CardioExchange Archive

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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May 11th, 2011

Optimal Medical Therapy and the Lack of COURAGE

William Borden, MD and John Spertus, MD, MPH

We welcome William Borden and John Spertus to answer questions from CardioExchange Editor-in-Chief Harlan Krumholz about their JAMA paper showing that optimal medical therapy (OMT) for patients with coronary artery disease (CAD) did not receive a meaningful boost from the publication of the COURAGE trial, despite the trial’s clear message showing the benefits of OMT. Using […]

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May 3rd, 2011

CABG Takes the Brunt of Decline in Revascularization Procedures

Larry Husten, PHD

In recent years, the overall revascularization rate in the U.S. has declined only slightly, but CABG rates have taken the brunt of the change, while PCI rates have remained relatively stable, according to a new study by Andrew Epstein and colleagues published in JAMA. The researchers found that from 2001-2002 to 2007-2008: The annual rate of revascularization […]

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March 16th, 2011

CABG vs. PCI for Angina Relief: Lessons from SYNTAX

David Cohen, MD MSc

CardioExchange welcomes David J. Cohen, Director of Cardiovascular Research at St. Luke’s Mid America Heart Institute in Kansas City, Missouri, to discuss the latest analysis from the SYNTAX randomized trial. The study has just been published in the New England Journal of Medicine, and Dr. Cohen is the lead author. Questions to Dr. Cohen come […]

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March 15th, 2011

GRAVITAS Editorial: Why Invite the Fox into the Henhouse?

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

Results from the GRAVITAS randomized trial, presented at the 2010 American Heart Association conference, have just been published in JAMA. They show that high-dose clopidogrel did not improve outcomes after percutaneous coronary intervention (PCI) in patients with “high on-treatment platelet reactivity” (i.e., during clopidogrel therapy), compared with clopidogrel given at conventional doses. Our interpretation at CardioExchange, reported at […]

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February 10th, 2011

What’s Keeping Us from Using FFR?

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

A recent study of PCI in subjects with multivessel CAD showed that procedure costs were lower when a management strategy based on the results of fractional flow reserve (FFR) measurements was employed. The FFR-based strategy resulted in fewer stents used, which more than offset the cost of the FFR pressure wire. Even though FFR-guided PCI has […]

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January 19th, 2011

What PROSPECT Doesn’t Tell Us

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

The PROSPECT trial provides some interesting insights about the mechanisms of thrombotic coronary artery disease, but how, if at all, should it change practice? Here are what the findings do and do not demonstrate: What the PROSPECT study says: In ACS patients treated with PCI, major adverse cardiovascular events that occurred during a median follow-up of 3.4 years were as […]

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January 10th, 2011

Have the COURAGE to Critique a Substudy

Harlan M. Krumholz, MD, SM

In this journal club, I compare the published data from an original trial with the authors’ conclusions in a substudy from that trial. Often, a substudy provides valuable insights that complement the initial trial findings. Sometimes, however, you need to look closely to identify the additional insight. Case in point: COURAGE. The Original COURAGE Trial As reported […]

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January 5th, 2011

Do Sleep-Deprived Invasive Cardiologists Cause Complications?

Richard A. Lange, MD, MBA

In an NEJM perspective, the former president of the Sleep Research Society reports an 83% increase in the risk of surgical complications in patients undergoing elective daytime surgery performed by attending surgeons who had a <6-hour opportunity for sleep between procedures during a previous on-call night.  He argues that physicians who have been awake for […]

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January 3rd, 2011

Medicare: The MasterCard That Keeps On Giving

Shanti Bansal, MD

In the cardiac catheterization lab one Tuesday morning, I encountered a situation that made me reflect on a bit of 18th-century British history. At that time, the British government was overburdened with prisoners. A plan was hatched for sea captains to transport many of them to Australia. Due to poor conditions, up to one third died […]

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