Interventional & Surgery news, trials, articles & opinions | theheart.org

COMFORTABLE-AMI: Bioerodable polymer DES trumps bare metal in STEMI

Wed, 16 May 2012 10:50:23 EDT

The trial is the first randomized controlled trial to show a safety advantage of a DES, investigators say.

COMPARE II: Nobori biolimus stent matches everolimus stents in all-comers

Wed, 16 May 2012 10:15:12 EDT

While equal to the market-leading Xience/Promus stents in terms of efficacy and safety, the Nobori failed to show an edge where many hope stents with bioerodable polymers will have their niche—in reducing stent thrombosis.

TAVI to treat surgical valve failure shows potential, with caveats

Tue, 15 May 2012 13:00:30 EDT

The largest series to date looking at use of a transcatheter valve to treat the failure of a surgically implanted prosthetic has found high rates of survival at one year, but enough in the way of safety signals that investigators are cautioning against widespread use of the practice.

Without warfarin, Watchman still prevents strokes, says registry

Tue, 15 May 2012 10:15:50 EDT

Patients with AF implanted with the left atrial appendage occluder in the earlier PROTECT-AF trial took warfarin the first six weeks; but in warfarin-contraindicated patients, Watchman still protects against stroke, suggests an observational study.

FAME II: FFR pinpoints stable CAD patients who fare worse with OMT

Tue, 15 May 2012 09:00:00 EDT

Preliminary data showing urgent revascularizations to be more than 10 times higher in patients treated with optimal medical therapy instead of PCI were what prompted the data safety and monitoring board to halt FAME II.

High percentage of New York state PCI cases are for indications of uncertain appropriateness

Mon, 14 May 2012 16:00:00 EDT

Since recent studies have found wide variation from center to center in the percentage of revascularizations categorized as appropriate by the national appropriate-use criteria, researchers in New York state looked at the registries in their state to see how often bypass surgery and coronary interventions conform to these national guidelines.

New angiography appropriateness criteria are SCAI's latest "quality tool"

Sun, 13 May 2012 16:30:35 EDT

A multisociety group led by the ACC and SCAI has released new appropriate-use criteria for diagnostic catheterization intended to help clinicians determine when cardiac catheterization is a reasonable option for the evaluation of patients.

Data gathering for Sunshine Act delayed

Fri, 11 May 2012 17:15:19 EDT

The CMS says that drug and device makers will not have to start collecting data on payments to physicians until 2013.

Ixmyelocel-T cell therapy may help DCM patients

Fri, 11 May 2012 14:00:28 EDT

Cell therapy could be an attractive adjunct for patients with ongoing heart-failure symptoms despite optimal medical and device therapy. A new study shows that a therapy derived from the patient's own bone-marrow cells could fill this role.

Taking STEMI patients to PCI hospitals saves time and lives

Fri, 11 May 2012 12:45:16 EDT

A new study has found that patients taken directly to a PCI hospital were reperfused an average of 31 minutes faster than patients first taken to a hospital without PCI capability, which was associated with a possible mortality reduction.

Riata revelations: ICD lead failure rates, mechanisms take HRS center stage

Fri, 11 May 2012 10:30:34 EDT

Next chapter in the Riata recall story: how often do the leads fail, and why? In one of many Riata-related presentations at the Heart Rhythm Society meeting, the rate was about 2% per patient year. Why is less easily determined.

Robots set to invade interventional world

Fri, 11 May 2012 10:15:27 EDT

Robotic control devices have become an established part of the surgical field, enabling procedures to be less invasive than ever before. Can the same technology make an impact in coronary interventions?

Femoral vs radial access: Rivals or complements?

Thu, 10 May 2012 17:00:35 EDT

Over the past few years, transradial coronary interventional access has gone from a small niche to one of the dominant topics at the SCAI annual meeting. Do the results of the RIVAL trial mean this technique completely supplants the traditional transfemoral approach?

Mark Midei's appeal for license reinstatement denied

Tue, 08 May 2012 12:50:05 EDT

A Maryland judge has turned down Dr Mark Midei's appeal to get back his Maryland medical license.

WHF defends Dubai WCC, reimburses Israelis denied visas

Fri, 04 May 2012 13:35:21 EDT

The World Heart Federation is apologizing to Israeli cardiologists who, at the last minute, were denied visas to attend the WCC 2012 in Dubai. One of the Israelis who attended, however, has spoken out to clarify that he and his colleagues "only have good words to say" about their visit to the Emirate city.

More adverse events seen on dabigatran vs warfarin

Fri, 04 May 2012 13:15:32 EDT

UPDATED // A new study in patents switched from warfarin to dabigatran has shown a high rate of events necessitating discontinuation of the new drug.

