When taking care of older patients, we often have an intuitive sense of which ones will do well after an intervention and which ones won’t. This has been termed the “foot of the bed” test, or alternately something which separates a “young 80-year old” from an “old 80-year old.” Frailty is a syndrome defined as…
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The FDA’s Circulatory System Devices panel voted 9-2 on Wednesday to recommend approval of the HeartWare Ventricular Assist System as a bridge to heart transplantation for patients with end-stage heart failure. The panel agreed unanimously (11-0) that the new device is effective. The panel was more divided about safety but ultimately voted 8-3 that the device…
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A new study sheds light on a rare but highly dangerous complication associated with device implants: cardiac device infective endocarditis (CDIE). Approximately 10% to 23% of device infections result in CDIE, leading, in one estimate, to an overall rate of 1.14 cases per 1000 device-years. In a paper published in JAMA, Eugene Athan and colleagues analyzed data…
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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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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…
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“We said it before, and we’ll say it again: an assessment of platelet reactivity by this method doesn’t effectively identify individuals at high risk for a cardiovascular event following PCI.”
This week’s topics include an “awful question” about statin therapy, coronary computed tomographic angiography in the ED, vorapraxar for secondary prevention, and stent wars.
Biodegradable stents: here to stay… or will they disappear? A newly-released study reports the long-term results of the first-in-man fully biodegradable coronary stent.
In the ASCERT observational study, stable patients (age 65 or older) with double- or triple-vessel CAD, but not left-main disease, were found to have better long-term survival after CABG than after PCI. ASCERT was a laudable achievement in terms of its scope and the level of collaboration it represents. The ASCERT investigators used inverse probability weighting…
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A new point-of-care test can rapidly identify people with a common genetic variant associated with impaired clopidogrel function. The authors claim that this is the first study to demonstrate the feasibility of delivering a genetic test at bedside. In an article published online in the Lancet, Jason Roberts and colleagues report on a new point-of-care test that can…
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