CardioExchange Archive

December 30th, 2011

CYP2C19 Genotyping: Down For The Count?

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

The controversy over the use of genetic testing to guide antiplatelet therapy reminds us of a WWF (Worldwide Wrestling Federation) tag team match.   What we agree upon (the match rules): Clopidogrel is a prodrug activated by several enzymes, including CYP2C19, and common genetic variations alter CYP2C19 activity. Here’s where the wrestling match begins: Are the CYP2C19 genetic […]

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December 15th, 2011

PCI and On-Site CABG: Out of Site, Out of Mind?

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

According to a recent meta-analysis of studies in patients undergoing PCI, rates of in-hospital mortality and emergency CABG for primary and non-primary PCI were similar at centers with and without on-site surgery.  At least, that’s the story the press is spreading around. However, several caveats should be noted . . . 1. The study included patients undergoing […]

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November 30th, 2011

Should FedEx Be in Charge of Primary PCI?

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

Federal Express built its business on being a leader in transportation and delivering on time.  Perhaps the results of primary PCI in the U.S. would be better if FedEx ran the program. In patients with acute MI who must be transferred to another hospital for primary PCI, experts agree that the door-in to door-out (so called, […]

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November 11th, 2011

Transapical TAVR on the Ropes: Is It Down for the Count?

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

STACCATO showed more adverse events with transapical transcatheter aortic valve replacement (TAVR) than with aortic valve replacement (AVR) in low risk, elderly patients. In patients with severe, symptomatic aortic stenosis who are believed to have high surgical risk, PARTNER substudy results presented at the AHA show Transapical TAVR provided no increase (and even a possible decrease) in quality […]

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November 11th, 2011

Shaky Start Ends STACCATO

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

The STACCATO trial planned to randomize 200 low-risk patients to transcatheter aortic heart valve implantation (TAVI) via the transapical approach (with the Sapien valve from Edwards Lifesciences) or surgical aortic valve replacement (AVR).  The primary endpoint was a composite of death, stroke, and renal failure at one month.  After enrolling only 70 patients (34 TAVI […]

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October 4th, 2011

Is “Stent and Send” Safe for Older Patients?

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

Should older patients who undergo elective coronary artery stenting be sent home the same day?  Using data from the CathPCI Registry, Rao and colleagues examined outcomes in Medicare-eligible patients who underwent elective, first-time PCI. The investigators identified 107,018 patients (<11% of the million-plus older patients undergoing PCI during 2005–2008 after exclusion of those with ACS or shock and those transferred from another hospital or […]

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September 1st, 2011

How Is TAVI Like a European Toaster?

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

Approval of TAVI and electric toasters is governed by the same regulatory framework in Europe, the “CE mark” — a mandatory conformity stamp for products placed on the market in the European Economic Area. Because high-tech (and low-tech) devices are approved in Europe faster than in the United States, many companies and consumers scold the FDA […]

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August 30th, 2011

Intra-Aortic Balloon Counterpulsation (IABP) Burned to a CRISP

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

Intra-aortic balloon counterpulsation (IABP) is a bust in AMI patients without cardiogenic shock, according to the Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction (CRISP AMI) trial. This open-label, 30-center, randomized, controlled trial was performed to determine if a routine strategy of IABP before primary PCI (and continued for at least 12 hours afterward) would […]

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August 18th, 2011

Are Interventionalists Getting Too Far “A Head”?

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

Nallamothu and colleagues have performed an observational analysis of Medicare data on fee-for-service beneficiaries undergoing carotid stenting between 2005 and 2007 in 306 hospital referral regions (HRRs). First, they determined how often carotid stenting was performed by different specialists (i.e., cardiologists, surgeons, radiologists) within each HRR, then they compared utilization rates and 30-day outcomes of the procedure across HRRs. What did they find? Although […]

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August 15th, 2011

Drug Eluting Stents: It Pays To Be Picky

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

 Why buy the most expensive stent when the cheaper one works just as well?  Two recent studies suggest that a more selective use of stents has merits.  In an analysis of pooled data from 4 trials (SPIRIT II-IV and COMPARE) comparing the more-expensive everolimus-eluting stent (EES) with the less-expensive paclitaxel eluting stent (PES), Stone and colleagues identified a […]

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