August 31st, 2011
New Resuscitation Strategies Fail to Improve Outcomes After Cardiac Arrest
Larry Husten, PHD
Two trials from the Resuscitation Outcomes Consortium (ROC) investigators were unable to demonstrate meaningful improvements to resuscitation strategies after cardiac arrest. The two trials, one testing an impedance threshold device and the other examining a strategy of early versus late rhythm analysis, have been published in the New England Journal of Medicine. In the first trial, 8718 patients were randomized […]
August 31st, 2011
TAVI—When Will It Come to an Operating Theater Near Me?
Stephen Fleet, MD
At the ESC meeting in Paris, Gerhard Schuler from Leipzig reviewed the current indications for Transcatheter Aortic Valve Implantation (TAVI). TAVI is considered appropriate for: Inoperable patients with severe aortic stenosis with a baseline 1-year mortality risk of 50%. Patients with severe aortic stenosis and a surgical risk of greater than 15%. Valve-in-valve implantation for […]
August 30th, 2011
Intra-Aortic Balloon Counterpulsation (IABP) Burned to a CRISP
Richard A. Lange, MD, MBA and L. David Hillis, MD
Intra-aortic balloon counterpulsation (IABP) is a bust in AMI patients without cardiogenic shock, according to the Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction (CRISP AMI) trial. This open-label, 30-center, randomized, controlled trial was performed to determine if a routine strategy of IABP before primary PCI (and continued for at least 12 hours afterward) […]
August 30th, 2011
No Benefit for Routine Counterpulsation Found in CRISP AMI
Larry Husten, PHD
Routine use of intra-aortic balloon counterpulsation (IABC) in STEMI patients who do not have cardiogenic shock does not reduce infarct size, according to a new trial. Results from the CRISP AMI (Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction) trial were presented at the European Society of Cardiology meeting in Paris by Manesh Patel […]
August 30th, 2011
New Results from EMPHASIS-HF Show Big Benefits For High-Risk Subgroups Taking Eplerenone
Larry Husten, PHD
Last November the main results of the EMPHASIS-HF trial demonstrated that eplerenone was significantly better than placebo in reducing the risk for death and hospitalization in patients with systolic heart failure and mild symptoms. Now a new analysis of the trial, presented by Bertram Pitt at the European Society of Cardiology meeting in Paris, reinforces the earlier findings […]
August 30th, 2011
Is Warfarin Still the First Choice in Atrial Fibrillation?
Stephen Fleet, MD
There’s an old maxim in medicine that one shouldn’t be the first to prescribe a new drug, nor the last. A fascinating debate between Michael Ezekowitz from the U.S. and Felicita Andreotti from Italy highlighted the differences between warfarin and the newer oral anticoagulants (NOACs) apixaban, rivaroxaban, and dabigatran. Even Dr. Ezekowitz, the warfarin protagonist […]
August 29th, 2011
Not Shocking: French Studies Evaluate Remote Monitoring of ICDs
Larry Husten, PHD
Remote monitoring of ICDs can reduce inappropriate shocks, but the overall clinical benefit and cost-effectiveness of the technology has not yet been demonstrated, according to two new studies presented at the ESC meeting in Paris. Salem Kacet presented the ECOST (Effectiveness and Cost of ICD Follow-Up Schedule with Telecardiology) study in which 433 ICD patients […]
August 29th, 2011
Shortfalls in Secondary Prevention Particularly Acute in Poor Countries
Larry Husten, PHD
It shouldn’t come as a surprise, but an international epidemiological study shows large shortfalls in the use of established drugs for secondary prevention. The shortfalls are dramatically acute in poor countries, said Salim Yusuf, who presented the results of the Prospective Urban Rural Epidemiological (PURE) study at the ESC in Paris on Sunday. The paper […]
August 29th, 2011
ESC: A Closure Device and a Warfarin Substitute for High-Risk AFib Patients
Stephen Fleet, MD
How can we manage a patient with atrial fibrillation and contraindications to warfarin therapy such as recurrent severe bleeding — a common scenario in clinical practice? Data from the manufacturer-sponsored ASAP study (ASA Plavix Feasibility Study with WATCHMAN Left Atrial Appendage Closure Technology) provides some hope, beyond what we had learned from the Protect AF […]
August 28th, 2011
Anatomical vs. Physiological Assessment of Coronary Artery Disease
Stephen Fleet, MD
Just as the great voleur Willie Sutton robbed banks because “that’s where the money is,” why don’t we just look for coronary artery disease (CAD) directly in the coronary arteries? At the ESC meeting today in Paris, Bharati Shivalkar of Belgium reviewed the assessment of CAD utilizing coronary CT angiography (anatomical) vs. the usual standard of care, […]