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The new sirolimus-eluting stent boasting a biodegradable polymer and a thin-strut design that is 25% thinner than the market-leading permanent-polymer stents looks similar to a market leader, at least on angiographic follow-up.
Full clinical outcomes presented at EuroPCR today "demonstrate low one-year mortality, low stroke rates, and low rates of aortic regurgitation and paravalvular leak," investigators said.
Professional societies have released an update to the "core competence" required of physicians wanting to perform percutaneous coronary interventions. In it, average annual volumes are lower, while patient-centered care, procedure appropriateness, and awareness of personal stats have moved to the forefront.
The CREST analysis showed that poststent deployment angioplasty reduced the risk of restenosis by 64% but was associated with a nearly fourfold increased risk of stroke.
A new analysis of BARBER-1 suggests that physician inertia might be the reason African American men failed to reduce their blood pressure lower than hoped.
If you don't use it, you're going to lose it—the old chestnut is supported by a new VA Medical Center study showing that fit elderly patients with hypertension had a lower risk of death than those with low levels of cardiorespiratory fitness.
US cardiologists seem to have a double standard when it comes to managing thromboembolic risk in patients with paroxysmal vs persistent atrial fibrillation, despite guidelines calling for equality.
Interim results show reduced risk of bleeding and no increased risk of thromboembolism when aortic-valve-replacement patients receive less aggressive anticoagulant therapy.
Speaking at the 2013 AATS meeting, Cheney describes his LVAD procedure the toughest of all his heart surgeries, while his transplant was a walk in the park. He and his cardiologist, Dr Jonathan Reiner, are coauthoring a book about Cheney's four-decade-long CVD odyssey.
Current eligibility criteria for gastric bypass and other bariatric surgeries mean it isn't offered to many patients for whom it might provide remission from diabetes, say researchers presenting at the PDMS sessions.
Not lipids, not HbA1c, CRP, not even insulin levels: metabolic markers that had mostly normalized during the first year after weight-loss surgery didn't slip back among teens who regained pounds during year 2 in the small prospective AMOS study.
Overall ischemic stroke rates have declined sharply in Sweden over the past 25 years, as have overall mortality rates after a first stroke. But some troubling trends among young Swedes are cause for alarm.
A survey of cardiologists in Spain reveals that only three out of four cardiologists are routinely asking patients whether they smoke, and the majority admit they seldom use tools and medications to help their patients quit.
A taste for salt, acquired as a toddler, may be putting young Americans at risk for later hypertension. The first study to review salt content in commercial foods for babies and toddlers identified prepared meals and salty snacks for toddlers as the main culprits.
CORRECTED // In a global epidemiologic study, slurping back too many sugary drinks was linked with hundreds of thousands of BMI-related deaths from CVD, diabetes, and cancer each year.
Many cardiologists expressed disappointment that they did not get to hear the PREVAIL results at the ACC late-breaking trial session this morning. But the ACC is standing by its decision to pull the presentation following an embargo break by the trial's sponsor, Boston Scientific.
Regarding the primary end point, the combination of coronary death, nonfatal MI, stroke, or coronary revascularization occurred in 15.0% of patients in the control arm and 14.5% of patients in the niacin/laropiprant arm, a difference that was not statistically significant. Equally important, the researchers also documented a significantly increased risk of adverse events with niacin/laropiprant, with approximately 30 adverse events per 1000 treated patients.
People who eat the most fried chicken, fish, and potatoes; high-salt foods such as bacon and ham; as well as sweetened beverages, have the highest risk for stroke.
Experts gathered at the International Conference on Prehypertension and Cardiometabolic Syndrome say they can't wait for the data from ongoing clinical trials—they are proceeding with low-dose pharmacological treatment in select high-risk patients.
An aging population grappling with rising rates of hypertension and other cardiometabolic risk factors should prompt a rethink of how hypertension is diagnosed, monitored, and treated, one expert argues.
Maintaining a hematocrit level of less than 45% is associated with a lower risk of thrombosis, as compared with maintaining a hematocrit level between 45% and 50%.
Subgroup analyses of the combined EINSTEIN-DVT and EINSTEIN-PE trials showed promising results for the novel oral anticoagulant compared with standard anticoagulation therapy in specific high-risk populations such as elderly, fragile patients, those with cancer, and those with large clots.
Dalcetrapib is the second CETP inhibitor to fall by the wayside despite initial excitement that raising HDL-cholesterol levels would translate into a reduction in clinical events. Some experts believe it might have been done in by a slight increase in blood pressure, the same problem that plagued torcetrapib.
UPDATED // The trial in primary-prevention patients, "a game changer," according to one expert, also showed a benefit for a key secondary end point when devices were programmed to deliver therapy only at a heart rate >200 bpm.
Rather, young adults who die from cardiac arrest are more likely to have been relaxing at home, according to a study of toddlers to 40-year-olds living in Ontario. Most deaths were in men (76%) over age 18 (90%). Playing organized football or hockey was not linked with an increased risk of death from this cause.
Researchers determined that for patients in the RAFT trial, implanting a cardiac resynchronization therapy defibrillator, as opposed to an implantable cardioverter defibrillator, is cost-effective. In their predictive model, the added cost per high-quality year of life was about Can$29 000, or US$33 000, which is below the $50 000 limit for a cost-effective healthcare intervention.
