CardioExchange Archive

August 23rd, 2012

New DES Get COMFORTABLE with AMI

Richard A. Lange, MD, MBA and L. David Hillis, MD

The use of drug-eluting stents (DES) in patients with acute myocardial infarction (AMI) has recently generated concern. In two meta-analyses (De Luca et al and Kaleson et al) , the use of early-generation DES resulted in a lower risk of repeat revascularization compared with bare-metal stents (BMS) in patients with AMI, but the DES group had a 2-fold increased […]

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August 6th, 2012

TAVR and the Price of Innovation

Daniel Mark, Richard A. Lange, MD, MBA and L. David Hillis, MD

In an article published in Circulation, Daniel Mark and Robert Mentz of the Duke Clinical Research Institute and University Medical Center examine the economic and policy implications of the recent validation of transcatheter aortic valve replacement (TAVR) in the PARTNER trials. CardioExchange is fortunate and pleased to present Dr. Mark’s responses to questions about his […]

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August 2nd, 2012

Survival Better with a Radial (vs. Femoral) PCI Approach: Sleight of Hand?

Richard A. Lange, MD, MBA and L. David Hillis, MD

Is there a plausible explanation for why the radial approach to PCI would yield better survival than the femoral approach in patients with ST-segment ACS?

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August 2nd, 2012

DES in Patients at Low Risk for TVR: Is the Benefit Worth the Cost? (Part III)

John Spertus, MD, MPH, Robert W. Yeh, MD MSc MBA, Richard A. Lange, MD, MBA and L. David Hillis, MD

In a recent article in Archives of Internal Medicine, researchers performed an analysis of current use of drug-eluting stents (DES) in patients at various levels of risk for target-vessel revascularization (TVR), and estimated the cost and clinical outcomes of using BMS rather than DES in patients at low risk (see News). To gauge reaction to […]

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July 27th, 2012

DES in Patients at Low Risk for TVR: Is the Benefit Worth the Cost? (Part II)

Richard A. Lange, MD, MBA, L. David Hillis, MD and Patrick Serruys, MD, PhD

In a recent article in Archives of Internal Medicine, researchers performed an analysis of current use of drug-eluting stents (DES) in patients at various levels of risk for target-vessel revascularization (TVR), and estimated the cost and clinical outcomes of using BMS rather than DES in patients at low risk (see News). To gauge reaction to […]

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July 25th, 2012

DES in Patients at Low Risk for TVR: Is the Benefit Worth the Cost? (Part I)

Gregg W Stone, MD, John A. Bittl, M.D., David Kandzari, MD, Richard A. Lange, MD, MBA and L. David Hillis, MD

In a recent article in Archives of Internal Medicine, researchers performed an analysis of current use of drug-eluting stents (DES) in patients at various levels of risk for target-vessel revascularization (TVR), and estimated the cost and clinical outcomes of using BMS rather than DES in patients at low risk (see News). To gauge reaction to […]

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July 16th, 2012

Does PPI + DAPT = MI?

Richard A. Lange, MD, MBA and L. David Hillis, MD

Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is the standard of care for prevention of coronary stent thrombosis. Unfortunately, DAPT is associated with an increased risk for gastrointestinal hemorrhage. Although this risk can be reduced with the concomitant administration of a proton pump inhibitor (PPI), initial observational studies suggested that PPI use with DAPT is associated with an increased […]

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July 2nd, 2012

Eroding Confidence in ASD Occlusion Devices

Richard A. Lange, MD, MBA and L. David Hillis, MD

The FDA has identified more than 100 cases of cardiac erosion following atrial septal defect occlusion (ASO) device implantation. All were associated with implantation of the AMPLATZER (AGA Medical/St. Jude Medical) or related cribriform ASO devices; none have been reported thus far with the GORE HELEX (Gore Medical) ASO device. Although the estimated occurrence of cardiac erosion […]

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May 22nd, 2012

iFR: A New Tool to Measure Functional Ischemia

Justin E Davies, MD, PhD, Richard A. Lange, MD, MBA and L. David Hillis, MD

The instantaneous wave-free ratio (iFR) is a pressure-derived  index of stenosis severity that does not require adenosine administration. The index was introduced at the 2011 TCT conference and validated by the results of the ADVISE study, published in December 2011. Following a series of presentations at the recent EuroPCR congress, Dr. Justin Davies answers questions […]

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May 18th, 2012

FAME II: Another Study Abides in Infamy

Richard A. Lange, MD, MBA and L. David Hillis, MD

In FAME II, a prospective study conducted at 28 centers in Europe and the United States, >1200 patients with ischemia (as determined by fractional flow reserve [FFR]) were randomly assigned to receive (a) PCI (with a DES) and optimal medical therapy (OMT) or (b) OMT alone. The primary endpoint was a composite of death, myocardial infarction […]

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