December 21st, 2010

Rick Lange & David Hillis: Looking Back at 2010 and Ahead to 2011


To celebrate the holiday season, CardioExchange asked several of our contributors to choose the 3 most important cardiology-related events of the past year and to make 3 predictions for 2011.

Looking back at 2010:

1. Stenting Versus Endarterectomy for Carotid-Artery Stenosis: In patients with carotid artery stenoses, stenting and endarterectomy were associated with similar rates of the primary composite endpoint — periprocedural stroke, MI, or death and subsequent ipsilateral stroke.  However, the incidence of periprocedural stroke was lower in the endarterectomy group, whereas the incidence of periprocedural MI was lower in those undergoing stenting.  Carotid artery stenting tended to show greater efficacy in those <70 years of age, whereas endarterectomy was more efficacious in older subjects. Our take:  Since stenting and endarterectomy have similar overall efficacy, the patient can decide which procedure and risk are preferable.  Physicians should “point” their older patients toward endarterectomy.

2. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery: In patients with severe aortic stenosis who were not suitable candidates for surgery, transcatheter aortic valve implantation (TAVI), as compared with standard therapy, significantly improved cardiac symptoms and survival.  Echocardiography after TAVI showed no evidence of deterioration of the bioprosthesis within the first year. Our take:  TAVI is the first truly viable alternative therapy for nonsurgical AS patients, as balloon valvuloplasty in this patient population has been “a bust.”

3. Clopidogrel With or Without Omeprazole in Coronary Artery Disease: This prospective, double-blind, randomized comparison of the proton pump inhibitor (PPI), omeprazole, and placebo in subjects with coronary artery disease receiving clopidogrel did not show an increased risk of cardiovascular events with the concomitant use of clopidogrel and omeprazole, even in high-risk subgroups.  Those receiving omeprazole manifested a significant reduction in the risk of gastrointestinal bleeding. Our take:  The increased risk of gastrointestinal bleeding with dual antiplatelet therapy is substantial.  It’s reassuring to know that a PPI is safe in these patients.



Predictions for 2011:

1. Governmental scrutiny of the use of interventional procedures will increase… will the oversight of physicians and hospitals who encourage their overuse (as recently reported in Baltimore, MD, and Austin, TX).

2. The utility of platelet reactivity assays to guide antiplatelet therapy after PCI will become even more confusing…..before it (hopefully) becomes clearer.

3. The AHA/ACC/SCAI will issue joint guidelines regarding which patients benefit from revascularization and the most appropriate form of revascularization (PCI or CABG) for specific patient subgroups…..but little will change.

One Response to “Rick Lange & David Hillis: Looking Back at 2010 and Ahead to 2011”

  1. Hiteshi KC Chauhan, MD Physician says:

    Insightful and succinct review and predictions.

    The fact that PPIs are safe in patients on anti-platelet therapy is highly reassuring.

    Competing interests pertaining specifically to this post, comment, or both:
    No conflicts of interest.