The latest results from the ADVANCE registry, the largest monitored prospective study of transcatheter aortic-valve implantation with CoreValve, suggest that the doctors implanting the devices have become much better at the procedure since the days of the first trials.
New follow-up data from the PARTNER B study confirms that inoperable patients with aortic stenosis are much more likely to live three years with a transcatheter aortic-valve implant than on optimal medical therapy.
Preliminary data from a series of patients receiving TAVI devices on top of failing surgically implanted mitral valves or rings, so-called valve-in-valve procedures, hint at decent long-term efficacy. But a high rate of cardiovascular death in the hospital is a serious teething problem that needs to be addressed.
Interventional cardiologists and cardiac surgeons outside the US will soon be faced with a large array of new valves they could employ for TAVI. When and whether to employ novel devices—which have subtle design differences compared with older ones—was a topic of much debate at PCR London Valves this week.
Patients who actually gain weight following a new diagnosis of type 2 diabetes are, happily, in the minority. But this often-overlooked group needs special attention from physicians, a new analysis suggests.
New subgroup suggests "target-directed" interventions can keep hemoglobin A1c levels within normal range for at least five years in both diabetic and nondiabetic patients. But at least one observer is raising questions about mortality rates in the study and the downsides of testing daily insulin injections in a nondiabetic population.
Teens gained almost two pounds for each can of soda they drank every day. But a new study revealed the previously unknown consequence that teens put on even more weight if they drank a bottle of sports drink each day.
Three studies, including two randomized trials, demonstrate a role for sugar-sweetened beverages in promoting obesity and support hopes that their replacement with noncaloric drinks can be an effective weight-control strategy.
With the pump implanted subcutaneously and its lines with only a minithoracotomy, the diminutive device is aimed at ambulatory patients who haven't necessarily reached end stage; so far it's been tested in only a handful of patients.
It was a wash between warfarin and aspirin in the overall trial, but subgroup analysis suggests some patients actually did benefit from warfarin with a lower mortality/stroke risk. Still, one observer has his doubts.
The renin inhibitor aliskiren showed no benefit when added to ACE-inhibitor/ARB treatment in diabetic patients at high cardiovascular and renal risk and increased the risk of stroke and hyperkalemia.
Dual therapy with oral anticoagulants and clopidogrel showed a large reduction in bleeding without increasing ischemic events compared with triple therapy including aspirin. Indeed, mortality was actually lower without aspirin.
Slowing the heart rate down during a cardiac CT scan also allows the radiologist to use techniques to reduce radiation exposure without compromising image quality. But how aggressive can the heart-rate-control protocol be without compromising safety?
UPDATED // The current appropriate-use criteria regard CT coronary angiography as inappropriate in intermediate- or low-risk patients and of uncertain value in high-risk patients, but real-world data show many asymptomatic patients are getting these scans anyway, and the results are surprising.
A new study shows that a modified echocardiogram, taking just 10 minutes to perform, can reasonably be added to an athlete-screening program. But the study did not answer the question of whether this was a useful or cost-effective move.
Volunteers who used handheld echo to screen patients in a remote corner of rural India—or helped read those images from locations around the globe—now have some solid numbers that attest to the feasibility and potential impact of their unique project.
New guidance documents on cardiac resynchronization therapy for heart-failure patients again stirred debate about whether CRT should be given to patients with moderate QRS prolongation.
The European Society of Cardiology is expected to release new guidance on stroke prevention in atrial-fibrillation patients later this year, and some of the experts familiar with the development of that document hinted at what the guidance will say during presentations at Cardiostim 2012.
The virtual program, which included no face-to-face contact with patients but still reduced HbA1c levels 2.0%, is economically feasible and can be implemented almost anywhere, say researchers.
UPDATED // Quality-improvement efforts resulted in better HbA1c, LDL-cholesterol, and blood-pressure levels and resulted in an increased likelihood that patients would receive aspirin and screening for retinopathy, renal function, and foot abnormalities.
After a series of negative trial results, the concept of raising HDL as a therapeutic approach to reduce CV risk looks to be in a sorry state. But lipid experts at the recent European Atherosclerosis Society Congress were adamant that the HDL hypothesis was not yet dead and that it is imperative that research in this direction continue.
The novel agent shows promise for an especially difficult-to-treat population, but could certain side effects and laboratory abnormalities affect its acceptance?
In the SHIFT trial of the heart-rate-lowering agent ivabradine, it was heart-rate reduction per se, not the level of accompanying beta-blocker therapy, that apparently accounted for the newer drug's observed benefits.
Data from a different era suggest digoxin may deserve a fresh appraisal for chronic heart failure even in the modern age of multidrug neurohormonal blockade.
Analyzing data from a large US database, investigators report that resistant hypertension was associated with increased risks of heart failure, stroke, and MI, but with lower rates of mortality.
In the first study, researchers showed that combination treatment with extended-release phentermine/topiramate reduces weight, improves BP, and decreases the progression from prehypertension to hypertension. In the second, laparoscopic adjustable gastric banding also reduced the weight of obese patients, decreased systolic and diastolic BP, and allowed nearly one-quarter of patients to stop taking their antihypertensive medications.
