CardioExchange Archive

January 11th, 2010

COMPARE: Everolimus vs paclitaxel stents

Richard A. Lange, MD, MBA

In the recently published COMPARE trial, the use of second-generation everolimus-eluting stents, when compared with paclitaxel-eluting stents, was associated with a significant reduction in the risk of major adverse cardiac events at 1 year.  This difference was driven by a reduction in the rate of MI and repeat target vessel revascularization.  Interestingly, this reduction was […]

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January 6th, 2010

Stent Gap Rap

Richard A. Lange, MD, MBA

According to a recent study using computed tomographic angiography (CTA), the incidence of so-called stent gaps — due to stent strut fracture or failure to overlap stents — is 17%.  These stent gaps are associated with an increased incidence of in-stent restenosis. Interestingly, stent gaps were identified in only 1% of routine coronary angiography procedures.   […]

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December 18th, 2009

Avoiding Wrong Meds in Dialysis Patients Having PCI: The Expert’s Recommendations

Richard A. Lange, MD, MBA

According to a recent study, almost one-fourth of dialysis patients undergoing PCI receive an antithrombotic agent (enoxaparin or eptifibatide) that is contraindicated in individuals with renal disease, resulting in excessive major bleeding and death.  In a CardioExchange blog, the study’s lead author notes that this error was more likely to occur in hospitals that were rural or non-teaching or that had lower […]

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December 16th, 2009

When the Right Med Is Wrong: Treating PCI Patients Undergoing Dialysis

thomastsai and Richard A. Lange, MD, MBA

We welcome Tom Tsai, MD, MSc, to this forum to talk about his article in last week’s JAMA: Contraindicated Medication Use in Dialysis Patients Undergoing Percutaneous Coronary Intervention (JAMA. 302:2458). We asked him our questions, and encourage you to ask yours. CardioExchange Editors: Your study found that nearly a quarter of dialysis patients undergoing PCI received contraindicated […]

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December 9th, 2009

Bleeding With PCI: We’re Making The Problem Worse

Richard A. Lange, MD, MBA

In a recent editorial regarding the management of ACS patients, we emphasized the importance of early risk stratification to identify patients who would most benefit (or not benefit) from intensive antithrombotic therapy or an invasive cardiac procedure.   However, a recently published study reported that 22% of dialysis patients  undergoing PCI received an antithrombotic agent (enoxaparin […]

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December 3rd, 2009

Sensitive Troponin Assay: Who Needs It? Not Me!

Richard A. Lange, MD, MBA

Sensitive assays for troponin (see here and here) improve early diagnosis of acute myocardial infarction and risk stratification.  However, according to a recent NEJM study, sensitive assays detect low circulating levels of cardiac troponin in the great majority (98%) of patients who have stable coronary artery disease and preserved LV systolic function.   In many […]

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December 1st, 2009

New Guidelines on Perioperative Use of Beta-Blockers: POISE for a DECREASE?

kirstenefleischmann and Richard A. Lange, MD, MBA

By now, there’s a good chance you’ve heard that the American College of Cardiology and the American Heart Association updated their guidelines on the perioperative use of beta-blockers in patients who undergo noncardiac surgery. Perhaps you’ve been thinking about the implications for practice. I certainly have, but then again I chaired the group that wrote […]

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November 24th, 2009

2009 AHA/ACC Updated STEMI Guidelines Released

Richard A. Lange, MD, MBA

The release of a new update to the STEMI guidelines was announced at the AHA Scientific Sessions.  Guidelines committee members report that the update incorporates evidence from key trials that have emerged over the past two years.  Changes include a greater emphasis on organized systems of emergency care, triage and transfer for PCI, and the possible roles of stenting the […]

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November 20th, 2009

AHA Interventional Recap

Richard A. Lange, MD, MBA

The AHA Scientific Sessions in Orlando this past week certainly provided interventionists with a lot to think about. Here are some of the presentations that caught my attention: 1. Cangrelor Not Beneficial in ACS Patients Receiving Clopidogrel and PCI (see discussion here) 2. (F)Utility of Platelet Assays (see discussion here): The POPULAR trial evaluated 6 platelet assays in clopidogrel-pretreated […]

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November 15th, 2009

Cangrelor Not Beneficial in ACS Patients Receiving Clopidogrel and PCI

Richard A. Lange, MD, MBA

In ACS patients undergoing PCI, giving cangrelor with clopidogrel did not reduce cardiac ischemic events (a composite end-point of death, MI, and ischemia-driven revascularization) compared with clopidogrel alone.       Since they both have the same antiplatelet mechanism of action (P2Y12 inhibitor), what’s the rationale for using cangrelor with clopidogrel? Clopidogrel has two major limitations: its platelet inhibition has […]

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