December 18th, 2009
Deciding When to Bridge
Anju Nohria, MD and James Fang, MD
A 61-year-old man presented with 6 hours of chest pain and ECG changes consistent with an acute anterior-wall myocardial infarction. His cardiac troponin I was 59 ng/mL. Urgent angiography revealed an occluded LAD and 70% proximal OM1, 70% proximal OM2, and 90% proximal RCA stenoses. He was taken to the catheterization laboratory, where an attempt to open the […]
December 18th, 2009
The CT Scan Is Out of the Bag
Brahmajee Kartik Nallamothu, MD, MPH
No doubt you’ve read about the FDA’s October announcement that it was investigating more than 200 cases of excess radiation exposure — at 8 times the expected level — during perfusion CT scans of the brain at a Los Angeles area medical center. In some patients, the excess exposure resulted in hair loss and reddening of […]
December 18th, 2009
Avoiding Wrong Meds in Dialysis Patients Having PCI: The Expert’s Recommendations
Richard A. Lange, MD, MBA
According to a recent study, almost one-fourth of dialysis patients undergoing PCI receive an antithrombotic agent (enoxaparin or eptifibatide) that is contraindicated in individuals with renal disease, resulting in excessive major bleeding and death. In a CardioExchange blog, the study’s lead author notes that this error was more likely to occur in hospitals that were rural or non-teaching or that had […]
December 16th, 2009
To Recommend Aspirin or Not to Recommend Aspirin, That Is the Question
Joseph S. Ross, MD, MHS
The debate over the use of aspirin in primary prevention of cardiovascular events among adults with no known cardiovascular disease continues to grow. In March, the United States Preventive Services Task Force assigned Class A recommendations to encourage: Men 45-79 to use aspirin when potential MI benefit outweighs potential GI harm Women 55-79 to use […]
December 16th, 2009
When the Right Med Is Wrong: Treating PCI Patients Undergoing Dialysis
thomastsai and Richard A. Lange, MD, MBA
We welcome Tom Tsai, MD, MSc, to this forum to talk about his article in last week’s JAMA: Contraindicated Medication Use in Dialysis Patients Undergoing Percutaneous Coronary Intervention (JAMA. 302:2458). We asked him our questions, and encourage you to ask yours. CardioExchange Editors: Your study found that nearly a quarter of dialysis patients undergoing PCI received […]
December 16th, 2009
New Guidelines
Andrew M. Kates, MD
How closely do you watch for new guidelines? It seems as if every week new guidelines are published on a variety of topics including atrial fibrillation, valve disease, STEMI and NSTEMI, and, most recently, the use of perioperative beta blockers. Between guidelines, appropriateness criteria and various position papers, it can be extremely challenging to keep abreast of the most […]
December 16th, 2009
FDA Advisers Recommend Expanded Use of Rosuvastatin
JoAnne M. Foody, MD
The Associated Press reports that, based on the JUPITER study, an FDA panel of advisers has recommended expansion of rosuvastatin. The FDA is expected to decide whether to act on this recommendation in 2010. According to the report, Astra Zeneca will develop an approach to use rosuvastatin in all patients at risk for heart disease based on hypertension and family history. […]
December 16th, 2009
FDA Advisers Recommend Expanding Crestor to Patients Without High Cholesterol
Larry Husten, PHD
An FDA advisory panel voted 12 to 4 on Tuesday to expand the use of rosuvastatin (Crestor) to patients with normal cholesterol levels and no history of cardiac disease, according to the Associated Press. The panel’s recommendation was based on last year’s JUPITER trial, in which rosuvastatin cut cardiovascular risk in patients with normal LDL […]
December 9th, 2009
Bleeding With PCI: We’re Making The Problem Worse
Richard A. Lange, MD, MBA
In a recent editorial regarding the management of ACS patients, we emphasized the importance of early risk stratification to identify patients who would most benefit (or not benefit) from intensive antithrombotic therapy or an invasive cardiac procedure. However, a recently published study reported that 22% of dialysis patients undergoing PCI received an antithrombotic agent (enoxaparin […]
December 7th, 2009
Dabigatran vs Warfarin: War or Peace?
Samuel Goldhaber, MD
CardioExchange Editors: Given the results of both your RE-COVER study and the recently published RE-LY study, should anybody still be using warfarin? Goldhaber: Warfarin is not going to fade away into oblivion. Anyone currently stable on warfarin has little reason to abandon this time-tested drug. If once monthly INRs are usually in the therapeutic range, and […]