While equal to the market-leading Xience/Promus stents in terms of efficacy and safety, the Nobori failed to show an edge where many hope stents with bioerodable polymers will have their niche—in reducing stent thrombosis.
Robotic control devices have become an established part of the surgical field, enabling procedures to be less invasive than ever before. Can the same technology make an impact in coronary interventions?
A multisociety group led by the ACC and SCAI has released new appropriate-use criteria for diagnostic catheterization intended to help clinicians determine when cardiac catheterization is a reasonable option for the evaluation of patients.
Greater waist-to-hip ratio—but not two more common obesity measures—meant a higher sudden death risk independently of diabetes, CV disease, and heart failure in the community-based cohort study.
Recurrences were less common for patients who underwent catheter ablation vs antiarrhythmic drug therapy, but it took the right connections for catheter therapy to come out on top.
The multidisciplinary program includes physicians, nurses, physical-activity specialists, social workers, dieticians, and targeted patients referred by family physicians as high risk for cardiovascular events based on their risk-factor profile.
The guidelines are intended to keep the car engine running before any problems occur, according to the experts. Prevention and education should ideally start with young parents and continues with children through kindergarten and as they advance through the school system. For adults, secondary prevention can be coordinated through nurse-based activities and by the efforts of general practitioners and cardiologists.
Most of the discussion of PARTNER trial and early rollout of transcatheter valves focused on differentiating TAVI candidates from patients better suited to surgical valve replacement. While experts continue to be alarmed by the number of relatively low-risk patients getting TAVI in some countries, they're also drawing attention to the number of TAVI procedures in patients who are too sick to benefit from any valve replacement.
The bottom line can benefit, if clinical gains aren't enough reason for wide-scale implementation of guidelines for blood-product use with cardiac surgery.
A nationwide campaign in Portugal—whereby pharmacy customers were encouraged to have their BP, cholesterol, and BMI assessed in-store—has demonstrated that this kind of approach is feasible and that pharmacists can act as good go-betweens for patients and physicians, says one of the researchers.
A small, short-term study looking at the effects of high-dose vitamin D on blood pressure in hypertensive subjects in Denmark during the winter months has shown somewhat discrepant results.
Even more striking, smokers were largely unaware that secondhand smoke increases the risk of heart disease and stroke among nonsmokers, a number that spiked even higher when nonsmokers were questioned.
Two new studies presented this week highlight the importance of urban design in the fight against obesity and cardiovascular disease, with investigators reporting that heart-healthy neighborhood features influence the amount of participation in physical activity.
Failing to meet the benchmarks defining cardiovascular health has important clinical implications, as investigators show that meeting a greater number of cardiovascular health metrics is associated with a lower risk of total and cardiovascular disease mortality.
BRIDGE-ACS evaluated how a coordinated education strategy could improve the Brazilian hospitals' adherence to evidence-based medicine for acute coronary syndromes.
UPDATED // Findings from two randomized trials showed that bariatric surgery was considerably better than traditional medical therapy for controlling type 2 diabetes in obese patients, independent of weight loss. But critics caution that much longer-term data are needed—to show actual changes in the serious complications of diabetes in years to come—before this "huge intervention" can be considered as a valid treatment for the condition.
A new study shows tPA was safe for patients who woke up with stroke symptoms, a population not normally treated since they could exceed the 4.5-hour window.
Why has the development of less invasive mitral-valve repair therapies lagged so far behind comparable strategies to treat the aortic valve? Experts from FDA, industry, and academic medical centers offered some possible answers in a roundtable discussion.
Only 104 of the 799 high-risk patients in the PARTNER A trial of the Sapien transcatheter valve were treated with the transapical approach, so it can be considered to be only the preliminary experience with this technique. Now data from 822 patients in the continued-access protocol are available.
A group of 45 AF experts from North America and Europe will soon publish a major update to the 2007 international clinical consensus statement for the use of catheter and surgical ablation for the treatment of AF.
Researchers of the beleaguered antiarrhythmic dronedarone believe the drug may still have a role to play in AF therapy for some patients and are testing it as a low-dose complement to another newer antiarrhythmic drug, ranolazine.
Overall, the bleeding risk scores were able to identify patients at high risk for bleeding but had limited ability to identify patients at intermediate risk, report investigators.
Patients with conditions such as atrial fibrillation who need to have their long-term warfarin anticoagulation interrupted so that they can undergo invasive procedures don't always require so-called "bridging" therapy, says one expert.
One study showed that transradial cardiac catheterization, including diagnostic angiograms and coronary interventions, was comparable to the femoral approach when performed by operators in training, while another suggested that the learning curve for transradial-access PCI is steeper than first thought.
Percutaneous approaches to repairing or replacing the mitral valve are much further behind in development than transcatheter aortic-valve implantation. Doctors at the recent London Valves and European Association of Cardio-Thoracic Surgery meetings discussed why.
The wide geographic variation in the uptake of TAVI was the subject of a session at the recent PCR London Valves Meeting, where attendees learned that Germany is the foremost adopter of this technology. Regulatory hurdles and funding and reimbursement issues, among other things, determine how quickly this new technology is being introduced, speakers explained.
