CardioExchange Archive

April 27th, 2010

COURAGE Two Years Later: Finding Common Ground

L. David Hillis, MD

Following is an exchange between Bill Boden and Gregg Stone, facilitated by Interventional Cardiology moderators Richard Lange and David Hillis. An audio file of the complete conversation from which this text was adapted is available here. Rick Lange: Given all the debate and controversy surrounding the COURAGE trial, what are the issues on which you find agreement? Gregg […]

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April 1st, 2010

Alcohol or the Knife?

L. David Hillis, MD

Your patient with symptomatic obstructive hypertrophic cardiomyopathy is faced with a choice and asks, “If it were you, would you have alcohol ablation or myectomy?” Recent U.S. studies show that alcohol ablation is safe and effective (i.e., low complication rate, durable hemodynamic effects, and good long-term survival), whereas European studies suggest it is not (due to […]

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February 9th, 2010

An ENDEAVOR to COMPARE 2nd Generation DES

L. David Hillis, MD

In two recent studies, second-generation drug-eluting stents were compared with first-generation paclitaxel-eluting stents.  In COMPARE, the everolimus-eluting stent was superior (31% risk reduction in “target lesion failure”), whereas in ENDEAVOR IV, the zotarolimus-eluting stent showed similar efficacy and safety to the paclitaxel-eluting stent.  In light of these data, is there any role for the zotarolimus-eluting stent?     

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January 6th, 2010

Lp(a): Risk and Relevance

L. David Hillis, MD

Clarke et al. provide convincing evidence that plasma Lp(a) lipoprotein is causally related to coronary artery disease. What’s needed next? First, we need to assess whether knowledge of Lp(a) lipoprotein concentrations improves predictive discrimination over more traditional risk factors. Second, we need an intervention that selectively lowers plasma Lp(a) lipoprotein concentrations and a randomized clinical trial to assess its efficacy. Of currently FDA-approved […]

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November 24th, 2009

Expand or Restrict Primary PCI?

L. David Hillis, MD

At last week’s AHA meeting, a late breaking clinical trial reported that STEMI patients in Massachusetts who underwent primary PCI at hospitals without cardiac surgery on site had similar rates of death, MI, and target vessel revascularization at 1 year as those who underwent primary PCI at hospitals with cardiac surgery on site.  In contrast, […]

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