CardioExchange Archive

December 8th, 2010

PROTECT II Study of Impella Stopped Early for Futility

Larry Husten, PHD

The PROTECT II study has been stopped early. The trial had been comparing the Impella circulatory support device to the intra-aortic balloon in high-risk PCI patients. The trial was terminated after an interim analysis by the Data and Safety Monitoring Board, which reached a “futility determination… regarding the primary end-point,” according to a press release […]

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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 12th, 2010

Time Out!

Brahmajee Kartik Nallamothu, MD, MPH

This week, JAMA published a commentary that Harlan Krumholz and I wrote about the growing use of ad hoc PCI and its implications for decision making about coronary revascularization. To cut to the chase, we believe that ad hoc PCI — the performance of a diagnostic cath and PCI in the same setting — makes […]

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November 8th, 2010

Up-Front Clopidogrel Loading Versus Common Sense

John E Brush, MD

From time to time, a sales representative visits my office promoting clopidogrel (Plavix) as a drug that patients who present with unstable angina/non–ST-segment-elevation MI (UA/NSTEMI) should start immediately as an up-front load. That strategy hasn’t been uniformly accepted in my clinician community because of concern about using an irreversible antiplatelet agent to treat patients who […]

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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 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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October 1st, 2010

A Case of Exuberance About a Subgroup in a Clinical Trial

Harlan M. Krumholz, MD, SM

In many clinical trials, researchers investigate whether an overall effect of an intervention is consistent across various subgroups, as I discussed in this Journal Club Series last week. Such subgroup analyses require assessment of what is called an interaction — that is, whether the effect in one group differs from that in another. Do the benefits differ, […]

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September 19th, 2010

A Rich OASIS for Your Journal Club

Harlan M. Krumholz, MD, SM

I’m always scouting for papers to discuss in journal club with my students. Earlier this month, I found the perfect pair: two simultaneously published articles from the industry-funded CURRENT–OASIS 7 randomized trial, one in the New England Journal of Medicine and the other in the Lancet. Many of the authors of the two papers were […]

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September 15th, 2010

A Fistful of Stents

PZ Myers, Ph.D.

CardioExchange welcomes this guest post from Pharyngula, a blog by PZ Myers, an associate professor of biology at the University of Minnesota, Morris. Dr. Myers recounts his PCI experience from the patient’s point of view. Here’s my status right now, for those who have been wondering. First of all, I’m not dead yet. Let’s get that […]

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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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