CardioExchange Archive

December 8th, 2010

The Spin on the Impella Device: PROTECTing Whom?

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

The PROTECT II study — a prospective, multicenter, randomized, controlled comparison of the Impella cardiac assist device (produced by Abiomed) and the intra-aortic balloon pump (IABP) in patients requiring hemodynamic support during nonemergent, high risk PCI — was stopped early based on a futility determination regarding the primary endpoint at the time of planned interim analysis. What’s […]

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November 22nd, 2010

Treating Resistant Hypertension: Singe – Don’t Stent – The Renal Artery

Richard A. Lange, MD, MBA

For years, interventional cardiologists (and radiologists) have been stenting renal arterial stenoses in patients with resistant hypertension, despite evidence that doing so does not lower blood pressure.  It appears we had the right organ (the kidney), but we’ve been doing the wrong procedure. We should have been delivering a singe, not a stent. Advances in endovascular catheter technology […]

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November 16th, 2010

What Does BASKET PROVE Have to Prove?

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

What to make of new findings that DES are just as good as BMS for treating lesions in large coronary arteries? David Hillis and Rick Lange provide a brief tour of the relevant issues. Getting a handle on the study… Previous data suggested that the use of DES in large native coronary arteries confers no benefit and […]

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November 15th, 2010

Let’s Bring CLOSURE to This Debate About PFO Treatment

Richard A. Lange, MD, MBA

In this blog, Rick Lange tells us how he would answer FAQs about PFO closure to prevent stroke. The controversy: Based on retrospective and nonrandomized studies, many physicians are convinced that percutaneous patent foramen ovale closure can reduce rates of cryptogenic stroke and transient ischemic attack. Although PFO closure devices are approved for stroke prevention in Europe […]

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November 4th, 2010

Clopidogrel and CYP2C19: What’s All the Fuss About?

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

You’ve heard a lot lately about so-called “clopidogrel resistance.” That sounds straightforward, but the underlying reason can be complex, possibly related to how the drug is metabolized by subjects with a certain genetic profile. We seek here to provide some perspective about clopidogrel’s metabolic and gene-related complexities. First, some brief background: Clopidogrel, a thienopyridine, is a […]

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October 22nd, 2010

What Do I Plan to Do with Dabigatran?

Richard A. Lange, MD, MBA

1. Discuss its pros (no need for INR monitoring, less bleeding than coumadin) and cons (cost, dyspepsia) with my atrial fibrillation patients 2. Avoid its use in patients with renal dysfunction (CrCl  <60), liver disease, pregnancy or stroke within the past 6 months 3. Lament the absence of the INR monitoring requirement, which I currently […]

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October 6th, 2010

The Skinny on Drug-Eluting Stents (DES)

Richard A. Lange, MD, MBA

(“All we want are the facts, ma’am.” –Joe Friday, Dragnet) Having trouble keeping up with DES and the recent stent studies? Want a brief tutorial? To learn the top six things every cardiologist should know about DES, read on… 1. What they do. DES are superior to both bare-metal stents and angioplasty in reducing the incidence […]

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September 23rd, 2010

Howdy, PARTNER!

Michael Mack, M.D., E Murat Tuzcu, MD, L. David Hillis, MD and Richard A. Lange, MD, MBA

CardioExchange welcomes Mike Mack and E. Murat Tuzcu, investigators for the PARTNER trial, an ongoing, randomized study of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis at high surgical risk. The first reported findings, published in the New England Journal of Medicine, showed an impressive 20% absolute reduction in 12-month mortality with […]

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September 13th, 2010

Three-year SYNTAX Results: Sensible, Not Sensational

Richard A. Lange, MD, MBA

In SYNTAX, 1800 patients with multivessel and/or left main disease were randomized to CABG or PCI with DES after a surgeon and an interventional cardiologist reviewed the coronary angiogram and agreed that either procedure was appropriate. (See the CardioExchange News blog for more study information.) The SYNTAX 3-year results show that patients with a low SYNTAX […]

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September 8th, 2010

“Cath Lab, We Have A Problem”?

Richard A. Lange, MD, MBA

According to a recently published study, a huge disconnect apparently exists between patients’ and cardiologists’ beliefs about the benefits of PCI. The patients had been referred for coronary angiography and possible PCI, had discussed PCI with a physician, and had provided informed consent. Most patients (~88%) believed that PCI would reduce their risks of MI, whereas most […]

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