Bypass moderate coronary lesions? Taking sides in the debate

Fri, 04 May 2012 11:30:07 EDT

When is it worth bypassing moderate coronary lesions? In the pathophysiology of CAD progression, as in politics, whether right or left seems to make a difference.

Some valve patients are too sick for TAVI or surgery

Wed, 02 May 2012 17:40:11 EDT

Most of the discussion of PARTNER trial and early rollout of transcatheter valves focused on differentiating TAVI candidates from patients better suited to surgical valve replacement. While experts continue to be alarmed by the number of relatively low-risk patients getting TAVI in some countries, they're also drawing attention to the number of TAVI procedures in patients who are too sick to benefit from any valve replacement.

Lives, money saved by protocol-guided transfusion use at cardiac surgery

Wed, 02 May 2012 16:00:08 EDT

The bottom line can benefit, if clinical gains aren't enough reason for wide-scale implementation of guidelines for blood-product use with cardiac surgery.

CMS restricts TAVI coverage to experienced operators

Tue, 01 May 2012 17:20:15 EDT

UPDATED // The coverage policy, which largely echoes the draft decision released in February, emphasizes the importance of the "heart-team" approach, in which surgeons and interventionalists collaborate on valve-repair decisions.

Older LVAD risk score not effective in current era

Tue, 01 May 2012 14:30:34 EDT

The destination therapy risk score provided poor discrimination of mortality for LVAD patients receiving the device as a bridge to transplant and modest discrimination for patients who receive LVADs as destination therapy.

CURE-AF: Success up as LA size declines for RF ablation at cardiac surgery

Tue, 01 May 2012 13:15:05 EDT

But arguably the trial's most important results, according to one expert, underscored a key difficulty in studying surgical procedures.

Beware valve involvement in device-related infective endocarditis

Fri, 27 Apr 2012 17:00:42 EDT

A number of factors were related to higher mortality, but all seemed to have a common thread, in a large international study of infective endocarditis associated with implanted devices.

DES or bare-metal stents for primary PCI? New meta-analysis provokes debate

Thu, 26 Apr 2012 13:30:38 EDT

UPDATED // Long-term outcomes with first-generation drug-eluting stents in primary PCI for STEMI show that they have benefits over and above bare-metal stents, say the authors of a new meta-analysis. But an accompanying editorialist is not so sure.

CARGO 2: AlloMap transplant-rejection test works in Europe

Tue, 24 Apr 2012 17:00:38 EDT

Researchers hope the findings will lead to wider European use of the gene-expressing profiling test, which they say could mean fewer surveillance endomyocardial biopsies.

Topol is most influential physician executive in new US poll

Tue, 24 Apr 2012 12:00:09 EDT

Dr Eric Topol, editor in chief of theheart.org, has been voted the number one most influential physician executive of 2012 in a poll run by Modern Healthcare, a US publication covering healthcare business news and research.

Court dismisses Mark Midei's defamation suit

Tue, 24 Apr 2012 10:00:43 EDT

The Baltimore Sun is reporting that Midei's suit against St Joseph Medical Center and its parent organization—seeking $60 million in compensation, plus up to $540 million in other costs and damages—has been dismissed.

Statin therapy prior to CABG reduces the risk of postoperative AF

Fri, 20 Apr 2012 16:45:43 EDT

Despite the findings, investigators are cautious in their interpretation of the results, noting that patients primarily were treated with atorvastatin and mainly underwent coronary artery bypass graft surgery, making extrapolations to other statins and different types of cardiac surgery difficult.

Marked gender disparities in CVD treatment, outcomes seen in CREATE registry

Thu, 19 Apr 2012 02:00:00 EDT

Not only are women experiencing ACS in India less likely to receive appropriate care, they are also more likely to die following treatment, a new analysis shows.

Endovascular AAA repair safer than open repair in the long run, Medicare data show

Wed, 18 Apr 2012 17:15:57 EDT

Endovascular abdominal aortic aneurysm repair reduced 30-day and in-hospital mortality in randomized controlled trials compared with open surgical repair but has not been shown to improve long-term survival. A new study looks at Medicare data to compare the long-term outcomes of the endovascular and open repair of intact AAAs.

Tough sell: WCC 2012 course coaxes trainees toward preventive cardiology

Wed, 18 Apr 2012 09:15:57 EDT

How to convince young doctors to get involved in CVD prevention, when other areas of cardiology are so alluring—and more lucrative? That's a central conundrum underpinning a trainee course that kicked off this year's meeting, in a region where soaring CV risk factors make it a life-and-death question.

