‘Rota Regret’ Makes Training in High-Speed Rotablation A Necessity, for Interventionalists Dealing with Heavily Calcified Coronary Lesions High-Speed Rotational Atherectomy Versus Modified Balloons Before Drug-Eluting Stent Implantation in Severely Calcified Coronary Lesions: The Randomized PREPARE-CALC Trial. 

The results of PREPARE-CALC trial, presented at TCT 2018, have shown that among patients with severely calcified coronary lesions, the routine use of upfront high-speed rotational atherectomy (RA) increases stent deliverability compared with the use of balloon modification techniques such as scoring or cutting balloons (MB), with similar rates of angiographic late lumen loss and other clinical outcomes at 9 months. In his presentation in San Diego, the author, Dr. Gert Richardt emphasized that a strategy of provisional MB remained feasible, safe, and effective as long as bailout RA was readily available and offered the advantages of compatibility with smaller sized catheters and less irradiation. Continue reading

Encouraging Outcomes in ABSORB IV Pave the Way for Polymeric Coronary Bioresorbable Vascular Scaffolds Blinded outcomes and angina assessment of coronary bioresorbable scaffolds: 30-day and 1-year results from the ABSORB IV randomised trial

In the long saga of ABSORB trials, the ABSORB IV trial presented at the TCT conference 2018 showed that polymeric coronary bioresorbable vascular scaffolds (BVS) were non-inferior to cobalt-chromium-based Xience DES for cardiovascular outcomes of target lesion failure and angina in fairly simple lesion types, with lower acute procedural success in a 1 year period. The results for this trial were published today in The Lancet. Continue reading

PCI in Nonagenarians: Age Is Just a Number

The outcomes of percutaneous coronary intervention (PCI) in nonagenarians is an understudied topic. A recent observational study published in the Journal of American College of Cardiology  has looked into the time-dependent PCI trends and outcomes in 70,000 nonagenarians from 2003 to 2014 using data from the National Inpatient Sample, which is the largest longitudinal hospital inpatient database in the United States. Continue reading

Optimal IVUS Guidance for Stent Placement: A Clear Winner? Intravascular Ultrasound-Guided Versus Angiography-Guided Implantation of Drug-Eluting Stent in All-Comers: The ULTIMATE trial

The results of the ULTIMATE trial, presented at the TCT conference 2018, have shown that IVUS-guided PCI is superior to angiography-guided PCI in the prevention of target vessel failure in an all-comers population. The study findings have been simultaneously published in the Journal of the American College of Cardiology. Continue reading

How Accurate is the Fractional Flow Reserve Derived From Routine Coronary Angiography? Results from TCT 2018, FAST-FFR study: Accuracy of Fractional Flow Reserve Derived From Coronary Angiography

The FAST-FFR study conducted by Fearon and his colleagues, and presented at the annual TCT conference 2018, has shown that Fractional Flow Reserve (FFRangio) measured from the coronary angiogram alone has a high sensitivity, specificity and accuracy compared with pressure-wire derived Fractional Flow Reserve (FFR). The results of this study were published ahead of print in Circulation. Continue reading

Tricuspid Edge-to-Edge Valve Repair Safe in Patients with Torrential Tricuspid Regurgitation TCT 2018: Results from the TriValve Registry

Results from a subgroup analysis of the TriValve Registry presented at TCT 2018 showed that interventional tricuspid edge-to-edge valve repair was safe with improvement in outcomes in patients, with high procedural success rates. Continue reading

Corevalve Evolut R (Medtronic) and Edwards Sapien 3 (Edward Lifesciences) Valves Reveal Equivalence in Transcatheter Aortic Valve Implantation (TAVI) in a Head-to-Head Comparison Results From The SOLVE-TAVI Trial Presented at the 30th Annual 2018 TCT Conference

