December 22nd, 2010

John Ryan: 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. Effects of CYP2C19 Genotype on Outcomes of Clopidogrel Treatment: Ten years after the initial decoding of the human genome, we felt we finally had a genetic test and a drug with clinical applicability. However, this study and others cast doubt on the ability to predict response to anti-platelet therapy, demonstrating that we still have a lot to learn in order to develop individualized medical therapy.

2. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery: I choose this paper because it has the potential to represent a paradigm shift and offers an entirely new therapy to patients. It is exciting to think about this as a natural progression of the advances that interventional cardiology has made in the past forty years.

3. Exposure to low-dose ionizing radiation from medical imaging procedures: It is always a good thing when studies provoke controversy, but these two studies in JACC and Circulation reminded us of the potential harm we can do to patients even with “non-invasive” imaging.

Predictions for 2011:

1. Now that there is published and presented literature on dabigatran, rivaroxaban, and apixaban, 2011 could represent a seismic shift away from warfarin. Or will physicians and patients want to learn more about these medicines before leaving the known for the unknown?

2. As health care reform continues to gather pace, expect more trials to be published aimed at decreasing costs and hospitalizations such as the telemonitoring in heart failure research that was presented at AHA this past November.

3. With the large number of studies looking at hypertension management in diabetics, such as ACCORD BP, it will be interesting to see if the JNC-8 guidelines due to be published in 2011 will have dramatically new recommendations.

2 Responses to “John Ryan: Looking Back at 2010 and Ahead to 2011”

  1. With all respect to Dr. Ryan and Dr. Bhatt, the procedure in looking back 2010 # 2, although admirable in itself, could still need some work in its performance, the size of the catheter, the valve or the way it is applied. See: Rodés-Cabau J, et al “Cerebral embolism following transcatheter aortic valve implantation: Comparison of transfemoral and transapical approaches” J Am Coll Cardiol 2011; 57: 18–28.

    Competing interests pertaining specifically to this post, comment, or both:

  2. Thank you Dr Sierra for drawing my attention to this upcoming JACC publication wherein 60 patients who ad undergone TAVI subsequently had MRI which showed new ischemic lesions in 68% of patients. In the PARTNER publication, the incidence of stroke was found to be 5%. These are valid concerns and will likely be addressed in the next PARTNER study where there will be a direct comparison between TAVI and surgical aortic valve replacement. The incidence of stroke in this study will be worth watching out for.