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Archives for June 2011

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The Elusive 30-Minute “Door-In to Door-Out” Benchmark for Primary PCI Transfers (23 Jun 2011)

CardioExchange Editors, Staff

The editors at CardioExchange have again asked a panel of experts to respond to a clinically important study. This time it was a retrospective cohort study, published in JAMA, of door-in to door-out (DIDO) times for patients with ST-segment-elevation MI who had been admitted to one hospital and then were transferred to another center for primary PCI. Few of the nearly 15,000 transferred patients had a DIDO time of 30 minutes or less, but that short transfer time was associated with shorter reperfusion delays and lower in-hospital mortality than was… Continue Reading

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When the Stuff Hits the Fan (20 Jun 2011)

Westby G Fisher, MD

CardioExchange welcomes this guest post, reprinted with permission, from Dr. Westby Fisher, an electrophysiologist practicing at NorthShore University HealthSystem in Evanston, Illinois, and a Clinical Associate Professor of Medicine at University of Chicago’s Pritzker School of Medicine. This piece originally appeared on his blog, Dr. Wes. Easy case. Seen it a hundred times. Old guy (or gal). Comes into ER. Found “down.” “Hey doc, looks like his hearts goin’ slow. I think he (or she) needs a pacer.” “On any meds that might do this?” “Nah.” “How’s his (her) potassium?” “4.3, normal.” And like… Continue Reading

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CardioExchange Panel: Whither High-Dose Simvastatin? (12 Jun 2011)

CardioExchange Editors, Staff

Last week, the FDA issued a warning high-dose simvastatin because of the risk of myopathy. CardioExchange got the reactions from a panel we assembled. Whose views do you agree with? What points did our panelists miss? See a similar panel’s reactions the publication of the SHARP Trial here. Given the FDA warning, do you see any role for high-dose simvastatin? Steven E. Nissen, MD I wrote a JAMA editorial about high-dose statins in ACS back in 2004. The FDA should have removed simvastatin 80 mg from the market years ago…. Continue Reading

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CardioExchange Panel: Ezetimibe + Simvastatin for Chronic Kidney Disease — What’s the Point of SHARP? (12 Jun 2011)

CardioExchange Editors, Staff

Last week saw the publication of the SHARP trial (Study of Heart and Renal Protection) in which some 9,200 patients with chronic kidney disease (CKD) were randomized to  either placebo or the combination of simvastatin and ezetimibe. CardioExchange put questions about these data to a panel of experts. Whose views do you agree with? What points did our panelists miss? See a similar panel’s reactions to the FDA warning on high-dose simvastatin here. Does the SHARP trial tell us anything about the value of adding ezetimibe to statin therapy? And would… Continue Reading