At this week’s annual European Society of Cardiology Congress in Rome, an important randomized clinical trial on stents was presented by Professor Kaare H. Bønaa, MD, PhD of the Clinic for Heart Disease, St. Olav’s University Hospital in Trondheim, Norway. Called NORSTENT, short for the “Norwegian Coronary Stent Trial,” this was the largest stent trial ever conducted, with 9,013 patients followed for six years. That’s serious! Continue reading
Category Archives: Patients
AimRADIAL Masterclass V + FFR Workshop in Budapest
On September 22-23, 2016, the 5th Advanced International Masterclass on the Transradial Approach will be held in Budapest, Hungary. And this year, AimRADIAL will be preceded on September 21 by a one-day comprehensive workshop covering all aspects of Fractional Flow Reserve (FFR) from the basic principles and set-up in the cath lab, to the differences between FFR, iFR, and CFR, a comprehensive review of the clinical study data so far, and finally a look at future modalities, like FFR-CT (although the title of that talk by Dr. Nick Curzen is “FFR-CT: the future is now“). Continue reading
InterZENtion: Transradial PCI as an Art
Transradial Coronary Interzentions by Dr. Ferdinand Kiemeneij
Transradial is one of the big buzzwords in interventional cardiology these days. In the United States practitioners recently have been discovering its advantages and have been learning how to perform it successfully. Utilization of transradial in the U.S. has jumped from 2% to almost 25% in less than a decade. In Europe, Japan, India, and China, transradial has been used for years and in most of those regions adoption runs from 50-90% of all catheter-based procedures. In Japan, and now in Europe, a specialized group of physicians has been pushing the limit of what can be done via the wrist artery, using “slender” procedures and equipment, with systems using 3, 4 and 5F sized catheters.
But the heart (pun intended) of this revolution in catheter-based access goes back over two decades to the pioneering work done by Dr. Ferdinand Kiemeneij, rightly dubbed “the father of transradial intervention.” You can read my interview with Dr. Kiemeneij here, but more importantly, you can and should and must read his brand-new hot-off-the-press book, “Transradial Coronary Interzentions,” available on Amazon. Continue reading
Filed under Europe, France, Global Trends, Innovators, Japan, Medical Education, Patient Experience, Patients, Transradial Approach
COURAGE: Does 15-Year Data Have Any Clinical Relevance?
This past week saw publication of an update to the 2007 COURAGE trial which compared optimal medical therapy (OMT) to stenting (PCI) as the initial management strategy for stable coronary artery disease. (Please note the phrase “initial management strategy.” This will not be the last time you see it in this post.)
Appearing in the New England Journal of Medicine and titled “Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease,” this study, performed by Dr. Steven P. Sedlis and other COURAGE trial investigators, is described as “an extended survival analysis to examine the potential long-term survival benefit from initial PCI among the patients with stable ischemic heart disease who were followed for up to 15 years after initial enrollment in the COURAGE trial.”
This new analysis concluded: “…we did not find a difference in survival between an initial strategy of PCI plus medical therapy and medical therapy alone in patients with stable ischemic heart disease.” This also was the finding of the original COURAGE trial at five years. Continue reading
Plavix and Aspirin After Stent: 8 Years Later – Is Longer Better?
No one thought it would take quite so long to get this information, but in just a couple hours results from the Dual Antiplatelet Therapy (DAPT) Study will be presented at the American Heart Association Scientific Sessions 2014. The question to be answered: Is there a benefit to extending dual antiplatelet therapy (aspirin plus a thienopyridine, such as clopidogrel/Plavix, prasugrel/Effient, etc.) beyond one year after stenting?
This is a question asked back in 2006, during a special two-day FDA hearing, convened to discuss all known issues with drug-eluting stents and prompted by the “ESC firestorm” over the problems of increased incidence of late stent thrombosis in drug-eluting stents. (See “Problems Resurface with Drug-Eluting Stents” – September 9, 2006.) Continue reading
AimRADIAL Masterclass Comes to Chicago
On October 23-25, 2014 the 3rd Advanced International Masterclass on the Transradial Approach will be held in Chicago and, if you already perform or want to start using the wrist approach to diagnostic or interventional procedures, you need to attend. Where else will you be able to spend two-and-a-half days with the most expert and experienced radial practitioners in the world?
I went to the very successful AimRADIAL course in New York City last fall and witnessed something I hadn’t really seen since the early days of angioplasty: a relatively small meeting (i.e. less than 300) attended by the pioneers of the procedure, cardiologists who have the largest experience in the radial approach, talking among themselves and trading their latest findings and techniques with each other, and sharing this information with the newer generation of physicians in attendance.It felt like an actual community! Continue reading
Let’s Disagree to Agree: the Not-So-Great Coronary Angioplasty Debate and a Patient’s Right to Speak
I read yesterday morning that I was now a party to “The Great Coronary Angioplasty Debate.” (Note to self: don’t look at Twitter before Sunday brunch.)
This all started a week ago, when Dr. Nortin Hadler posted an op-ed piece on The Health Care Blog, titled “The End of the Era of Coronary Angioplasty.” He opined that angioplasty was unnecessary in the setting of a major heart attack (a.k.a. STEMI) and might even worsen outcomes. His title and thesis was so over-the-top (intentionally so, I’m sure) that I felt obliged to pen a response to his very anti-stent article. Continue reading
Filed under Heart Attack, Patient Empowerment, Shared Decision-Making
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