CardioExchange Archive

January 31st, 2012

Appropriate Use Criteria for Revascularization Updated

Larry Husten, PHD

The ACC, AHA, and other organizations have released updated appropriate use criteria for coronary revascularization. The 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update incorporates data from the SYNTAX trial on the indications for PCI and CABG in patients with symptomatic, multivessel disease, as well as data from the CathPCI registry. Here are some of the key ratings: […]

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January 30th, 2012

Very Large Observational Study Finds Significant Mortality Advantage for CABG Over PCI in High-Risk Patients

Larry Husten, PHD

Although PCI has a small, early mortality benefit compared to CABG in high-risk patients, after the first year a striking survival advantage for CABG develops, according to results of the ASCERT study, presented on Monday at the annual meeting of the Society of Thoracic Surgeons (STS). Fred Edwards presented the high-risk subset of ASCERT (ACCF-STS Database Collaboration […]

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December 15th, 2011

PCI and On-Site CABG: Out of Site, Out of Mind?

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

According to a recent meta-analysis of studies in patients undergoing PCI, rates of in-hospital mortality and emergency CABG for primary and non-primary PCI were similar at centers with and without on-site surgery.  At least, that’s the story the press is spreading around. However, several caveats should be noted . . . 1. The study included patients undergoing […]

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July 15th, 2011

Panel: Why Don’t Cardiologists Eat Their OATs?

CardioExchange Editors, Staff

In 2006, the Occluded Artery Trial (OAT) showed no benefit of routine PCI in patients with persistently occluded infarct-related arteries that were identified at least one day after an MI. According to a recent study, led by Judith Hochman, OAT has had minimal impact on clinical practice. We asked Hochman and two other experts why […]

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July 12th, 2011

Pass (Up) the Guidelines, Please

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

The Occluded Artery Trial (OAT) demonstrated no benefit of routine PCI in persistently occluded infarct-related arteries identified more than 24 hours after MI. These results were incorporated into the revised guidelines for STEMI, NSTEMI, and PCI (published in 2007 and 2008) as a class III recommendation (i.e., not indicated and inappropriate). The senior investigator for […]

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July 7th, 2011

Expert Panel: How Often Is PCI Appropriate?

CardioExchange Editors, Staff

The CardioExchange editors have asked a panel of experts to weigh in on a new study published in JAMA. It showed that nearly all the acute percutaneous coronary interventions (PCIs) in the National Cardiovascular Data Registry from June 2009 through September 2010 were warranted, according to “appropriate use criteria” for coronary revascularization. However, the study […]

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July 7th, 2011

NCDR Report on PCI Appropriateness: A Slap on the Back…or a Slap in the Face?

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

According to an analysis of data from the National Cardiovascular Data Registry (NCDR), nearly all (98.6%) acute PCIs (i.e., those done for STEMI, NSTEMI, and unstable angina) were classified as appropriate. For nonacute indications, however, only 50% were classified as appropriate; 38% were of uncertain appropriateness, and 12% were deemed inappropriate. Dig under the hood and what […]

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July 5th, 2011

Only Half of Nonacute PCIs Deemed Appropriate

Larry Husten, PHD

Only half of all PCIs performed for nonacute cases have a definite indication, according to a report from the National Cardiovascular Data Registry published in JAMA. Paul Chan and colleagues analyzed data from more than half a million PCI procedures performed between July 1, 2009 and September 30, 2010. Out of 500,154 PCIs, they found […]

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June 23rd, 2011

The Elusive 30-Minute “Door-In to Door-Out” Benchmark for Primary PCI Transfers

CardioExchange Editors, Staff

The editors at CardioExchange have again asked a panel of experts to respond to a clinically important study. This time it was a retrospective cohort study, published in JAMA, of door-in to door-out (DIDO) times for patients with ST-segment-elevation MI who had been admitted to one hospital and then were transferred to another center for […]

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June 2nd, 2011

Small Study Suggests Possible Benefits of Fish-Oil Supplements for PCI Patients

Larry Husten, PHD

A small study from Poland raises the possibility that supplements containing omega-3 fatty acids may have beneficial effects when given to PCI patients already taking aspirin and clopidogrel. The investigator-initiated study randomized 54 PCI patients to either 1 g per day of n-3 PUFA daily or placebo for one month. The results have been published […]

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