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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August 1st, 2012

RIFLE-STEACS: Radial Access Improves Outcomes in Early Invasive Therapy

Larry Husten, PHD

For early invasive therapy for ST-segment elevation acute coronary syndrome (STEACS), the use of radial access instead of femoral access reduces bleeding complications and improves outcomes, according to the first large, randomized trial testing the two approaches in this population. The results of the Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome (RIFLE-STEACS) […]

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May 7th, 2012

All Dressed Up and No Place to Go: False-Positive Activation of the Cath Lab for Primary PCI

Larry Husten, PHD

Primary PCI is widely recognized as the best early option for patients with  ST-segment elevation myocardial infarction (STEMI). However, efforts to deliver primary PCI to the broadest possible population inevitably result in an increased number of false-positive activations of the cardiac catheterization laboratory. Now, a new study published in the Archives of Internal Medicine finds that […]

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April 24th, 2012

Primary PCI Meta-Analysis: Mortality Trumps All

Chohreh Partovian, MD, PhD

In a new meta-analysis Dr. Gregg Stone and members of the Drug-Eluting Stent in Primary Angioplasty (DESERT) Cooperation concluded that reduction in target-vessel revascularization (TVR) associated with drug-eluting stents (DES) in primary PCI provided a powerful reason for continued use of DES in primary PCI. An accompanying editorial by James Brophy focused on several potential DES weaknesses in the study. […]

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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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January 30th, 2012

Selections from Richard Lehman’s Weekly Review: Week of January 30th

Richard Lehman, BM, BCh, MRCGP

This week’s topics include lifetime cardiovascular risks, anticoagulation self-monitoring, opting for thrombolytics over late transfer for PCI, exercise’s antidepressant effect, and the worry that statins can induce diabetes.

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December 13th, 2011

Meta-Analysis Finds No Danger for PCI Performed at Centers Without Surgical Backup

Larry Husten, PHD

On-site surgical backup for PCI has long been mandated by guidelines, though its necessity in the modern era has been questioned, and the most recent PCI guidelines published last month lack a specific recommendation about surgical backup. Now a large meta-analysis, published in JAMA, suggests that PCI performed without surgical backup may be safe. Examining data […]

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November 30th, 2011

Thrombolysis Instead of Primary PCI

Sanjiv Shah, MD

The latest analysis of 2009 CMS data for 13,776 STEMI patients of door-in to door-out (DIDO) time by Herrin and colleagues does not bring encouraging news. After many years of hard work to reduce DIDO time for patients who present at facilities without primary PCI capability, only a small fraction of patients (<10%) are transferred […]

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November 30th, 2011

Should FedEx Be in Charge of Primary PCI?

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

Federal Express built its business on being a leader in transportation and delivering on time.  Perhaps the results of primary PCI in the U.S. would be better if FedEx ran the program. In patients with acute MI who must be transferred to another hospital for primary PCI, experts agree that the door-in to door-out (so called, […]

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November 28th, 2011

Long Transfer Delays for STEMI Patients at Most Hospitals Without Primary PCI

Larry Husten, PHD

Fewer than 10% of STEMI patients eligible for PCI who arrive at a hospital without PCI capability are transferred within the recommended times, according to a new study published in the Archives of Internal Medicine. Although dramatic improvements in door-to-balloon times have been achieved in recent years in PCI-capable hospitals, the new report suggests that […]

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