Results from an open-label, multi-center, 2×2 factorial design randomized trial powered for equivalence, comparing the self-expanding Corevalve Evolut R valve to balloon expandable Edwards Sapien 3 valve, have shown that the two valves were equivalent to each other in terms of decreasing all-cause mortality, stroke, moderate or severe prosthetic valve regurgitation, and permanent pacemaker implantation (p=0.02). Trial results presented at the 2018 TCTMD conference held at San Diego, California, also showed equivalence in a comparison between general anesthesia vs local anesthesia (with conscious sedation) in terms of decreasing all-cause mortality, stroke, myocardial infarction, infection requiring antibiotic treatment, and acute kidney injury (p=0.02). Continue reading

Landmark COAPT trial Demonstrates the Benefit of Transcatheter Mitral-Valve Repair Using MitraClip in Patients with Heart Failure TCT 2018: Findings of the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial

The spectacular results of the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial, presented at TCT 2018, show that transcatheter mitral valve approximation using the MitraClip, on a background of maximally tolerated guideline-directed medical therapy (GDMT) was superior to GDMT alone in the reduction of Heart Failure (HF) hospitalization and mortality in symptomatic HF patients with grade 3-4+ Mitral regurgitation (MR). These landmark findings were simultaneously published today in the New England Journal of Medicine. Continue reading

Polymer-Free Amphilimus-Eluting stents: A Novel Elution Technology Results of the ReCre8 study, TCT 2018

Polymer-free amphilimus-eluting stents (PF-AES) are non-inferior to permanent-polymer zotarolimus-eluting stents (PP-ZES) in terms of target-lesion failure at 12 months, according to the results of the ReCre8 study, presented by Pieter R. Stella, MD, Ph.D. (University Medical Center, Utrecht, the Netherlands) at TCT 2018. The results for the first RCT comparing PF-AES versus latest generation PP ZES in an all-comers PCI population were simultaneously published in Circulation. Continue reading

Polymer coated sustained-release Eluvia DES outshines non-polymer coated Zilver DES for femoropopliteal artery stenosis Clinical outcomes at 1 year presented at TCTMD 2018

A randomized global, prospective, multi-center, single-blind trial comparing the Eluvia paclitaxel-eluting stent (Boston Scientific) to  Zilver PTX paclitaxel-eluting stent (Cook Medical) has shown that the Eluvia stent outperformed Zilver in terms of efficacy, which was defined as primary patency at 12 months. These findings, published in The Lancet, were presented by Dr. William Gray at the annual TCT 2018 conference held in San Diego today. Continue reading

SORT-OUT and BIONYX Successfully Demonstrate Non-Inferiority in the World of Drug-Eluting Stents Results from the 30th Annual TCT Conference 2018, San Diego

Findings from the SORT-OUT trial, presented at the 30th annual Transcatheter Cardiovascular Therapeutics (TCT) conference 2018 held at San Diego, showed that at 12 months, polymer free Biolimus A9-coated BioFreedom stent was non-inferior to the thin strut, biodegradable polymer cobalt-chromium sirolimus-eluting Orsiro stent in an all-comers patient population. Continue reading

Physician burnout: An Emerging National Epidemic

Results of two studies published in the latest issue of the JAMA have focussed on the syndrome of physician burnout and rates of career choice regret within the US medical establishment. While findings from one study showed that a high prevalence of symptoms of burnout was present with substantial variation with differing specialties, a systematic review found marked variation in the prevalence estimates of burnout among physicians and inconsistency in burnout definitions, thereby underscoring the dilemmas in the assessment of this fast-growing problem. Continue reading

Apple Watch Series 4 Receives FDA Approval as a Class II Medical Device

The Apple watch series 4 received FDA approval as a class II medical device. Apple claims that the device can detect falls and arrhythmias. It can also record an electrocardiogram (ECG) in 30 seconds “anytime and anywhere,” according to Apple. Continue reading

