardiothoracic Surgery 2008 Meeting.)

Debating PCI-related delays and the management of STEMI patients

Wed, 01 Oct 2008 17:45:10 EDT

Should the ACC/AHA guidelines for the management of STEMI patients extend the acceptable PCI-related delay to as long as 120 minutes? A group of Danish researchers thinks so, but Dr Elliott Antman, who cochaired the writing committee of those guidelines, disagrees. (Terkelsen CJ et al. Antman E. J Am Coll Cardiol 2008; 52:1211-1215, 1216-1221.)

Miniaturized heart pumps: Difference between life and death in small children

Tue, 30 Sep 2008 15:45:10 EDT

Reporting on his own initial experience with a miniaturized ventricular assist device used as a bridge to transplant in small children, a leading pediatric heart surgeon is hoping that the pump—widely available in Europe—will soon be approved for use in the US. (Gandhi SK et al. Circulation 2008; 118:S89-S93.)

Survival post-heart surgery just as good when surgical trainees hold the scalpel, study suggests

Mon, 29 Sep 2008 16:00:00 EDT

Even though trainees were more likely to do higher-risk procedures, their results, in terms of mid-term survival and freedom from cardiac rehospitalizations, were just as good as those of their teachers, a new single-center study shows. (Stoica SC et al. Circulation; published online before print September 29, 2008.)

FDA once again postpones decision on prasugrel

Mon, 29 Sep 2008 09:00:27 EDT

Aortic-valve bypass: A time-tested, minimally invasive alternative to valve-replacement surgery

Fri, 26 Sep 2008 15:00:28 EDT

Authors of a new report say AV bypass was eclipsed by surgical valve replacement, but the prospect of transcatheter valves has refocused interest in the older procedure, which can be used in very high-risk patients and has a number of advantages over percutaneous replacement. (Gammie J et al. Circulation; published online before print September 15, 2008.)

Taxus "Atom" stent approved for small vessels; FDA also okays use in bare-metal-stent restenosis

Thu, 25 Sep 2008 17:30:10 EDT

Two-year Massachusetts registry results support mortality benefit of DES in AMI

Wed, 24 Sep 2008 17:00:00 EDT

Whether the benefits are due to restenosis reduction, the additional months of dual antiplatelet therapy, or other effects of the DES itself are unclear, authors note. (Mauri L et al. N Engl J Med 2008; 359:1330-1342.)

Poor and Medicaid recipients with MI have longest prehospital delays

Wed, 24 Sep 2008 13:45:26 EDT

New research shows that those with Medicaid insurance and those living in low-income neighborhoods are less likely than their better-off counterparts to get to the hospital quickly after an acute MI. This adds to prior studies that have shown that race, sex, age, and comorbid conditions can influence the time taken to get to the hospital following AMI. (Foraker RE et al. Arch Intern Med 2008; 168:1874-1879.)