Igaki-Tamai stent safe out to 10 years

Mon, 16 Apr 2012 17:15:35 EDT

Long-term data of 50 patients treated with the first fully bioabsorbable stent implanted in the coronary arteries shows the stent to be safe out to 10 years and associated with MACE rates similar to those of bare-metal stents.

Maryland set to establish independent review system for PCI

Mon, 16 Apr 2012 16:45:13 EDT

The Maryland chapter of the ACC has successfully lobbied the state's legislature to improve oversight of cath labs in the state, although the bill does not include the accreditation requirements the group sought last year.

Abiomed's newest Impella pump earns CE Mark

Thu, 12 Apr 2012 17:00:09 EDT

Abiomed has announced that its Impella cVAD temporary circulatory support device has been approved for sale in Europe.

Hospitals launch medical practices to lure well-insured

Tue, 10 Apr 2012 16:00:00 EDT

America's hospitals are busier than ever expanding into new and affluent geographic markets to lure well-insured patients, a strategy that could drive up costs as well as jeopardize independent physician practices, according to a new study.

PCI bests meds in stable CAD, but message is "do better meds"

Thu, 05 Apr 2012 18:30:00 EDT

Is optimal medical therapy a pipe dream, at least right now? An analysis of clinical-practice data from NY State reopens the COURAGE-oriented debate.

Incomplete revascularization makes for worse outcomes out to one year

Thu, 05 Apr 2012 16:00:09 EDT

The residual SYNTAX score, which is derived from the SYNTAX score used to assess coronary anatomic severity and complexity and calculated after coronary revascularization, was a strong predictor of mortality, MI, and ischemic target lesion revascularization, report investigators.

Dr Gary Gibbons named director of the NHLBI

Thu, 05 Apr 2012 11:30:00 EDT

Currently at the Morehouse School of Medicine in Atlanta, Gibbons will begin his new role as director of the NHLBI this summer. He is taking over for Dr Susan Shurin, who was named acting director after Dr Elizabeth Nabel left in January 2010.

Mitral regurgitation: Early hazard, later gains following TAVI

Wed, 04 Apr 2012 17:00:00 EDT

Mortality in the first 30 days is higher among patients with moderate to severe mitral regurgitation undergoing transcatheter valve implantation. After the first month, however, MR tends to be diminished, supporting a role for TAVI in this high-risk group.

Medical societies list 45 dubious tests, therapies

Wed, 04 Apr 2012 16:00:00 EDT

The American College of Cardiology is one of nine societies that each identified five tests and procedures that are common but often unnecessary, running up the cost of care and sometimes harming a patient's health.

heartwire's Lisa Nainggolan picks up AHCJ award

Wed, 04 Apr 2012 14:15:00 EDT

Nainggolan's feature story "Lost in transition: The looming epidemic of grown-up congenital heart disease" has placed third in the Association of Health Care Journalists' annual journalism awards in the trade-publication category.

St Jude stops sales of CRT leads with possible insulation problem

Wed, 04 Apr 2012 13:15:00 EDT

St Jude Medical is warning physicians to look out for externalized conductors on some of its QuickSite and QuickFlex CRT leads and will stop selling the models possibly affected by this issue.

Sleep-deprived doctors safely perform PCI in small, single-center study

Wed, 04 Apr 2012 13:00:00 EDT

In this single-center study, researchers did not find any evidence that middle-of-the-night procedures adversely affect the safety and efficacy of PCIs performed the next day by the same operator.

Statin therapy changes plaque composition fast

Tue, 03 Apr 2012 17:15:00 EDT

Some studies have shown that statin therapy can cause nonatherosclerotic coronary plaques to regress, so the YELLOW trial investigators are trying to determine whether statins can modify the composition and flow physiology of obstructive lesions.

TWENTE published: Resolute matches Xience V stent

Mon, 02 Apr 2012 16:00:00 EDT

The Resolute zotarolimus-eluting stent was shown to be noninferior to the Xience everolimus-eluting stent in the treatment of "real-world" patients with complex lesions and when used for off-label indications.

Arrhythmic risk can stay elevated even after improved LVEF

Mon, 02 Apr 2012 15:00:59 EDT

Could an LVEF that has risen above 35% since ICD implantation indicate less need for a replacement device?

Low BMI may up complication, mortality risk at ICD implantation

Mon, 02 Apr 2012 11:15:52 EDT

Some simple precautions might help prevent the two most common complications that were seen in underweight patients.