Early Discharge Following Uncomplicated TAVR Safe, According to a Meta-Analysis

A recent meta-analysis published in the Journal of American College of Cardiology has shown that early discharge (ED) after uncomplicated Transaortic valve replacement (TAVR) is safe and has no negative impact on discharge to 30-day mortality or the need for permanent pacemaker insertion (PPI). Continue reading

ASPREE: Another Warning Bell for Aspirin, “Wonder Drug”Fails to Work Wonders Results of Aspirin in Reducing Events in the Elderly (ASPREE trial)

The results of the Aspirin in Reducing Events in the Elderly (ASPREE) trial published in the New England Journal of Medicine showcase higher all-cause mortality among apparently healthy older adults receiving daily aspirin as compared to placebo, coupled with the shocking finding of mortality being attributed primarily to cancer, thereby painting a bleak picture of Aspirin (ASA) and heralding an end to its use in primary prevention. Continue reading

Do Valsartan Contaminants NDMA and NDEA Bear A Potential Cancer Risk? Danish nationwide cohort study on N-nitrosodimethylamine (NDMA) contaminated valsartan products and risk of cancer, FDA notes second contaminant

The discovery of Valsartan products that were contaminated with NDMA, in July 2018, in drug products manufactured in China, triggered the withdrawal of all affected products by medical agencies across Europe and the United States. Being one of the most well characterized and potent animal carcinogens known, Pottegard and his colleagues conducted an expedited observational cohort study using the nationwide Danish healthcare registry. They aimed to quantify the potential effects of NDMA contaminated valsartan products in terms of increased cancer risk, in order to provide timely information for regulatory bodies evaluating its carcinogenic effects. Results from this Danish cohort study, published in the BMJ, however, failed to show a significant increase in overall short-term cancer risk due to consumption of NDMA contaminated valsartan. Continue reading

Can TTR levels Determine Long-term Prognosis in AFib Patients on Vitamin K Antagonists? Outcomes Among Patients With Atrial Fibrillation and Appropriate Anticoagulation Control

Findings from a Danish nationwide registry conducted among patients with Atrial Fibrillation (AF), initiated on Vitamin K Antagonists (VKA) for stroke prevention between 1997 and 2011, found that almost one-half of patients with prior good level of VKA control (TTR ≥70%) had TTR <70% during the following year. Additionally, those with a prior TTR of ≥70% had a limited long-term prognostic value for stroke, thromboembolism or major bleeding risk, according to the online publication in JACC. Continue reading

Operator Experience of Atleast 225 Procedures Associated With Improved TAVR Outcomes The Learning Curve and Annual Procedure Volume Standards for Optimum Outcomes of Transcatheter Aortic Valve Replacement

Findings from an international TAVR registry involving 16 centers and spanning over a decade have important implications for operator training and patient care at centers performing TAVR. The study, published in JACC Cardiovascular Interventions, is a testament to the learning curve that still exists with both greater procedural safety and lower mortality rates reported when TAVR is performed by experienced operators. Additionally, TAVR performed at low annual volume (<50 procedures) institutions is associated with decreased procedural safety and higher patient mortality. This stepwise improvement in patient outcomes bears important implications for operator training and patient care at centers performing TAVR. Continue reading

Angiographic Completeness Not Associated With Outcomes Following FFR-guided PCI Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS

Researchers have confirmed that the extent of residual angiographic disease calculated using the residual SYNTAX score (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) or RSS has no association with ischemic events occurring subsequently in patients presenting with ACS. The study, published in JACC, reinforces the concept that functionally complete revascularization is applicable even in ACS patients. Continue reading

UK based RCT Emphasizes on Long Term Cardiovascular Benefits of Antihypertensives and Statins Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy Study: 16 year follow up results

The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy Study is a UK based trial that reports long-term beneficial effects of antihypertensives and statins in terms of mortality and cardiovascular outcomes after 16 years of follow-up in patients with hypertension. Continue reading