Progress & concerns

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 - CandaceStuart
Candace Stuart, Editor

Several studies fell in the eyebrow-raising category this week, one as a pleasing surprise and two as alarms.

First, the positive news. In an analysis of 17 years of data on PCI patients, a team led by the Mayo Clinic’s Daniel B. Spoon, MD, found that deaths from cardiac causes decreased by 33 percent at five years after PCI while deaths from non-cardiac causes increased by 57 percent. They noted a drop in fatal MIs and sudden cardiac death and a bump up in deaths from cancer and chronic diseases.

The study shows that PCI patients are surviving cardiac-related issues to die of something else. This could mean that PCI patient management strategies are working, and that is plausible. In that case, interventional cardiologists deserve a pat on the back.

On the alarm side, another study found that one in four diagnostic catheterizations in New York were considered inappropriate. Applying appropriate use criteria to data from the New York’s Cardiac Diagnostic Catheterization Database, researchers found that only 35.3 percent of cases rated as appropriate.

The term “inappropriate” has fallen out of favor in exchange for “rarely appropriate,” and for good reason. The criteria cannot account for the myriad scenarios a physician may encounter in clinical practice, and at times what is best for a specific patient will not fit neatly into an appropriate use bucket. But 25 percent of the total falling under “inappropriate” seems high.

The authors suggested that the criteria were recent and facilities may not have had a chance to integrate them into practice.

But what really made me pause this week came in the form of one data point to calculate the risk of stroke in young people who recently used cocaine. The researchers had interviewed 1,101 participants between the ages of 15 and 49 who had a first-time ischemic stroke between 1992 and 2008 as well as 1,154 people with no stroke history about cocaine use, among other things.

In the stroke group, 28 percent of respondents reported using cocaine. In the control group, 26 percent used cocaine.

That snorting coke increases stroke risk is not an eye opener. But more than a quarter of young people appear to be abusing the drug, which signals a significant problem. Hopefully these findings will inform not only neurologists and stroke experts but also public health leaders as they try to turn the tide on substance abuse.    

Candace Stuart

Cardiovascular Business, editor