An Arizone cardiac surgery group has agreed to pay $100,000 to resolve an investigation into potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). In the agreement the surgical group did not offer an admission of liability but did agree to implement a corrective action plan in addition to the payment….
Preoperative Statins Found to Reduce AF and Length of Stay But Not Mortality
April 18, 2012 by Leave a Comment
In a systematic review published in the Cochrane Library investigators at the University of Cologne in Germany analyzed data from 11 trials that tested the effects of preoperative statins in 984 patients undergoing heart surgery. Preoperative administration of statins reduced the risk of developing atrial fibrillation (AF) and shortened the length of stay on the ICU and in the…
Mark Midei Can’t Get a Job Taking Blood Pressure At A Walmart
April 8, 2012 by 9 Comments
Earlier this year I had the extraordinary experience of spending several hours on the phone with Mark Midei, the poster-boy (or scapegoat, depending on whom you ask) for all that’s wrong with interventional cardiology in the US. I approached the conversation with some trepidation and discomfort. I’d followed his story closely– but not obsessively– and…
Failure of Another Trial Testing Guided Antiplatelet Therapy Prompts Debate
April 6, 2012 by 4 Comments
Updated, Saturday, April 7 Yet another trial has failed to prove the hypothesis that guided antiplatelet therapy with platelet function testing or genetic testing improves outcomes. Although there has been no public announcement so far, the TARGET-PCI (Thrombocyte Activity Reassessment and GEnoTyping for PCI) was suspended last October, according to the TARGET-PCI page on ClinicalTrials.Gov….
Proof-of-Concept for Bedside Rapid Genotyping Test of CYP2C19
March 28, 2012 by 1 Comment
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…
ASCERT Observational Study Finds Long Term Advantage for CABG Over PCI in High Risk Cases
March 27, 2012 by Leave a Comment
A very large observational study finds that long-term mortality in high risk patients is lower after bypass surgery than after PCI. The results, which were previously revealed in January at the annual meeting of the Society of Thoracic Surgeons (STS), were presented in final form at the American College of Cardiology by William Weintraub and published simultaneously…
What To Do When Federal Investigators Knock On The Door
March 26, 2012 by 2 Comments
For more than a year now the federal investigation of hospitals suspected of improperly implanting ICDs has been the subject of considerable rumor and speculation. Now, two cardiologists who were involved in a federal audit at one hospital have published a detailed account of their experience. Jonathan Steinberg and Suneet Mittal are Columbia University-affiliated electrophysiologists…
PARTNER: TAVR Results Appear Durable at Two Years
March 26, 2012 by Leave a Comment
Two year results of the influential PARTNER trial provide continued support for the growing acceptance of transcatheter aortic valve replacement (TAVR) in clinical practice. Previously, results of PARTNER at one year had demonstrated a similar mortality in high risk patients with aortic stenosis who received TAVR and surgery. The two year results were presented at the American College…
Study Supports PCI Without Onsite Surgical Backup
March 25, 2012 by Leave a Comment
Here’s a great example of genuine medical progress: 10% of the first 50 patients who received balloon angioplasty from the developer of the procedure, Andreas Grüntzig, required emergency bypass surgery. By 2002 only 0.15% of PCI patients required emergency surgery, leading many to believe that surgical backup was no longer necessary. Now a large new…
Large Meta-Analysis Finds Very Low Thrombosis Rates for Xience Stent
March 22, 2012 by Leave a Comment
A large new meta-analysis published in the Lancet provides the best evidence yet that the cobalt-chromium everolimus eluting (CoCr-EES) stents (Xience and Promus) have a significantly lower rate of stent thrombosis than bare-metal stents BMS) and other drug-eluting stents (DES). Tullio Palmerini and colleagues analyzed data from 49 randomized trials comparing different stents in more than 50,000 patients….
