CardioExchange Archive

August 2nd, 2012

Survival Better with a Radial (vs. Femoral) PCI Approach: Sleight of Hand?

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

Is there a plausible explanation for why the radial approach to PCI would yield better survival than the femoral approach in patients with ST-segment ACS?

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July 7th, 2012

New Algorithm for Patients with LBBB and Suspected MI

John W McEvoy, MB BCh BAO, Ian Neeland, MD, James De Lemos, MD and John Ryan, MD

John McEvoy reflects on the clinical scenario of selecting patients with left bundle-branch block and suspected MI for primary PCI — and on a new algorithm to help in the decision-making process. The authors who created the algorithm respond.

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May 22nd, 2012

iFR: A New Tool to Measure Functional Ischemia

Justin E Davies, MD, PhD, Richard A. Lange, MD, MBA and L. David Hillis, MD

The instantaneous wave-free ratio (iFR) is a pressure-derived  index of stenosis severity that does not require adenosine administration. The index was introduced at the 2011 TCT conference and validated by the results of the ADVISE study, published in December 2011. Following a series of presentations at the recent EuroPCR congress, Dr. Justin Davies answers questions […]

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May 18th, 2012

FAME II: Another Study Abides in Infamy

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

In FAME II, a prospective study conducted at 28 centers in Europe and the United States, >1200 patients with ischemia (as determined by fractional flow reserve [FFR]) were randomly assigned to receive (a) PCI (with a DES) and optimal medical therapy (OMT) or (b) OMT alone. The primary endpoint was a composite of death, myocardial infarction […]

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May 15th, 2012

No Benefit Found for Exercise Echocardiography in Asymptomatic Patients Following CABG Or PCI

Larry Husten, PHD

Routine exercise echocardiography in asymptomatic patients after revascularization does not lead to better outcomes, according to a new study published in Archives of Internal Medicine. Although guidelines generally discourage the practice, post-revascularization stress tests are still commonly performed. Serge Harb and colleagues performed exercise echocardiography on 2105 patients after CABG surgery or PCI and followed them […]

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May 14th, 2012

Revascularization in New York State: High Questionable Rates for PCI but Not CABG

Larry Husten, PHD

A large study looking at real-world use of elective coronary artery bypass surgery (CABG) and stenting (PCI) in New  York State finds that nearly two thirds of PCI procedures have inappropriate or uncertain indications. By contrast, 90% of CABG procedures were deemed appropriate and 1.1% inappropriate. In a paper published in the Journal of the American College […]

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April 24th, 2012

Meta-Analysis Compares Drug-Eluting and Bare-Metal Stents for Primary Angioplasty

Larry Husten, PHD

A new meta-analysis comparing drug-eluting stents (DES) and bare-metal stents (BMS) in patients with MI has provoked opposing take-away messages from the study authors and an editorialist. The authors emphasize the reduction in target-vessel revascularization (TVR) associated with DES, but the editorialist focuses on several potential DES weaknesses suggested by the study. In the paper, published in […]

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April 17th, 2012

Why Make A Stent Out of Cornstarch?

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

Biodegradable stents: here to stay… or will they disappear? A newly-released study reports the long-term results of the first-in-man fully biodegradable coronary stent.

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April 12th, 2012

Ascertaining ASCERT: How Well Do Registry Data Measure Up to the ‘Bedside Test’?

Øystein Horgmo, BSc

In the ASCERT observational study, stable patients (age 65 or older) with double- or triple-vessel CAD, but not left-main disease, were found to have better long-term survival after CABG than after PCI. ASCERT was a laudable achievement in terms of its scope and the level of collaboration it represents. The ASCERT investigators used inverse probability weighting (propensity […]

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March 27th, 2012

ASCERT Observational Study Finds Long-Term Advantage for CABG over PCI in High-Risk Cases

Larry Husten, PHD

A very large observational study finds that long-term mortality in high-risk patients is lower after bypass surgery than after PCI. The results, which were first revealed in January at the annual meeting of the Society of Thoracic Surgeons (STS), were presented in final form at the American College of Cardiology by William Weintraub and published simultaneously in the New England […]

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