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Journal of Invasive Cardiology Blogs
10th Biennial Meeting
Purpose and Overview
Introduction to the Proceedings from the
10th Biennial Meeting of the
International Andreas Gruentzig Society
held January 25–31 in Cape Town, South Africa
The Role for Low-Molecular Weight Heparin after a Cath Procedure
Urban legends intrigue me. They are either very prevalent in medicine, or the challenges of documenting simple, common observations are deeper than it would seem likely. An example is the use of low-molecular-weight heparin after a cardiac catheterization procedure. I am not referring to its use in acute coronary syndromes, which was tested in the ACUITY trial. I am referring to the use of these compounds after a diagnostic study or intervention. This is where the “urban legend” comes in. I have heard several reports that low-molecular-weight heparin has been associated with late vascular bleeding complications. This can be particularly dangerous because it allegedly can occur a day or so after the vascular puncture, that is, after the patient has gone home. This is a frightening scenario, as one can envision a very dramatic bleed, potentially life-or-limb threatening, possibly requiring surgery, transfusions, and holding of necessary dual antiplatelet therapy.
Introducing the IAGS blog
Visit this space regularly for selected blogs from IAGS members providing updates from the sessions presented during the 10th Biennial IAGS Meeting (held in South Africa in January 2009) and related discussions.
PROGRAM
Drug-eluting Stent Design: Perils, Potential, Progress
Speakers: James Zidar, Campbell Rogers
Moderator: Nickolas Kipshidze
Panelists: Michael Mooney, Thomas Mabin, Jamey Jacobs, Hall Whitworth
Drug-eluting Stent Management Dilemmas I
Speakers: Alfredo Rodriguez, Bonnie Weiner
Moderator: Richard Gray
Panelists: George Vetrovec, J. Jeffrey Marshall, Tarek Helmy
Drug-eluting Stent Management Dilemmas II
Speakers: Cindy Grines, H. Vernon Anderson
Moderator: Howard Cohen
Panelists: Tony Dortimer, Richard Gray, Adam Greenbaum, George Hanzel
Structural Heart Disease I
Speaker: William O’Neill
Moderator: George Hanzel
Panelists: Hall Whitworth, Larry Dean, Bonnie Weiner
Pondering on Paradigms from Across the Pond
Currently, coronary investigation (in the UK) is based on the paradigm of hemodynamics, in which a large coronary plaque causes significant luminal obstruction, symptoms and hypoperfusion of the myocardium. This paradigm has been the cornerstone of our therapeutic approaches to chronic stable angina, acute coronary syndromes and acute myocardial infarction for the last 40 years. Unfortunately, in the majority of cases, this diagnosis comes after a plaque has become significant or ruptured and the patient has been exposed to the risk and ultimately an inferior outcome. Surely, to improve cardiovascular risk prediction, outcomes and prevention we must change our investigational strategy? Why do we wait till symptoms come, risk builds and bad prognostic events happen before trying to patch things up in the cath lab?
PFO and Cryptogenic Stroke: Finding Closure
There’s no denying the impact of stroke. Not only is it the third leading cause of death, but it is in many ways more feared than heart disease or cancer. As interventionists, our sights have turned to three controversial procedures: (1) carotid stenting, (2) left atrial appendage isolation, and (3) PFO closure. While the first two concern older patients, the third affects those younger and often in the prime of life, throwing patient and physician fears and preferences into the debate.
Using New Anti-platelet Agents: Are You Ahead of the Curve?
A conversation between two interventionalists:
Subhash Banerjee, MD (VA North Texas and UT Southwestern Medical Center)
& Sunil V. Rao, MD (Durham VA and Duke University Medical Center)
An Interventional Cardiologist’s (brief) View on the Health Care Debate
I wonder how many people reading this have the same mixed feelings that I do with regards to the current health-care coverage debate. There are clearly some tremendous advantages which could be realized by making health care available to the currently uninsured, and by making insurance available to people with pre-existing conditions. I have worked at county hospitals directly or indirectly for most of my career, so I have seen the impact of our current lack of universal health care on many members of our society. I have been struck how many employed, hard-working members of society have not been able to afford health insurance, and then being stuck with medical bills that overwhelm them. We have all heard about individuals with devastating health issues who have lost their savings and declared for bankruptcy due to their massive medical bills. These stories, and the recognition that there are ~30 million Americans without health insurance, cry out for reforming our system.
Cardiology is a Team Sport
In patient care, we all know the best outcomes come with teamwork. A team approach achieves the best care by drawing upon the unique strength of each member to form the ultimate authority or “single voice of action.”
Recently I had an 84 year-old patient with Hypertrophic Cardiomyopathy (HCM) who suffered cardiogenic syncope while driving. I made a tough decision to have my colleague implant an ICD for secondary prevention. Unfortunately, she developed pericardial tamponade, requiring echocardiography, pericardiocentesis, and surgical intervention the next morning for ongoing bleeding. She eventually left the hospital, thanks to the heroic teamwork of non-invasive cardiologist, interventional cardiologist, electrophysiologist and cardiothoracic surgeon.
Clopidogrel-Proton Pump Inhibitor (PPI) interaction: Where Do You Stand?
I would submit for starters that drug-drug interaction issues are one of the most vexing, often substantiated by competing claims rooted in plausible pharmacokinetic mechanisms. Nevertheless, each one of us has to find our own version of the truth.
Regarding this issue there unfortunately isn’t an absolute one. This realization manifests on how we practice and what we advise our patients. Well, then this blog should get all of you out there to respond with pithy comments on your take of the evidence presented so far publicly. Also, how justifiable is the position FDA has adopted? Another important question is, are most PPI prescriptions for patients on dual anti-platelet therapy (DAPT) justified?
Word of Caution: Proving “Less is More” is More or Less Easy
Let’s talk about Comparative Effectiveness, as it seems to be the buzz word of the day. As cardiologists, we’re used to this type of research; in fact, I doubt any other field has performed more randomized controlled trials. But, why call it Comparative Effectiveness? I can’t help but worry that the driving force is less about science than about cost, and therefore really Cost Effectiveness. For a field as rich in innovative and expensive technology as interventional cardiology, this is potentially an important distinction.
Interventional Cardiology has an Image Problem
Washington state has convened a Health Technology Assessment program to evaluate for therapies which are deemed insufficiently cost-effective for state-sponsored insurance programs to cover. They decided to address drug-eluting stents (as opposed to bare metal stents) and I was invited to be a consultant for this process, along with several other physicians, most of whom were not interventional cardiologists. As we discussed the relative merits of drug-eluting stents versus bare metal stents for a variety of conditions, a consistent theme kept cropping up from those who were not interventional cardiologists.
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Press Release
— Bethlehem, Pennsylvania – Invatec received 510(k) clearance from the U.S. Food and Drug Administration (FDA) in October to market its Mo.Ma Ultra Proximal Cerebral Protection Device for use during carotid artery stenting (CAS). The device effectively reduces and captures debris released during the stenting procedure to prevent it from traveling to the brain, where it has the potential to cause a stroke.
CME Showcase
 The Use of Remote Robotic Navigation in Complex Arrhythmias Complimentary Accredited Web Archive This activity is designed for electrophysiologists and EP allied professionals. Diagnosing Coronary Artery Disease: Advanced Cardiovascular Imaging Solutions  New Standards of Care for CRMD Antibiotic Protection Complimentary CME Accredited Webcast Dates: November 18, 2008 Time: 6:00 pm ET November 19, 2008 Time: 3:00 pm ET This activity is sponsored by the North American Center for Continuing Medical Education. |
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