Richard A. Lange, MD, MBA

All posts by Richard A. Lange, MD, MBA

August 23rd, 2012

New DES Get COMFORTABLE with AMI

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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 […]


August 6th, 2012

TAVR and the Price of Innovation

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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 […]


August 2nd, 2012

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

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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?


August 2nd, 2012

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

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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 […]


July 27th, 2012

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

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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 […]


July 25th, 2012

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

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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 […]


July 16th, 2012

Does PPI + DAPT = MI?

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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 […]


July 2nd, 2012

Eroding Confidence in ASD Occlusion Devices

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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 […]


June 26th, 2012

Unlikely PARTNERs Support TAVR

The FDA approval of TAVR and the design of postmarketing surveillance involved a remarkable degree of collaboration and cooperation among the stakeholders. What to do while we wait for data to accumulate?


May 22nd, 2012

iFR: A New Tool to Measure Functional Ischemia

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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 […]