Esomeprazole is "at least as bad" as omeprazole in reducing the antiplatelet effects of clopidogrel, a new randomized trial shows, but when it comes to statin effects, SPICE found no differences between rosuvastatin and atorvastatin on platelet function.
Canadians who tend to pride themselves on being healthier, generally, than their neighbors south of the border need to take a cold hard look at CVD trends in their own country, according to American cardiologist Dr Clyde Yancy.
Provocative new observational data from the UK show higher in-hospital and three-year mortality with the use of off-pump bypass surgery compared with conventional on-pump CABG. But not all surgeons here at the EACTS meeting agreed with the findings, and the results generated much debate.
Four-year results from the landmark SYNTAX trial continue to support the notion that low-risk patients with three-vessel or left main disease can arguably be treated with either PCI or CABG, but those at intermediate or high risk should probably get surgery.
The lifestyle habits that lead to obesity and cardiovascular risk often begin in childhood, but convincing kids to eat healthy food and stay active is difficult in a country full of tasty but unhealthy treats and impediments to regular exercise.
Researchers first observed the obesity epidemic in the 1980s. What do the data on people born since the 1980s predict about the future incidence of obesity?
Over the past few years, patients and physicians have become increasingly aware of the potential hazards of radiation exposure from cardiovascular imaging, especially CCTA. So now many centers have begun implementing comprehensive radiation-reduction programs to reduce the radiation dose from each scan and the cumulative exposure of each patient.
Little research has been completed on the role of computed-tomography angiography for guiding therapy decisions, so some researchers in South Carolina scanned patients with prior positive stress nuclear myocardial perfusion studies with CCTA and elective catheter angiography to see how CCTA guided therapy.
Their use may vary between internal-medicine and emergency-medicine doctors, depending, to some extent, on the questions asked—or not asked—at the history-taking.
UPDATED // Offering a rare glimmer of good cardiovascular-disease news for a diabetes drug, a new meta-analysis suggests that dipeptidyl peptidase-4 inhibitors, at worst, do not increase the risk of cardiovascular events and, at best, may even have a protective effect.
Lead investigator of an analysis of long-term data from the San Luigi Gonzaga Diabetes Study says a blood test two hours after lunch is a strong predictor of major events and, at least for all-cause mortality, as predictive as HbA1c.
With the possibility that oxygen may be killing rather than helping MI patients and few studies on this issue conducted, a large-scale trial is desperately needed, attendees at the ESC meeting heard today.
The guidelines update recommendations issued in 2007 and include use of new antiplatelet agents, new ways to rule out ACS, an up-to-date bleeding score, and a reminder to physicians to be their own best critics.
For patients at very high risk of cardiovascular disease, the ESC/EAS writing committee states that LDL-cholesterol levels should be lowered to less than 70 mg/dL, a target that is not optional, as it is in the NCEP guidelines. Even moderate-risk patients have a new target, that being less than 115 mg/dL, which is also lower than the NCEP guidelines. The task force believes there is a wealth of evidence supporting the "lower-is-better" LDL theory.
Despite the recent failure of AIM-HIGH, as well as ACCORD-Lipid and FIELD, niacin and fibrates are the drugs of choice for treating patients with high triglycerides and low HDL-cholesterol levels. That said, authors of the new report urge that patients adopt healthier lifestyles, pushing for diet and exercise first to alter the adverse lipid profile.
CORRECTED // When the ESC was planning new guidelines on the treatment of atrial fibrillation, the task force expected to be able to include information on trials of many new anticoagulants that were about to come on the market. But only a few of these expected trials were complete when guidelines were published in September 2010, so the ESC is considering another update.
In a debate on the best therapy for patients with ventricular tachycardia and preserved left ventricular ejection fraction, the experts agreed that doctors must decide on ablation or an ICD without definitive data to support either option.
Insulin degludec achieves glycemic control to a similar extent as insulin glargine, but with a lower rate of nocturnal hypoglycemia, in patients with type 1 and type 2 diabetes.
Significant differences in blood-pressure readings between arms in hypertensive patients are surprisingly common and can indicate a patient is at increased risk of vascular disease and death, a new meta-analysis shows.
Recent data from a cross-sectional study show that patients with hypertension who also suffer from migraine are much more likely to have had a cardiovascular event, particularly a stroke or TIA, than those with high BP alone. These results add to an accumulating body of evidence that indicates migraine could one day be considered a risk factor for stroke, says one expert. He acknowledges, however, that further research is still needed.
In patients presenting with ACS, a relatively new echo technique—speckle tracking—can be used to more easily stratify patients according to predicted risk of death, researchers report.
A large study of elderly patients with severe aortic stenosis but with preserved LV function who did not undergo surgery identified four echo parameters that predicted mortality.
Why didn't nesiritide alleviate dyspnea better in the largest-ever randomized trial in acute decompensated heart failure? A post hoc analysis suggests that, just maybe, "time to treatment may be more important than the kind of therapy."
A "debate" had much to teach about the physiology underlying the benefits of contemporary heart-failure therapy and what could be a new twist in managing patients with the disorder.
