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Coronary Intervention & Surgery

 - question mark, uncertain

Acknowledging there was room for improvement, the authors of PCI appropriate use criteria (AUC) have applied lessons from the last set of guidelines in a revision scheduled for publication this year, a member of the writing committee said.

 - PCI

Cardiovascular Business met with Ajay J. Kirtane, MD, SM, from the Center for Interventional Vascular Therapy and chief academic officer at Columbia University Medical Center in New York City, on March 16, the closing day of the American College of Cardiology scientific session. Here is what he offered as highlights.

 - heart, cardiology, cardiac

Contrary to previous gains with new interventional technology, data suggest that second-generation, everolimus-eluting stents have similar rates of death as CABG. Moreover, PCI with these stents had increased rates of MI and repeat revascularization but a lower rate of stroke. 

 - caution

TOTAL may not totally spell the end of routine manual thrombectomy with PCI, but it should make interventional cardiologists think twice about using it with STEMI patients. The large, international trial showed no clinical benefit and possible harm.

 - clinical trial

Jeffrey Cavendish, MD, of Kaiser Permanente in San Diego, shared his impressions of the first day of the American College of Cardiology’s (ACC) scientific session with Cardiovascular Business. His highlights touch on three Ps: prevention, PROMISE and PEGASUS.

 

More Stories

Guideline-based therapy may be underutilized following PCI, CABG

Rates of optimal care following PCI or CABG surgery were uncomfortably low, according to a study published online Feb. 24 in Circulation. The analysis revealed that by five years of follow-up, only around a third of patients in either group were receiving guideline-based therapies.

Worth stressing? Anger may trigger MI episodes

People with quick tempers have another reason to try to curb their rage. A small study found that stress related to anger had a significant impact on the risk for MI with coronary occlusion.

Apron protects operators from radiation but at cost to patients

Draping a lead apron over patients during transradial PCIs reduced radiation to operators but it almost doubled exposure to their patients. Still, researchers argued that the benefit to physicians outweighed the risk to patients.

Real-world use gives fondaparinux advantage over heparin

In a real-world setting, patients with non-STEMI (NSTEMI) treated with fondaparinux had lower rates of death and major bleeding compared with low-molecular weight heparin, according to a study published in the Feb. 17 issue of JAMA.

15 suits filed over cardiac cath procedures at LifePoint facilities

LifePoint Hospitals reported that it may face fines and liability costs from investigations into improper interventional cardiology procedures at two of its hospitals.

Off-label use of familiar PCI drug results in fewer bleeds

Occasionally, off-label use can be as safe and effective as the originally approved method, sometimes more so. This appears to be the case for eptifibatide, according to a study published online Feb. 5 in Circulation: Cardiovascular Interventions.

Angina relief device succeeds on symptoms

Using a narrowing device in the coronary sinus may provide relief of symptoms and improve angina by at least one class, according to a study published Feb. 5 in the New England Journal of Medicine.

Collaborative valve registry shines as example of cooperation, data excellence

Good data are key to understanding new processes and improving care. This was underscored by a paper published in the February issue of Health Affairs, which promoted the Transcatheter Valve Therapy Registry as a model for collaboration and harmonized patient data collection.

Guidewire coating debris found in nearly half of thrombus samples

Foreign material found in emboli and histological samples of cardiac tissue may be a sign that hydrophilic guidewire coating detaches more frequently than previously reported. The study published in the February issue of Circulation: Cardiovascular Interventions suggested that embolized guidewire coating may put patients at greater risk for complications. 

Sleepless in the cath lab? Next-day patients still safe

Operators who pull an all-nighter in the cath lab don’t appear to put the patients they treat the next day at risk, according to one study. The likelihood of bleeding complications increased under the care of chronically sleep-deprived physicians, though.

Key Antiplatelet Presentations Yield More Questions Than Answers

The Dual Antiplatelet Therapy study presented at the American Heart Association conference shows that knowledge gaps still exist.

Ultrasound beats touch for quick, accurate transradial access

First-pass success for transradial access of cardiac catheterization improved by more than 20 percent when ultrasound was used to guide the puncture, according to a study published online Jan. 14 in Journal of the American College of Cardiology: Cardiovascular Interventions.

Morphine may dull antiplatelet loading in STEMI patients

Treating pain with morphine may slow down oral antiplatelet therapy in STEMI patients. The odds of high residual platelet reactivity were nearly three times higher for patients taking morphine two hours after administration of oral antiplatelet therapy.

Bivalirudin holds lead over heparin amid changing practices

Improved PCI procedural methods have not changed bivalirudin’s edge over heparin, according to a study published in the Jan. 6 issue of the Journal of the American College of Cardiology.

Ups & downs of revascularization

The price for cardiac revascularization keeps rising while the need for procedures appears to be in decline. Go figure.

PCI, CABG rates march steadily lower in Mass.

Coronary revascularization rates dipped by 39 percent over a decade in Massachusetts, according to an analysis published online Jan. 5 in JAMA Internal Medicine. Elective PCIs saw the steepest decline.

Bleeding complications may continue first year after TAVR

While periprocedural safety of transcatheter aortic valve replacement (TAVR) procedures has improved, late bleeding complications may still be an issue. 

Active trend analysis helps hospitals find & correct PCI device issues

Active and real-time is better, especially when assessing device safety in the general population. A Massachussetts-based hospital network analyzing the safety of PCI-related devices found that a real-time safety alert was able to change practices to improve patient safety and outcomes.

LVAD replacement approach leads to better outcomes

Surgeons using a nonsternotomy approach to replace continuous flow left ventricular assist devices (LVADs) found patients had better survival, according to a study published online Dec. 10 in Annals of Thoracic Surgery.

In 5-year analysis, PCI wins over CABG for cost but not outcomes

Some things don’t make decisions easier: PCI may be more cost-effective, but CABG has fewer long-term major adverse events, according to a study published in the Dec. 1 issue of Catheterization and Cardiovascular Interventions.