Interventional Cardiology
Recently Released Joint Statement Proposes New Model of Care for Patients with Valvular Heart Disease
A joint report that proposes an integrated model of care for patients with valvular heart disease (VHD) was recently released by the American Association for Thoracic Surgery (AATS), American College of Cardiology (ACC), American Society of Echocardiography (ASE), Society for Cardiovascular Angiography and Interventions (SCAI) and Society of Thoracic Surgeons (STS). This collaboration was published with the aim of optimizing the care received by patients with VHD.
Depression Is Associated with More Severe Angina and Dyspnea in Patients with Chronic Total Occlusion
A study led by Dr. Robert Yeh that was published in JACC: Cardiovascular Interventions showed that in the setting of chronic total occlusion (CTO), patients with depression had more significant angina before percutaneous coronary intervention (PCI). However, these patients also had a greater improvement in health status after PCI.
Study Suggests ICU Care May Be Overutilized in Stable STEMI Patients
A study led by Dr. Jay S. Shavadia published in JACC: Cardiovascular Interventions showed that although more than 80% of stable patients with an ST-elevation myocardial infarction (STEMI) were treated in the intensive care unit (ICU), the risk of developing a complication requiring ICU care was around 16%. These findings suggest that implementing a risk-based triage strategy could be a better alternative to the current strategy where patients with STEMI are typically admitted to the ICU.
Randomized Trial Shows That Transcatheter Aortic-valve Replacement is Non-inferior to Surgery in Low Risk Patients
A study by Dr. Jeffrey Popma and colleagues published in the New England Journal of Medicine showed that transcatheter aortic-valve replacement (TAVR) was non-inferior to surgery with respect to death or the occurrence of a disabling stroke by 24 months in the low-risk group of patients with aortic stenosis. Previous studies showed that in patients with severe aortic stenosis who were at high risk of complications or death from surgery, TAVR with a self-expanding supra-annular bioprosthesis had better outcomes than medical therapy or surgery. However, there was not enough evidence to advocate the use of TAVR instead of surgery in a younger, healthier population. The authors aimed to address this knowledge gap through this study.
AHA Releases a Scientific Statement Regarding Patients with Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease
The American Heart Association (AHA) released a scientific statement that aims to provide a formal and updated definition for Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease (MINOCA). It also outlines a useful framework for the diagnostic approach and management of patients with potential MINOCA.
Meta-Analysis Affirms Safety and Efficacy of Catheter-Based Renal Denervation for Blood Pressure Reduction
A meta-analysis conducted by Sardar et al. evaluated the change in blood pressure in response to catheter-based renal sympathetic denervation (RSD). The data, published in the Journal of the American College of Cardiology (JACC), suggested that RSD reduces ambulatory systolic blood pressure (ASBP) in patients with hypertension as compared with sham controls. Continue reading
TAVR Using Balloon Expandable Valve Superior To Surgical Aortic Valve Replacement In Low Risk Patients With Severe Aortic Valve Stenosis 1-year trial results presented at the ACC 2019 annual scientific session, New Orleans
A randomized multi-center trial which enrolled 1000 patients from 71 centers around the world has shown that in patients with severe aortic stenosis who are at low surgical risk, the rate of the composite of death, stroke, or rehospitalization at 1 year is significantly lower with transcatheter aortic valve replacement (TAVR) than with surgery. Continue reading
TREAT Trial Addresses the Safety and Efficacy of Ticagrelor Use for STEMI Management in the Setting of Fibrinolytic Therapy ACC 2019: Ticagrelor versus Clopidogrel in Patients with STEMI Treated with Fibrinolytic Therapy
According to the results of the TREAT trial, among patients aged under 75 years with STEMI, administration of ticagrelor after fibrinolytic therapy did not significantly reduce the frequency of cardiovascular events in comparison with clopidogrel. The results of the 12-month analysis were recently published in the Journal of the American College of Cardiology. Continue reading
COAPT Analysis Affirms Quality of Life Advantage of MitraClip for Secondary MR ACC 2019: Health Status After Transcatheter Mitral-Valve Repair in Heart Failure and Secondary Mitral Regurgitation
NEW ORLEANS — Transcatheter repair of functional mitral regurgitation (or secondary MR) with MitraClip improved quality of life and hemodynamics better than optimal medical therapy alone, COAPT trial analyses showed. Indeed, the COAPT QOL study showed that among patients with symptomatic HF and 3+ to 4+ secondary MR receiving maximally-tolerated medical therapy, edge-to-edge TMVr resulted in substantial early and sustained health status improvement compared with medical therapy alone. Continue reading
Is the Improvement in Fractional Flow Reserve After Percutaneous Coronary Intervention (ΔFFR) Associated With Clinical Outcome and Symptomatic Relief?