A number of studies presented this week are addressing improvements in hypertension control. One project, from a group in Northern California, showed that by adhering closely to clinical guidelines, developing a hypertension registry, and disseminating best practices from high-performing centers to other groups, hypertension control rates could be boosted from 44% to 80%.
The researchers noted that 30% of firefighters had elevated blood-pressure levels, and of those who had normal blood pressure, 13% had an excessive systolic and diastolic blood-pressure response to an exercise stress test. This adrenergic response might also occur while fighting fires and could partially explain why this high-risk occupation has a higher risk of coronary heart disease.
The new document stresses the importance of universal familial-hypercholesterolemia screening by age 20. Children as young as two years old should also be screened if they have a family history of premature cardiovascular disease or elevated cholesterol levels. The consensus group emphasizes the use of statins as first-line therapy during treatment.
A number of studies are attempting to determine why omega-3 fatty acids increase LDL cholesterol. One study suggests that EPA might prevent lipid peroxidation, which would help LDL-cholesterol clearance, while DHA does not. Other analyses confirm the differential effects of EPA and DHA on LDL-cholesterol levels.
View our slideshow for results from the leading trials and most important debates from EuroPCR 2011. Featuring analysis of RECLOSE 2-ACS, DISCOVER FLOW, TAVI updates, renal denervation, BASE-ACS, SOURCE, DES meta-analysis, and the SCAAR registry.
Interventional cardiologists are mulling the potential new applications for renal denervation, even as they admit that the very limited data supporting the procedure in resistant hypertension need to be replicated in larger outcome studies.
The predicted mortality of CABG patients stayed about the same from 2000 through 2008 as their actual mortality, and stroke rates declined dramatically, indicating that it's time to set new benchmarks.
Surgeons in the US say they don't want to see transcatheter aortic-valve implants substituted for as many valve-replacement surgeries as they have in Europe, because the PARTNER A neurological events data show that the traditional surgical approach has a lower risk of neurological events and the durability of TAVI is not yet proven.
The use of an investigational diagnostic mapping system allows clinicians to identify and ablate localized drivers of AF, resulting in significantly better outcomes when combined with conventional ablation than pulmonary vein isolation alone.
The new consensus statement covers genetic testing for 13 channelopathies and cardiomyopathies, including long-QT syndrome, Brugada syndrome, atrial fibrillation, and hypertrophic cardiomyopathy, among others. Authors say genetic testing is just one piece of information used to diagnose patients and should not be used to circumvent the clinical decision-making process.
UPDATED // A report on transradial access for percutaneous intervention proposes a three-tier competence structure for assessing interventionalists' skill, while calling for more research on how best to train both new and experienced interventionalists in the technique.
The Society for Cardiovascular Angiography and Interventions has released a national quality program, including a Quality Improvement Toolkit for all hospital cath labs.
Couples who attended a preventive cardiology program together, after one partner had suffered a coronary disease event, changed their dietary and exercise habits in tandem, a new analysis from the EUROACTION study shows.
A new study finds those who sleep badly for short periods of time have a 65% increased risk of cardiovascular disease compared with normal sleepers; it's time that sleep was considered a serious risk factor for CVD, says the researcher.
Among the main reasons for first readmission were infection, bleeding, planned procedure, device malfunction, and neurological complications. Experts, however, say the rate of readmissions is "acceptable" given the dismal readmission rates seen with traditional heart-failure therapy in these very ill patients.
A strategy in which everolimus was added to a reduced-dose cyclosporine regimen improved renal function in approximately 50% of patients, Italian investigators report.
There's no subterfuge here—the ACC announced its new corporate partners back in 2010 and insists it has solid disclosure and protection policies in place. But as the second annual ACC CardioSmart Health Fair throws open its doors to some of America's highest-risk citizens, some are asking whether the hundreds of thousands of dollars donated by a fast-food restaurant and soda company, among others, lead to more harm than good.
The lead investigator of the PROTECT II trial, which was stopped early for futility, presented per-protocol analysis of the interim data, which he says proves that Abiomed's Impella circulatory support device provides much better hemodynamic support than an intraoperative balloon pump in high-risk PCI patients.
A panel of cardiologists working on improving care of STEMI patients agreed at CRT 2011 that regional coordination of emergency services and referring hospitals is the key to further improving care of these patients.
At Cardiovascular Research Technologies 2011, an interventionalist debates a surgeon on whether more left main disease cases will be treated with surgery or percutaneous intervention.
A new randomized trial finds no beneficial effect and a hint of harm associated with antihypertensive treatment with candesartan in the acute phase of stroke.
New studies are raising the question of whether patients with mild strokes or rapidly improving symptoms may also still reap benefit from treatment with tPA.
Building a successful ventricular assist device program is harder than it may appear, surgeons experienced with running programs told their colleagues.
Experience of two decades with this approach in Australia shows that coronary bypass with the right internal thoracic artery, which is rarely used, can yield results equivalent to or better than that of the more commonly used bypass grafts.
Drs Claudio Schonholz and Nelson "Nick" Hopkins argued for flow-reversal/proximal-occlusion devices and filters, respectively. One expert, however, said the issue remains unresolved until better measures of embolization, and what these translate into clinically, are developed.
