September 10th, 2010
Meta-Analysis Finds High Risk for Carotid Stenting in Older Patients
Larry Husten, PHD
Carotid stenting should not be performed in patients age 70 years or older, according to the results of a new meta-analysis appearing in the Lancet. Researchers in the Carotid Stenting Trialists’ Collaboration combined data from 3433 patients with symptomatic carotid stenosis who were randomized to either endarterectomy or stenting in the EVA-3S, SPACE, and ICSS trials. At 120 […]
September 8th, 2010
U.S. CABG Centers Rated
Physician's First Watch, CardioExchange Staff
Consumer Reports published ratings for 221 CABG centers in the U.S. on Tuesday. The ratings, based on data collected by the Society of Thoracic Surgeons, take into account 11 performance measures — for example, postoperative renal failure, operative mortality, and surgical re-exploration. All centers included in the report volunteered to have their data made public. A New […]
July 27th, 2010
CABG in the Real World
Larry Husten, PHD
Two studies in Archives of Internal Medicine look at different aspects of CABG in the real world. Auerbach and colleagues analyzed data from more than 80,000 CABG patients and found that quality can be improved and costs reduced by directing patients away from low-volume surgeons and hospitals in favor of higher-volume surgeons and hospitals. However, […]
July 20th, 2010
Who Should Treat Advanced HF/Transplant Patients?
Larry Husten, PHD
The ACC, AHA, and several other organizations have released the first Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant. “The current statement describes the level of experience, knowledge, and technical skills necessary for competent performance in caring for these complex patients,” write the authors of the report, including the chair […]
June 4th, 2010
Composite Endpoints and the CREST Trial
davidrind
CardioExchange welcomes this guest post reprinted with permission from Dr. David Rind, an academic primary care physician and medical editor in Boston. This piece originally appeared on his blog, Evidence in Medicine. For more on the CREST trial, see the NEJM article and editorial, the Journal Watch summary by Dr. Howard Herrmann, and an Interventional Cardiology blog by Dr. […]
June 4th, 2010
Carotid Stenosis: Stent, Remove or Don’t Touch?
Richard A. Lange, MD, MBA
The Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) compared carotid stenting with endarterectomy in patients with symptomatic or asymptomatic carotid stenoses. The risk of the composite primary outcome — stroke, MI, or death — was similar for both treatments over the 2.5 years of follow-up. What’s the nitty gritty? Periprocedural stroke was more likely after stenting, […]
May 27th, 2010
The Tests Say Intervene, but the Patient Feels Fine
Anju Nohria, MD and James Fang, MD
A 58-year-old asymptomatic man with hypertension and hyperlipidemia was noted to have an abnormal electrocardiogram during his routine annual physical examination. His primary care physician ordered a treadmill stress test. The patient exercised for 6 minutes and 39 seconds of a standard Bruce protocol, achieving 8.1 METs. He stopped because of dyspnea. His heart rate increased […]
May 13th, 2010
All this talk about migraines and PFO closure is giving me a headache!
Richard A. Lange, MD, MBA
Despite a previous randomized trial showing no improvement in migraine headaches with PFO closure, a new study disputes these findings. In patients with refractory migraines (aura in 80%) and at high risk of right-to-left shunting (all had an atrial septal aneurysm, eustachian valve, large shunt, and coagulation abnormalities), PFO closure significantly improved migraine symptoms. Howie Herrmann is […]
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 […]
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 […]
NEJM Journal Watch — Recent Cardiology Articles- Strategies and Criteria for the Diagnosis and Management of Myocarditis
- Sex-Based Disparity in CABG Outcomes: Are We Moving Toward Parity?
- Can Genetic and Social Risk Scores Improve Cardiac Risk Prediction?
- Extensive Ablation vs. Pulmonary Vein Isolation in Persistent Atrial Fibrillation
- Can a Novel Stent Design Improve Long-Term Outcomes of Percutaneous Coronary Intervention?