October 5, 2011 · 12:10 pm

In Memoriam: J. Willis Hurst, MD

J. Willis Hurst, MD (1920-2011)

J. Willis Hurst, MD
(1920-2011)

Sad news out of Atlanta that Dr. J. Willis Hurst passed away on October 1 after a brief illness, a few weeks short of his 91st birthday. Hurst was a major figure in cardiology worldwide, having served as Professor and Chairman of the Department of Medicine at the Emory University School of Medicine for 30 years, and the author of “Hurst’s The Heart“, undisputedly the “bible” of cardiology, which is in its 13th edition and has been translated into more than five languages. It is considered to be the most widely used cardiology
textbook in the world. I know that every cardiologist’s office I’ve ever been in (and that’s a lot) has “Hurst’s The Heart” prominently displayed on the bookshelf. Continue reading →

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Filed under History, Innovators, Video

September 23, 2011 · 11:20 am

Cross-Country Training for Transradial Wrist Angioplasty

Duke Transradial LogoHaving an coronary angiogram or heart stent placed via the wrist approach is common in Europe. India and Japan — much less so in the U.S. — even though the wrist (transradial) approach offers lower complications and higher patient comfort. Some studies have even shown that the radial approach, with its significantly lower bleeding complications, is superior in treating heart attacks (STEMI) since those patients need to be on high levels of anticoagulation meds.

So why are only 5% of U.S. procedures done via the wrist while figures in other countries run 50-80%? One reason has been training. In the U.S. cardiology fellows are trained in the femoral (leg/groin) approach, because that’s what’s practiced at their hospitals. So it’s been a self-perpetuating practice. Continue reading →

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Filed under Global Trends, Meetings & Conferences, Transradial Approach

September 8, 2011 · 6:45 pm

Transradial Angioplasty Training in Las Vegas

This weekend Richard R. Heuser, MD, FSCAI and John E. Lassetter, MD, FSCAI of St. Luke’s Hospital and Medical Center in Phoenix, Arizona will be conducting a one-day course in transradial (wrist) angioplasty at the Wynn/Encore Hotel in Las Vegas, Nevada. But the games of chance will be relegated to the casinos because, as Dr. Heuser recounts in his exclusive interview with Angioplasty.Org, the wrist approach to diagnostic and interventional coronary procedures is safer for patients, more comfortable for patients and (trumpet fanfare) has the potential to reduce costs of healthcare as well.

And Dr. Richard Heuser has been performing PCIs since the beginning days of balloons and stents — so his perspective on why the transradial approach offers significant benefits is definitely of import to cardiologists across the U.S. Continue reading →

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Filed under Interviews, Meetings & Conferences, Transradial Approach

July 9, 2011 · 7:05 pm

Are Stents Beings Overused? How Much and Where?

Paul S. Chan, MD, MScDr. Paul Chan sat down with me recently to talk about the study published this week in JAMA that he served as lead author on. The article, “Appropriateness of Percutaneous Coronary Intervention.” has generated hundreds of news reports about “unnecessary stenting”, “overuse of angioplasty”, etc.

In my exclusive interview with Dr. Chan, we talked about the real meaning of this study, what it was meant to do (benchmark the use of PCI in the U.S.) and how it’s being (mis) interpreted by the press (I’ll be discussing this aspect in a subsequent post). Continue reading →

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Filed under Appropriate Use Criteria (AUC), Interviews

July 6, 2011 · 11:30 pm

A Perspective on the Appropriate Use of Angioplasty and Stents

Ralph Brindis, MD, MPH, FACCDr. Ralph Brindis is the Immediate Past President of the American College of Cardiology and helmed the National Cardiovascular Data Registry (NCDR) since its inception in 1997 — this is the registry that was the source for the data analyzed and reported in yesterday’s JAMA study, “Appropriateness of Percutaneous Coronary Intervention.”

In my exclusive interview with Dr. Brindis, I talked with him about the study, his feeling about what it showed, both the positive findings and what he calls “opportunities for improvement.” While there was almost 100% adherence to guidelines for acute angioplasties (which made up 71% of the total angioplasties performed) the study also pinpointed the fact that PCIs for non-acute patients had a higher rate of “inappropriates”, as defined by the ACC/SCAI Appropriateness Criteria — and that this rate varied widely from hospital to hospital. This means that those hospitals with higher than average “inappropriate” PCIs needed to look at their cases, their decision-making process and work to bring it closer to the norm. Continue reading →

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Filed under Appropriate Use Criteria (AUC), Interviews, Media Coverage

July 5, 2011 · 4:15 pm

Angioplasty and Stents Inappropriate Only 4% of the Time

Are Stents Appropriate?A major study of a half-million angioplasties, published today1 in the Journal of the American Medical Association (JAMA), refutes two major myths about angioplasty and stent use in the United States: myth #1, that angioplasty is vastly overused and unnecessary in most cases; and myth #2, that most angioplasty is used in stable patients and therefore has little or no benefit over drugs in reducing death or heart attacks.

Titled “Appropriateness of Percutaneous Coronary Intervention“, this paper is the first comprehensive look at how closely interventional cardiologists in the U.S. are adhering to the practice guidelines for PCI (angioplasty and stenting) most recently published by the professional cardiology and surgical societies in January 2009. Continue reading →

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Filed under Appropriate Use Criteria (AUC), COURAGE, Media Coverage

April 29, 2011 · 10:55 pm

Stent By Wrist in Houston

Radial Access in Houston Texas“A new twist on stents” is how Channel 13 KTRK-TV, the ABC affiliate in Houston, billed Christi Myers’ story today about the transradial approach to angioplasty and stenting. We’ve been writing about the growing adoption of radial access in the U.S. for four years now, so it’s great to see a TV report on this technique…because it means that patients in that locale (Houston, Texas) will be that much more aware that there is an option, a choice to be made, when having to get an angiogram, angioplasty or stent placed. (The piece profiles Dr. Colin Barker of the University of Texas Health Science Center at Houston.) Continue reading →

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Filed under Media Coverage, Patient Experience, Transradial Approach