CardioExchange Archive

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 […]

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December 16th, 2009

New Guidelines

Andrew M. Kates, MD

How closely do you watch for new guidelines? It seems as if every week new guidelines are published on a variety of topics including atrial fibrillation, valve disease, STEMI and NSTEMI, and, most recently, the use of perioperative beta blockers.  Between guidelines, appropriateness criteria and various position papers, it can be extremely challenging to keep abreast of the most […]

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December 16th, 2009

FDA Advisers Recommend Expanded Use of Rosuvastatin

JoAnne M. Foody, MD

The Associated Press reports that, based on the JUPITER study, an FDA panel of advisers has recommended expansion of rosuvastatin. The FDA is expected to decide whether to act on this recommendation in 2010. According to the report, Astra Zeneca will develop an approach to use rosuvastatin in all patients at risk for heart disease based on hypertension and family history. […]

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December 16th, 2009

FDA Advisers Recommend Expanding Crestor to Patients Without High Cholesterol

Larry Husten, PHD

An FDA advisory panel voted 12 to 4 on Tuesday to expand the use of rosuvastatin (Crestor) to patients with normal cholesterol levels and no history of cardiac disease, according to the Associated Press. The panel’s recommendation was based on last year’s JUPITER trial, in which rosuvastatin cut cardiovascular risk in patients with normal LDL […]

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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 7th, 2009

Dabigatran vs Warfarin: War or Peace?

Samuel Goldhaber, MD

CardioExchange Editors: Given the results of both your RE-COVER study and the recently published RE-LY study, should anybody still be using warfarin? Goldhaber: Warfarin is not going to fade away into oblivion.  Anyone currently stable on warfarin has little reason to abandon this time-tested drug.  If once monthly INRs are usually in the therapeutic range, and […]

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December 4th, 2009

The Final CMS Rule Is Flawed

vincentjbufalino and Larry Husten, PHD

The Centers for Medicare and Medicaid Services (CMS) Final Rule on the cardiology fee schedule (download the entire 450-page document here) is an ill-conceived policy change that will drastically affect the practice of cardiology in the United States. Relying on limited, unrepresentative data from the Physician Practice Information survey (PPIS) done by the AMA, the CMS determined that […]

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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 2nd, 2009

Cardiology in the Big Tent
Helping our fellows make the most of a national meeting

James De Lemos, MD

I remember the first national meetings I attended as a fellow. They were sensory overload experiences: Huge crowds, stargazing at the cardiology luminaries, preparing and overpreparing for my own talks (attended by few beyond my closest friends), staying up too late at the lobby bars. Now, seeing this experience through the eyes of our own […]

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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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