Solid four-year safety and efficacy data with biodegradable-polymer DES

Fri, 30 Mar 2012 14:30:15 EDT

Treatment with the biodegradable-polymer drug-eluting stents significantly reduced the risk of target lesion revascularization 18% and stent thrombosis 44% compared with the Cypher stent. The reduction in stent thrombosis was driven by a significant reduction in the risk of very late stent thrombosis.

Riata ICD lead failures: Focus shifts to short-circuit risk

Thu, 29 Mar 2012 13:45:29 EDT

Abraded insulation and exposed cables were only the beginning of the leads' safety issues. They haven't been implanted in well over a year, but lots of people still have them.

RAPID GENE: Point-of-care genetic test singles out clopidogrel nonresponders

Thu, 29 Mar 2012 12:00:42 EDT

Patients in the RAPID GENE test, randomized to undergo point-of-care gene testing, then given prasugrel instead of clopidogrel if found to be carriers of the CYP2C19*2 allele, were significantly less likely to demonstrate high on-treatment platelet reactivity seven days post-PCI.

BCIS-1: IABP associated with a long-term reduction in mortality

Tue, 27 Mar 2012 14:30:52 EDT

Researchers report that the elective use of IABP during PCI was associated with a 34% reduction in the risk of death after a median follow-up of 51 months. They were cautious in interpreting the data, however, noting that further studies are needed to determine if the finding is real.

ASCERT CABG, PCI analysis: Lower mortality with surgery

Tue, 27 Mar 2012 09:00:00 EDT

UPDATED WITH COMMENTARY // Four-year survival was significantly better with bypass surgery than PCI for patients with two- and three-vessel stable CAD. Did the analysis adequately control for risk, or does that miss the point?

IMMEDIATE: EMS-given GIK fails to slow unstable angina's march to MI

Tue, 27 Mar 2012 09:00:00 EDT

UPDATED WITH COMMENTARY // Out-of-hospital glucose-insulin-potassium, administered by emergency medical services in the first hours of a suspected ACS event, failed to reduce the progression of unstable angina to MI and was not associated with an improvement in 30-day survival rates. Still, the researchers are excited that GIK reduced infarct size and don't think that GIK should be abandoned just yet.

EINSTEIN PE: Rivaroxaban equals standard therapy, halves major bleeding

Mon, 26 Mar 2012 15:00:17 EDT

The new oral factor Xa inhibitor rivaroxaban proved equivalent to standard care of LMWH plus vitamin-K antagonist for the treatment of acute pulmonary embolism in the EINSTEIN PE study reported today. The new drug also halved major bleeds, in particular the troublesome intracranial hemorrhage, said the investigator. Commentators said they eagerly await cost-effectiveness data.

STAMPEDE: Bariatric surgery betters standard diabetes treatment in the obese

Mon, 26 Mar 2012 11:30:00 EDT

UPDATED // Findings from two randomized trials showed that bariatric surgery was considerably better than traditional medical therapy for controlling type 2 diabetes in obese patients, independent of weight loss. But critics caution that much longer-term data are needed—to show actual changes in the serious complications of diabetes in years to come—before this "huge intervention" can be considered as a valid treatment for the condition.

Transcatheter valves in inoperable patients at two years: PARTNER B

Mon, 26 Mar 2012 09:00:00 EDT

Two-year outcomes in the PARTNER B trial, testing transcatheter aortic-valve replacement against best medical care in inoperable patients, have now been published.

PARTNER A: Even mild paravalvular leaks linked with higher mortality at two years

Mon, 26 Mar 2012 09:00:00 EDT

UPDATED // A phenomenon virtually unheard of in the surgical valve-replacement era, paravalvular leaks were linked with higher mortality, although overall mortality rates were no different between surgery- and TAVR-treated patients. Investigators are calling paravalvular regurgitation a new "target" that could potentially further improve TAVI results.

CORONARY: Off-pump and on-pump CABG give similar short-term outcomes

Mon, 26 Mar 2012 09:00:00 EDT

The largest study ever to compare the two techniques has shown similar 30-day results for the primary end point. Differences in secondary end points may drive decisions on an individual basis until long-term results are available, suggests the lead author.

MI in pregnancy "a different entity"

Mon, 26 Mar 2012 07:30:14 EDT

MI in pregnancy or in the postpartum period creates a host of issues that are different from a conventional heart attack, data from a new survey of such cases show.

Renal-denervation debate centers on response time

Sun, 25 Mar 2012 19:30:00 EDT

CORRECTED // A session updating attendees on the latest findings from studies on renal denervation for severe resistant hypertension attracted much attention today.

BRIDGE ACS: Quality initiative leads to more evidence-based ACS care

Sun, 25 Mar 2012 09:00:00 EDT

BRIDGE-ACS evaluated how a coordinated education strategy could improve the Brazilian hospitals' adherence to evidence-based medicine for acute coronary syndromes.