Questions Raised About Antiplatelet Therapy in Chronic Kidney Disease
March 19, 2012 by Leave a Comment
Many people develop chronic kidney disease (CKD) as they grow older, and many people with CKD take antiplatelet agents to prevent cardiovascular events. However, the efficacy of antiplatelet therapy in CKD has not been examined, despite the fact that people with CKD are more likely to die from nonatherosclerotic conditions and are more likely to…
Achieving CLOSURE: Final Act of PFO Closure Device
March 14, 2012 by Leave a Comment
You can choose from a myriad of metaphors– closing the book, sealing the deal, fixing a hole– but the story is simple: the publication of CLOSURE 1 in the New England Journal of Medicine is the final act of the long and sad melodrama of the CLOSURE 1 trial. As initially reported at the American Heart Association…
Angioplasty Pioneer Geoffrey Hartzler Dead at 65
March 14, 2012 by Leave a Comment
Geoffrey Hartzler, a key figure in the development of interventional cardiology in the United States, has died from cancer at the age of 65. He was one of the first cardiologists to learn the technique of percutaneous transluminal coronary angioplasty (PTCA) from its founder, Andreas Gruentzig. Hartzler then went on to perform the first angioplasty…
Michael Ezekowitz Joining Cardiovascular Research Foundation To Establish AFib Research Center
March 8, 2012 by 3 Comments
Correction: An earlier version of this article erroneously stated that Ezekowitz would be leaving Lankenau. Michael Ezekowitz is joining the Cardiovascular Research Foundation (CRF) in New York City to start a new center for atrial fibrillation research. Ezekowitz, a cardiologist at the Lankenau Institute for Medical Research in Philadelphia, had been a professor and vice president for clinical research at…
Four Cardiovascular Societies Release Criteria for TAVR Programs and Operators
March 2, 2012 by 1 Comment
A newly released statement contains detailed recommendations about the requirements necessary for hospitals and physicians to participate in transcatheter aortic valve replacement (TAVR) programs. The expert consensus document was released jointly by the American College of Cardiology Foundation (ACCF), the Society for Cardiovascular Angiography and Interventions (SCAI), the American Association for Thoracic Surgery (AATS) and the Society for…
Slow Uptake of Transcatheter Aortic Valves: Learning from History?
February 28, 2012 by Leave a Comment
Transcatheter aortic valve replacement (TAVR) has been one of the most exciting new developments in cardiovascular medicine in recent years. The growing enthusiasm over TAVR led to concern and even alarm in some quarters that the introduction of TAVR would ignite a stampede of uptake, mirroring the early over-enthusiasm for similarly disruptive devices like stents…
Meta-Analysis Finds No Advantages for PCI Over Medical Therapy in Stable Patients
February 27, 2012 by Leave a Comment
Patients with stable coronary artery disease (CAD) today do no better with stents than with medical therapy, according to a new meta-analysis published in the Archives of Internal Medicine. Kathleen Stergiopoulos and David Brown identified 8 trials with 7,229 patients comparing stents to medical therapy in which stents were used in the majority of PCI cases. ”By limiting…
FDA Approves Medtronic’s Resolute Drug-Eluting Stent for Treatment of CAD, Including Diabetics
February 17, 2012 by Leave a Comment
The FDA has approved the Medtronic Resolute zotarolimus-eluting stent for the treatment of coronary artery disease. The Resolute DES is approved for use in a wide variety of patients, including diabetics. The new stent uses the same drug-and-polymer combination as the popular Resolute Integrity DES. The Resolute clinical trial program enrolled more than 5,000 patients worldwide, a…
Prominent Interventionalists Attack Appropriate Use Criteria For PCI
February 8, 2012 by 5 Comments
A group of leading interventional cardiologists has launched an attack on the growing role of appropriate use criteria (AUC) for PCI in the US. They argue that severe flaws in current guidelines render unreliable current attempts to assess the rate of appropriate procedures. In a paper published in JACC: Cardiovascular Interventions, Steven Marso and colleagues (Paul…
CMS Releases Details Of Proposed National Coverage For TAVR
February 2, 2012 by 5 Comments
(Updated with statement from the ACC and STS) On Thursday the Centers for Medicare & Medicaid Services (CMS) released a memo containing details of its proposed Medicare coverage for TAVR (transcatheter aortic valve replacement). The memo is a response to a formal request for national coverage determination (NCD) from the Society of Thoracic Surgeons (STS) and…
Consensus Document Provides Roadmap To Uptake Of TAVI In US
January 31, 2012 by 3 Comments
Following the recent approval by the FDA 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…
Appropriate Use Criteria for Revascularization Updated
January 30, 2012 by Leave a Comment
The ACC, AHA, and other organizations have released updated appropriate use criterial 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…
Very Large Observational Study Finds Significant Mortality Advantage for CABG Over PCI in High Risk Patients
January 30, 2012 by Leave a Comment
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) meeting. Fred Edwards presented the high-risk subset of…
Blue light special: AAA screening at Kmart in the disease-mongering aisle
September 15, 2010 by 9 Comments
Now, in addition to all the other stuff there, you can go to Kmart and get screened for abdominal aortic aneurysm (AAA). Some people will even receive free ultrasound tests. The new program, from the Find the AAAnswers Coalition, was announced on Friday. It’s a perfect example of disease mongering, the selling of a sickness…
At the Dallas valve meeting even the faculty is for sale
August 4, 2010 by 6 Comments
[August 6 Update: the Industry Prospectus discussed below has been removed from the DLIV 2010 website. You can download an archived copy here.] Company banners, ads in program books, sponsored badge holders, headrests on buses with company logos– these are just a few of the commercial items to be found at medical meetings these days….
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