Experts warned that it is important to clearly define the link between "venous insufficiency" and MS and that interventionalists and MS experts must answer the remaining unknowns given the high level of public interest in the procedure and the new era of regulation and medical cost containment.
The absolute reduction in VTE risk was 0.76%, meaning that for every 125 patients treated with apixaban instead of enoxaparin, clinicians would prevent one episode of major VTE, report investigators.
Discussion as to what role the new oral anticoagulant rivaroxaban might play in the treatment of venous thromboembolism was the subject of a press conference at the American Society of Hematology meeting today. Hematologists gave heartwire their view on the issue.
Join Drs Melissa Walton-Shirley and James Young as they discuss the latest news in heart-failure treatment from aldosterone antagonists to novel left ventricular assist devices.
This year's lineup of late-breaking trials includes some of the most eagerly anticipated trials of recent memory, looking at everything from nesiritide, rivaroxaban, and anacetrapib to platelet-function tests and CRP-guided therapy to PFO closure, renal sympathetic denervation, and a new nonpulsatile VAD.
Used in addition to traditional wires to close the chest, the bone cement is fully functional within 24 hours, completely sealing the breastbone, and is designed to be integrated with native bone as the body heals.
CORRECTED // The updated recommendations incorporate the new anticoagulant dabigatran, even though the drug is not yet approved in Canada. The purpose of including dabigatran in the 2010 recommendations is to have the guidelines as current as possible, and that includes taking a position on drugs evaluated in clinical trials and expected to soon be in the armamentarium of practicing clinicians.
Authors say their 12-month randomized study, in which both strategies of diet and physical activity led to roughly a 10% weight loss, should be a wake-up call to clinicians who tend to think that intensive behavioral approaches don't work in severely obese people.
If statins are metabolized in the small intestine, will they retain their efficacy after gastric bypass? That's a question Norwegian investigators set out to answer.
The one-year results vault the in-house-coated polymer-free stent into the ranks of results seen with some of the market-leading DES. The proprietary technology, however, is not widely available.
The hope, say investigators, is that the polymer-free biolimus A9-eluting stent can reduce late adverse events attributed to the polymer, such as stent thrombosis, and potentially reduce the duration of dual antiplatelet therapy.
ADDITION, a large, randomized, primary-care-based trial, has failed to show a significant impact of intensive treatment of type 2 diabetes on cardiovascular events compared with routine care in those newly diagnosed with diabetes. But the trial, which was much applauded, shows the feasibility of screening patients for undiagnosed diabetes and demonstrates that early intervention does reduce events, say the investigators.
Two relatively new agents for type 2 diabetes have a role to play in the treatment of this disorder because they have been shown to induce weight loss as well as improve glycemia. And these drugs have enabled insulin to be withdrawn in some insulin-dependent patients, says one expert.
Surveillance for allograft rejection is generally no less costly using the AlloMap test, but patients prefer the test, with only provisional biopsy, because—most likely—they have to suffer fewer of the invasive procedures. So should the test have a role in patients at low risk for rejection?
A 100-patient randomized trial suggests that performing tai chi can boost quality of life in patients with mild to moderate heart failure. Should it matter that the exercises didn't also improve six-minute-walk distance or aerobic capacity?
Attendance at this year's ESC Congress in Stockholm is showing early signs of beating last year's record of 32 000 attendees. This year's hot-line sessions, chosen from a record number of abstract submissions, include full details from the AVERROES trial of apixaban—top-line results of which were released early by the company—plus new randomized studies of ivabradine, erythropoietin in STEMI, and a long-term head-to-head comparison of two DES.
UPDATED WITH COMMENTARY // The trial suggests that heart-rate reduction could become a clinically important goal and in fact a treatment target on its own in patients with chronic heart failure. Questions are raised, however, about how the patients who received ivabradine would have fared if more of them had been optimally treated with beta blockers.
Once-weekly exenatide was better at lowering glycosylated hemoglobin levels in patients with type 2 diabetes in two randomized trials that pitted it against sitagliptin, pioglitazone, and insulin glargine.
The future of the Rheos system for use in patients with resistant hypertension is hanging in the balance after a data safety monitoring board told the company the pivotal trial of the device in this indication has failed to meet one of its end points.
A potential new treatment option for patients with resistant hypertension involving a catheter-based procedure to ablate the renal sympathetic nerves has led to a decent blood-pressure reduction that lasted two years in a small number of patients. It is expected that the results of a controlled trial with the therapy in more than 100 patients will be reported at the AHA meeting in November.
The clinical usefulness of a multiple biomarker index, one that includes markers of inflammation, depends on atherosclerotic disease burden, according to the results of a new study. The increased risk of events for asymptomatic patients with a biomarker score above the median occurs mainly in those with a mild amount of atherosclerosis disease, report researchers.
The researchers showed that the engineered myocardial tissue shares structural and functional similarities with native myocardial tissue, including testing positive for troponin I.
Myocardial longitudinal strain and cardiac troponin plasma concentrations may help identify patients in whom anthracyclines and trastuzumab are cardiotoxic.
