CardioExchange Archive

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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August 9th, 2011

Will ISCHEMIA Tell Us More than COURAGE? PART II: Banking on Eight Years of Equipoise

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

(Continued from Part I: Aiming to Beat Bias with Blinding) On August 1, 2011, the Langone Medical Center at New York University announced that the National Heart, Lung, and Blood Institute has provided a grant to fund the ISCHEMIA study of an invasive strategy versus optimal medical management in patients with stable coronary artery disease and […]

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August 8th, 2011

Will ISCHEMIA Tell Us More Than COURAGE? Part I: Aiming to Beat Bias with Blinding

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

On August 1, 2011, New York University announced that the National Heart, Lung, and Blood Institute would fund the ISCHEMIA study of an invasive strategy versus optimal medical management in patients with stable coronary artery disease and moderate-to-severe ischemia. We welcome the members of the study Executive Committee, chaired by Dr. Judith Hochman, to answer […]

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July 12th, 2011

Pass (Up) the Guidelines, Please

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

The Occluded Artery Trial (OAT) demonstrated no benefit of routine PCI in persistently occluded infarct-related arteries identified more than 24 hours after MI. These results were incorporated into the revised guidelines for STEMI, NSTEMI, and PCI (published in 2007 and 2008) as a class III recommendation (i.e., not indicated and inappropriate). The senior investigator for […]

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July 7th, 2011

NCDR Report on PCI Appropriateness: A Slap on the Back…or a Slap in the Face?

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

According to an analysis of data from the National Cardiovascular Data Registry (NCDR), nearly all (98.6%) acute PCIs (i.e., those done for STEMI, NSTEMI, and unstable angina) were classified as appropriate. For nonacute indications, however, only 50% were classified as appropriate; 38% were of uncertain appropriateness, and 12% were deemed inappropriate. Dig under the hood and what […]

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June 27th, 2011

TAVI: Playing in the Sandbox Together

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

Kudos to the the American College of Cardiology Foundation (ACCF) and the Society of Thoracic Surgeons (STS) for getting ahead of the game by rolling out a joint position statement regarding transcatheter aortic valve implantation (TAVI) before the FDA panel convenes in July to consider approval of the procedure.  It’s a terrific first step to avoid some of the […]

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June 10th, 2011

TAVR: A Stroke of Genius or Bad Luck?

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

After presentations at the ACC and American Association for Thoracic Surgery 2011 meetings, the PARTNER A results are finally published. PARTNER A compared  transaortic valve replacement (TAVR, also known as TAVI) with surgical aortic valve replacement (AVR) in patients with aortic stenosis who were eligible for AVR but considered to be at high surgical risk . At 1-year […]

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May 24th, 2011

Stent BioWars: Erode or Absorb?

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

In January 2011, we blogged about ABSORB, a  bioresorbable stent, when it received CE approval for use in Europe. Drug-eluting stents (DES) are composed of a metal scaffold that is coated with a polymer containing an antiproliferative agent , which is released gradually over the weeks to months after the stent is inserted.  The durable polymer residue has […]

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