In an analysis of two randomized clinical trials published in JAMA cardiology, Fournier et al. reported that the larger the improvement in FFR, the larger the symptomatic relief and the lower the event rate. This was suggestive of the fact that measuring FFR before and after PCI could provide clinically useful information. Continue reading
DECISION-CTO Demonstrates No Significant Difference in Death, MI, Stroke, or Any Revascularization with CTO PCI vs. No CTO PCI
The results of the DECISION-CTO trial conducted by Lee et al. showcased that CTO-PCI was feasible with high success rates. In addition to this, there was no difference in the incidence of major adverse cardiovascular events with CTO PCI vs. no CTO-PCI, however, the study was limited by low power for clinical endpoints and high crossover rates between groups. The results were published online in Circulation. Continue reading
Early and Late Leaflet Thrombosis Following TAVR A Multicenter Initiative From the OCEAN-TAVI Registry
A real-world multicenter study by Yanagisawa and his colleagues published in Circulation: Cardiovascular Interventions reported that untreated early leaflet thrombosis did not affect the cumulative event rates of death, stroke, and rehospitalization for heart failure. The investigators also stressed on the fact that late leaflet thrombosis was newly detected in patients during the 3-year follow-up period. Continue reading
EuroCTO: A Simple Scoring System to Predict Technical Success when Performing CTO PCI Derivation and Validation of a Chronic Total Coronary Occlusion Intervention Procedural Success Score From the 20,000-Patient EuroCTO Registry: The EuroCTO (CASTLE) Score
A study by Zsolt Szijgyarto and his colleagues published in JACC: Cardiovascular Interventions has derived the EuroCTO (CASTLE) from the largest database of CTO cases to date and offers a useful tool for predicting procedural outcomes. The investigators stated that previous CABG, age over 70 years, a blunt stump, severe tortuosity, length of the occlusion, and the extent of calcification were strongly associated with unsuccessful CTO-PCI. Continue reading
FDA Issues Cautionary ‘Dear Doctor’ Letter In Response to Study Reporting Increased Deaths with Paclitaxel-Coated Devices in PAD Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality
The FDA issued a Dear Doctor letter while investigating a potential safety signal with paclitaxel-coated balloons and stents used to treat peripheral artery disease. “This review will focus on the causes of death, the paclitaxel dose delivered, and patient characteristics that may impact clinical outcomes. Additional statistical analyses will be performed to clarify the presence and magnitude of any long-term risks,” the letter stated. Continue reading
Administration of Cangrelor In Addition to Crushed Ticagrelor Bridges Gap of Antiplatelet Inhibition in Patients Undergoing Primary PCI Results from the CANTIC study
According to a new study, Cangrelor could serve to bridge the gap of antiplatelet inhibition in patients undergoing primary percutaneous coronary intervention (P-PCI) for acute coronary syndrome, who were administered crushed ticagrelor. Additionally, no drug-drug interactions (DDI) were reported between the two P2Y12 inhibitors, based on the findings published in Circulation. Continue reading
Women in Interventional Cardiology: ‘If You Love it, You Will Make it!’ Study Identifies Factors Dissuading Female Cardiology Fellows From Pursuing Interventional Cardiology
According to a recent publication in JACC: Cardiovascular Interventions, many factors uniquely dissuade women from pursuing interventional cardiology (IC) compared with men, largely related to the culture of IC as a subspecialty. Targeted resolution of these specific factors may provide the most impact in reducing sex imbalances in the field. Continue reading
New Study Sets the Stage for Determining Optimal Antithrombotic Regimen in TAVR Patients The FRANCE TAVI Registry
According to a study published in JACC: Cardiovascular Interventions, sex, renal failure, and atrial fibrillation affected mortality the most at 3-year follow-up following transcatheter aortic valve replacement (TAVR). In contrast, anticoagulation (mostly given for atrial fibrillation) was found to reduce the risk of bioprosthetic valve dysfunction (BVD) after TAVR. Continue reading
Adjunctive Low Dose Alteplase During Primary PCI Fails to Imrpove Microvascular Obstruction in STEMI Patients Results of the T-Time trial presented at the American Heart Association (AHA) 2018 Scientific Sessions
A multi-center randomized, double blind, placebo-controlled, parallel group clinical trial has shown that among patients with acute ST-elevation myocardial infarction (STEMI) presenting within 6 hours of symptoms, adjunctive low-dose intracoronary alteplase given after reperfusion via primary percutaneous intervention does not reduce microvascular obstruction. Continue reading
Prior Cerebrovascular Disease: A Key Factor In The Assessment for Optimal Left Main Coronary Artery Revascularization Strategy Results From the EXCEL Trial
A study conducted by Dr. Gregg W.Stone and his colleagues from Columbia University Medical Center demonstrated that patients with left main coronary artery disease (LMCAD) and prior cerebrovascular disease (CEVD) compared with those without CEVD have higher rates of stroke and reduced event-free survival after revascularization. In their publication in JACC: Cardiovascular Interventions, they stated that PCI need not be a priori preferred over CABG for LMCAD in patients with known CEVD. Patients with CEVD should undergo evaluation for both PCI and CABG, with careful consideration of comorbidities, the likelihood of safely achieving complete revascularization, and patient preferences in order to determine the optimal coronary revascularization strategy. Continue reading
ILLUMENATE European RCT Demonstrates Durability of Low-Dose DCB in Humans For the First Time Sustainable Antirestenosis Effect With a Low-Dose Drug-Coated Balloon: The ILLUMENATE European Randomized Clinical Trial 2-Year Results
The two-year results of the ILLUMENATE European randomized clinical trial conducted by Brodmann and her colleagues have displayed a sustained treatment effect with a low-dose drug-coated balloon (DCB) with an optimized coating formulation. This trial, published in JACC Cardiovascular Interventions, has demonstrated, for the first time, a statistically significantly higher primary patency rate for a low-dose DCB versus PTA at 2 years. Continue reading