The novel therapy, aimed at enhancing levels of an enzyme that mediates myocardial contractility, appeared to improve a number of functional and echocardiographic measures in patients with NYHA class 3-4 heart failure. But the trial had some quirks that complicated its interpretation.
Medical therapy directed by direct pulmonary-artery-pressure readings from the tiny device led to a 30% drop in six-month risk of heart-failure hospitalization for the trial's patients with NYHA class 3 disease.
Patients with atrial fibrillation enrolled in the ROCKET-AF trial—looking at whether the novel anticoagulant rivaroxaban is better than warfarin for preventing stroke—are at higher risk of stroke than those who have participated in other recent trials of novel agents for this indication.
One of the largest stroke trials to date not funded by industry shows once again no significant benefit of supplementation with B vitamins in patients with recent stroke or TIA.
The trial was not powered for clinical end points, but numerically, MACE rates were lower for the Nevo—designed with recesses to carry sirolimus and polymer—than the Taxus Liberté in the 400-patient trial.
Rates of cerebral embolisms associated with TAVI procedures reached 70% for both types of procedure but apparently had no neurological or cognitive correlates.
Omega-3 PUFAs from fish oil, started a day or two before surgery, didn't protect against the common post-CABG complication in a >200-patient placebo-controlled trial; on the other hand, researchers reported elsewhere at the HRS sessions that a much longer daily intake of fish-oil caps by patients with symptomatic SVT seemed to help stabilize the atria at electrophysiologic testing.
Vernakalant is more effective than amiodarone for the rapid conversion of atrial fibrillation to sinus rhythm and is associated with a higher rate of symptom relief, according to the results of a new study.
Investigators report that older and diabetic patients and those who underwent complex procedures, as well as those who live many miles from the treating hospital, could be safely discharged the same day of the radial-access procedure.
Swedish researchers report that a new anthropometric measure—waist-to-hip-to-height—is better than other body-mass measures widely in use, at least for predicting all-cause mortality. But just how feasible would such a tool be in general practice?
Delving deeper into the findings of the ACCORD BP study reveals that certain subgroups may benefit more from intensive BP lowering because they are at higher absolute risk of stroke. But the lead investigator says he still can't recommend this strategy in these subgroups.
A second triple-antihypertensive combination therapy looks set to hit the US market in the not-too-distant future; while experts say these products will have a role to play in the management of hard-to-treat patients, they warn that they are powerful agents and should not be used lightly.
UPDATED WITH COMMENTARY // A randomized trial suggests potential, at least, for fewer biopsies in transplant recipients when the invasive procedure is driven primarily by a positive finding on a gene-expression test along with clinical or echo signs, compared with a strategy of routine biopsy surveillance.
Together, two retrospective studies suggest that cardiopulmonary resuscitation duration isn't related to short-term allograft function or transplant-recipient outcomes.
While nonsmokers are likely to derive benefits in terms of a significantly reduced stroke risk if they consumer moderate amounts of alcohol, no such reduction was seen in smokers.
Although there was a suggestion that some of the effect could have simply been due to more attention being paid to the patients, most agree that any intervention that helps warfarin control is worthwhile.
A variety of experts at the CRT conference discuss what it will take to bring minimally invasive transcatheter-valve implants to patients beyond those ineligible for open-heart surgery.
Researchers say their study is the first to confirm a link between dietary fat and stroke in older women and should serve as a reminder to clinicians to educate their patients about food choices.
Individuals living within 100 m of major roadway were more than three times as likely to have coronary atherosclerosis detected by angiography as those who lived farther away.
Researchers say the incremental benefit of vigorous activity over moderate physical activity is small and that as long as individuals are burning a certain number of calories per week they lower their risk of cardiovascular disease.
A small study suggests supports the safety of early surgery for mitral regurgitation in the setting of endocarditis, instead of waiting for the usual six weeks for antibiotics to work.
An observational study in Maine finds that patients who went home between PCI and cardiac surgery had a significantly lower risk of acute kidney injury than patients undergoing PCI and surgery in the same hospital admission.
CT angiography helps risk-stratify men under 55 and women under 65 with chest pain but adds little information to the risk profile of older patients, a secondary study from ROMICAT shows.
Inspired from a series of case scenarios, Drs Garcia, Lima, and Bax contemplate difficult options based on the latest imaging findings and best practice.
A randomized trial found no protection from in-hospital cardiovascular events with a strategy of blood transfusions to maintain hemoglobin above 10 g/dL, compared with a more conservative approach to transfusion therapy, in patients with CV disease or risk factors who underwent hip surgery.
After a median follow-up of 12 years, MI rates were essentially the same among those treated with surgery and those who received conventional care for weight loss.
Researchers in Ottawa find that the longevity of porcine replacement heart valves may depend partly on whether the blood type of the patient matches the blood type of the valve's "original owner."
Inflammatory responses contribute to coronary plaque rupture, thrombosis, and vascular occlusion. Some viruses have proteins that interfere with these inflammatory responses. Researchers have identified a viral-derived protein that may eventually be an anti-inflammatory treatment for coronary syndromes.
After 10 years of clinical use of TZDs, "we are still at the beginning," and randomized controlled trials shed light on their use in appropriate diabetic patients, speakers at a diabetes symposium reported.
