The document comes amid growing debate over when physicians should or should not move ahead with either PCI or surgery. (Patel MR et al. J Am Coll Cardiol; published online before print January 5, 2009.)
Washington, DC - Six medical professional societies have teamed up to produce "appropriateness criteria" to guide the use of revascularization procedures, both PCI and surgery. The document, also endorsed by a handful of other societies, comes amid increasing debate over whether certain interventions—PCI in particular—are being overused in patients who could just as well be managed medically.
But according to Dr Gregory J Dehmer (Texas A&M University College of Medicine, Temple), one of the writing-committee members, the appropriateness criteria were prompted by concerns about rising healthcare costs and the need to make sure that expensive technology and services are applied in an evidence-based fashion.Read full article »
(Patel MR et al. J Am Coll Cardiol; published online before print, January 5, 2009.)
Inside: Interventional/Surgery
Accredited educational programs, supported by industry, developed by theheart.org
Provisional T-stenting, crush, or culotte? Which is the best way to tackle bifurcation lesions? Dr Hildick-Smith presents an overview including the results of his TCT 2008 late-breaking BBC-ONE trial.
Can drug-eluting stents now be considered the standard of care in patients with STEMI undergoing PCI? Can target lesion revascularization be reduced further? What about bleeding? Please join Drs Stone, White, and Harrington as they tackle these and other pressing questions in the treatment of AMI.
Will SYNTAX results mean more patients with complex lesions now receive DES? Join our international panel of experts, Drs Serruys, Mohr, Beatt, and Smith as they discuss optimal management of patients with complex cardiovascular lesions.
Several recent studies have demonstrated that patients with atherothrombosis who experience bleeding may be at increased risk for long-term adverse ischemic events. Whereas the specific mechanism(s) that may explain the correlation between bleeding and ischemic events remains to be fully elucidated, these findings may have important ramifications for the selection of appropriate antiplatelet therapy. Drs. Berger, Mehta, Simon, Steg, and White discuss.
Harmonizing guideline recommendations for antiplatelet therapy with recent clinical trial data and concerns about bleeding can pose a challenge. Drs Berger, Mehta, Simon, Steg, and White each give presentations addressing issues relating to the appropriate use of antiplatelet therapy in patients with atherothrombotic disease
Warfarin remains the cornerstone of stroke prevention in patients with AF. However, many patients are unable or unwilling to take it. Could antiplatelet therapy fill this gap? How might investigational anticoagulants change the playing field? Dr Naccarelli leads a panel discussion with Drs Connolly and Camm.
The optimal management of patients with ACS is an ever-evolving process; clinical experience and practice often outpace guidelines. Watch Drs Bohm, Camm, Fox, Mehta, and Connolly address the state-of-the-art management of ACS and the role of antiplatelets in ACS and beyond.
Current guidelines for thienopyridines in PCI note the lack of RCT data for higher loading doses. Read Dr Wang's lowdown on loading doses, including recent presentations from the 2008 SCAI-ACCi2 meeting. Then watch Drs Mehta and Mehran discuss where CURRENT-OASIS-7 will fit in.
Although prehospital screening translates into improvements in reperfusion for STEMI patients, only one in four patients transported to the hospital by emergency medical services receives a prehospital electrocardiogram. (Diercks DB et al. J Am Coll Cardiol 2009; 53:161-166.)
An FDA advisory committee will review prasugrel for the treatment of ACS patients who are managed with PCI on February 3, 2009. Separately, the FDA has also said it may consider changing the label for clopidogrel following studies published last week that show it might not be effective in up to 30% of patients.
Nuisance bleeding, such as easy bruising, bleeding from cuts, and minor hemorrhages from broken vessels, affects 85% of patients taking clopidogrel following stent implantation, one center reports. Of these patients, 11% stop taking the antiplatelet medication. (Roy P et al. Am J Cardiol 2008; 102:1614-1617.)
A number of studies published this week show that acute-MI patients who possess the genetic variant linked previously with variability in the antiplatelet response to clopidogrel are at an increased risk of cardiovascular events when placed on the antiplatelet regimen. (Collet JP et al. Lancet; published online before print December 22, 2008. Simon T et al. Mega JL et al. N Engl J Med 2008; published online before print December 22, 2008.)
Early benefit of DES appears to disappear after the first year, new registry data suggest. (Philpott at al. CMAJ; published online before print December 18, 2008.)
A new collection of studies, several of which test a course of therapy based on tests of low clopidogrel responsiveness, speaks to the intense interest in the topic but also to the lack of consensus over ways to test for platelet effects and any clear sense of the way forward. (Aleil B et al. Cuisset T et al. Gladding P et al. J Am Coll CardiolIntv 2008; 1: 631-638, 649-653, 612-627.)
Experts warn that a catch-up phenomenon, due to the rise of obesity and diabetes in younger adults, may end up undoing all the gains made in recent decades to reduce death from coronary heart disease and stroke. (Lloyd-Jones D et al. Circulation; published online before print December 15, 2008.)
CT advocates say being able to rule out disease is the true value of a screening test, but others see the high false-positive rate with CTA as a recipe for soaring healthcare costs and unnecessary add-on tests. (Meijboom WB et al. J Am Coll Cardiol 2008; 52:2135-2144.)
UPDATED // Edwards Lifesciences says it followed FDA guidance to decide that its Myxo annuloplasty ring was similar enough to already-available rings to permit the company to market it without filing for a new device approval. But deciding when a device is "substantially equivalent" is an imperfect process, experts say.
It liked the idea of an agent that allows simultaneous myocardial perfusion imaging and wall-motion assessment but wasn't convinced that the efficacy data presented outweighed the apparent risks.
In our first program Drs Gibbons, Holmes, and Simari discuss cell therapy and the latest trials in intervention. Our second program features Drs Gibbons, Ackerman, and Redfield discuss personalized genomics and heart failure.
Join Drs Raymond Gibbons, Antonio Colombo, William Boden, Ph Gabriel Steg, and Valentin Fuster for another look at the COURAGE trial, as they discuss the latest data and talk about where things stand now on the larger controversy.
Dr Melissa Walton-Shirley talks to Drs Ph Gabriel Steg and Raymond Gibbons about the differences in STEMI care on both sides of the Atlantic and what US cardiologists can learn from their colleagues in Europe.
Join Drs Valentin Fuster, William Boden, Antonio Colombo, Raymond Gibbons, Franz Messerli, Marc Pfeffer, Philip Poole-Wilson, Ph Gabriel Steg, Renu Virmani, and Harvey White as they plumb the depths of the SYNTAX (Part 1) and CARDIA trials and weigh in on the cancer scare in the SEAS study (Part 2).