C-PORT E nine-month results: Elective PCI doesn't need surgery safety net

Sun, 25 Mar 2012 09:00:00 EDT

UPDATED WITH INTERVIEW // Consistent with the trial's already-reported six-week outcomes, the rate of major adverse complications at nine months was about the same regardless of the presence of on-site cardiac surgery.

INFUSE-AMI: Intracoronary abciximab, not thrombectomy, reduces infarct size

Sun, 25 Mar 2012 09:00:00 EDT

UPDATED WITH COMMENTARY // The intracoronary administration of abciximab delivered to the infarct lesion site resulted in a significant, albeit modest, reduction in infarct size in patients presenting with a large anterior STEMI, new research shows.

TAVI registry updates ADVANCE the field, raise hopes for lower stroke rates

Sat, 24 Mar 2012 16:25:34 EDT

Low stroke rates in two registries tracking outcomes for the two leading transcatheter valves are raising hopes that the cerebrovascular events that concerned people in the pivotal PARTNER trial may not necessarily represent the real-world occurrence of this problem going forward.

Anti-inflammatory bindarit cuts in-stent late loss with bare-metal stents

Sat, 24 Mar 2012 16:00:00 EDT

Although the drug was superior to placebo, investigators say in-stent late loss needs to decline further for bindarit, an anti-inflammatory compound that selectively inhibits monocyte chemotactic proteins, to be valuable in clinical practice.

GIFT exome analysis unearths two new genes related to platelet function

Sat, 24 Mar 2012 15:20:38 EDT

A different kind of genetic analysis, whole exome sequencing, of some of the participants in the GRAVITAS trial has led to the discovery of two new genes believed to be critical to platelet function. This novel approach holds much promise in general for the assessment of response to drugs, says the researcher.

RESET: Three months of DAPT with Endeavor stent safe as conventional DAPT

Sat, 24 Mar 2012 13:45:19 EDT

Treatment with aspirin and thienopyridine therapy for three months with the Endeavor stent was noninferior to standard 12-month dual antiplatelet therapy in patients treated with other DES in terms of the primary end point, a composite of death from cardiovascular causes, MI, stent thrombosis, target vessel revascularization, or bleeding at one year.

TRA 2�P-TIMI 50: Future possible for vorapaxar in patients with prior MI?

Sat, 24 Mar 2012 09:00:00 EDT

UPDATED WITH COMMENTARY // The novel antiplatelet agent may have a net clinical benefit in selected secondary-prevention patients, particularly those with a prior MI without a history of stroke or TIA and who weigh over 60 kg. But many experts not involved in the trial were concerned about the bleeding risk with the drug, with suggestions that it may not be suitable for general availability.

Everolimus DES: Stent-thrombosis advantage vs bare-metal stents in meta-analysis

Fri, 23 Mar 2012 18:45:02 EDT

Stents like the widely used Xience V showed a lower rate at one year and at other time points compared with bare-metal stents and some other drug-eluting stents in 50�000-patient meta-analysis.

Cardiologists are happy(ish), married non-tweeters, survey reveals

Thu, 22 Mar 2012 17:00:00 EDT

Cardiologists, for the most part, drive Japanese cars, believe in a higher power, and are moderately savvy when it comes to social media. Those are just some of the cardiology pearls from a recent "lifestyle survey" of physicians.

Circulating endothelial-cell test may predict plaque ruptures

Wed, 21 Mar 2012 14:00:00 EDT

A group at Scripps Translational Science Institute is developing a blood test that uses circulating endothelial cells to spot a plaque rupture in progress.

Higher death rate with "off-pump" vs "on-pump" CABG: Cochrane review

Tue, 20 Mar 2012 17:30:21 EDT

The authors conclude that CABG should be routinely performed "on pump," and "off-pump" surgery should be reserved for patients with contraindications to aortic cannulation.

Drug-coated balloon reduces restenosis over long term

Mon, 19 Mar 2012 16:00:00 EDT

The paclitaxel-coated balloon showed promise as a treatment for in-stent restenosis in early trials, but whether the results would hold up over the long term was not evident until the release of the five-year follow-up data.

What's going to be hot at ACC 2012

Mon, 19 Mar 2012 14:00:51 EDT

There are 18 late-breaking clinical trials, many addressing unresolved issues with already-approved products or procedures. Outside the main tent, the program offers debates, live and taped cases, a new Q&A series with "legends" in cardiology, plus a novel gambit for attracting attendees to the exposition: a "thought leaders' theater" located in the exhibit hall.