Individuals with schizophrenia and diabetes—as opposed to diabetes only—have a greater risk of CAD but a smaller likelihood of receiving CABG or PCI, a large cohort study suggests.
Diabetologists are trying to tease out the best message to convey when it comes to target HbA1c levels for primary-care physicians and other nonspecialists who might be treating patients with type 2 diabetes.
Can an intrathoracic fluid-status monitor, added to an already-indicated ICD or CRT-D device in patients with heart failure, serve as the decompensation early-warning system now provided—unreliably but as recommended in the guidelines—by the bathroom scale?
The two-year prospective registry-based study of a performance-improvement initiative's effectiveness saw significant jumps, >70% in some cases, in the appropriate use of six out of seven measured evidence-based treatments for patients with chronic heart failure.
One trial showed that despite a mean treatment delay of 67 minutes, STEMI patients undergoing primary PCI taken first to an emergency department before transfer had equivalent rates of major adverse cardiac events when compared with those who presented directly to a PCI facility. A smaller study showed that taking patients directly to the cardiac center resulted in significantly better survival when compared with patients who were transported to an emergency department.
Doubling the dose of clopidogrel reduced the risk of MI and stent thrombosis in STEMI patients without increasing the risk of bleeding. The benefit extended to patients who received a bare-metal stent or a drug-eluting stent.
UPDATED // Compared with a 1996 survey by JAMA editors, a 2008 survey indicates that the practice of having ghost writers pen papers, then not appear as authors, is down to 8%, from 12% in 1996. The practice of inviting a prominent name to appear in the list of authors, without requiring that person to contribute to the research, has held steady at roughly 20%.
Clinicians and researchers need to be more aware before signing on to studies about what potential conflicts might arise with the sponsor and set the ground rules for such areas as access to data, manuscript preparation, and right to publish.
Bioerodable polymers may offer a solution to the stent-thrombosis problem that plagues permanent-polymer drug-eluting stents, particularly if efficacy is equivalent. More follow-up is needed, experts say.
Short-term outcomes are the same whether beta blockers are continued or withheld at hospitalization for acute decompensated heart failure, and there are good reasons to continue them, according to researchers.
Doctors from the Portuguese Society of Hypertension have spearheaded a unique mass-media campaign about the harmful consequences of consuming too much salt, which in turn has led to the Portuguese Parliament approving a law restricting the sodium content of processed foods.
The lead investigator for a controversial new analysis of hydrochlorothiazide says the drug is a "paltry" antihypertensive at the usual doses prescribed (12.5 mg-25 mg/per day) and should not be used as initial therapy. Others, however, offered plenty of caveats for the "provocative" conclusions.
The investigational glucagonlike peptide-1 (GLP-1) analog is also associated with more weight loss and better tolerability than the already-on-the-market GLP-1 receptor blocker exenatide.
The largest study to date looking at whether the risk of bone fractures is increased in the setting of thiazolidinedione drugs suggests that fracture risk is more than 40% higher in people taking TZDs and that both men and women are vulnerable.
Not even a 50% one-year mortality rate seen for the transapical approach in the PARTNER EU registry is dampening enthusiasm for the Sapien valve or for the transfemoral-only CoreValve and the up-and-coming devices still in development.
The findings should help quell fears of a late catch-up phenomenon with a stent some have referred to as "DES-lite" and dispel concerns raised in meeting presentations last year about increased adverse events with this device.
The consensus statement is intended to clarify important issues, such as indications, techniques, and outcomes, so that patient care can be optimized and areas of improvement identified.
In an interim analysis, the stent appeared to reduce revascularization rates and improve Rutherford score, walk distance, and walk score. A randomized trial completed enrollment last year.
The regional study highlights the need for studies addressing whether stent-thrombosis-STEMI patients should be treated the same as other STEMI patients.
After 12 weeks of treatment with a dual-acting receptor antagonist, 60% of patients treated with the highest dose of the agent achieved blood-pressure control, whereas just 32% of patients treated with high-dose irbesartan achieved the same degree of control.
Children who have higher-than-normal triglyceride levels will grow up to be at greater risk for cardiovascular events when they hit their 40s and 50s, Cincinnati researchers say.
Inadequate very early antithrombin and antiplatelet therapy appears a strong driver of early stent thrombosis in STEMI patients undergoing primary PCI. Researchers say to give all patients a heparin bolus and 600 mg of clopidogrel as soon as possible.
Investigators who adjusted clopidogrel dose on the basis of VASP index found they could reduce risk of stent thrombosis as well as MACE at 30 days. (American Heart Association 2008 Scientific Sessions.)
In a comparison with the Cypher stent, SORT-OUT III showed an increased risk of MI and stent thrombosis with the Endeavor zotarolimus-eluting stent at nine months, while two-year registry data suggest an increase risk in all-cause mortality. While everybody urged caution in interpreting the findings, experts say the results are a warning signal. (TCT 2008.)
Critics say the CMS should have waited for pending publications of the SAPPHIRE, CAPTURE 2, and EXACT data before announcing its decision, especially as new results from PROTECT, EMPIRE, and EPIC indicate that stroke, death, and MI rates are continuing to decline. (TCT 2008.)
