On Thursday the Centers for Medicare & Medicaid Services (CMS) released a memo containing details of its proposed Medicare coverage for transcatheter aortic valve replacement (TAVR). The memo is a response to a formal request for national coverage determination (NCD) from the Society of Thoracic Surgeons (STS) and the American College of Cardiology (ACC). The memo will be open…

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The ACC, AATS, SCAI, and STS have issued a critical consensus document to guide the use of transcatheter aortic valve replacement (TAVR) as it enters clinical practice in the U.S. (see also our CardioExchange news coverage here). CardioExchange Interventional Cardiology moderators Rick Lange and David Hillis posed the following questions to writing committee member Steven R Bailey, the Janey Briscoe Distinguished Professor of…

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Following the recent FDA approval of transcatheter aortic valve replacement (TAVR), the ACC, AATS, SCAI, and STS — in conjunction with several other medical organizations — have released a critical consensus document to guide use of the new landmark procedure. “We have tried to collate the evidence into a coherent road map for judicious use, rational…

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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…

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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…

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Since 2002, the incidence of acute MI in England has dropped by one-half and the case fatality rate by one-third, according to a new study published in BMJ. The overall decline in deaths from MI is about equally due to improvements in the prevention of MI and the treatment of MI. Kate Smolina and colleagues analyzed data…

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The current standard of care for individuals undergoing carotid arterial stenting (CAS) entails the use of an embolic protection device (EPD) to minimize the risk for embolic stroke. At present, the only FDA-approved EPD is a filter that is placed distal to the stenosis (i.e., it is advanced across the lesion) before stenting. In a recently completed randomized trial, a proximal balloon occlusion device…

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The U.S. government has joined a cardiologist in a whistleblower lawsuit against Hamot Medical Center  in western Pennsylvania  and a group of cardiologists with whom he once practiced, Ed Palattella reports in the Erie Times-News. Cardiologist Tullio Emanuele, who now practices in Kentucky, has accused five former colleagues — members of Medicor Associates Inc. and its affiliate, Flagship…

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David J. Cohen, the principal investigator of an observational PCI registry study of drug-eluting versus bare-metal stents, sheds light on a risk-adjustment technique called “instrumental variable analysis.” CardioExchange welcomes your thoughts on the value of this method and on the study it was used to elucidate. The Study Using data from a prospective observational PCI…

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A NEJM editorial fellow interviews a NEJM editorialist about subclinical AF and the risk of stroke.