Stents not effective? Study sparks debate pt. 1

U.K. PCI study sparks U.S. debate

On Wednesday, November 1, results from the Objective Randomized Blinded Investigation with Optimal Medical Therapy of Angioplasty in Stable Angina (ORBITA) study were published in The Lancet.

The next day, this article was published in the New York Times:

"A procedure used to relieve chest pain in hundreds of thousands of heart patients each year is useless for many of them," it began... "The new study, published in the Lancet, stunned leading cardiologists by countering decades of clinical experience. The findings raise questions about whether stents should be used so often—or at all—to treat chest pain."

Without further knowledge, the debate may start right here—the New York Times article had little in the way of medical detail to satisfy invasive cardiovascular professionals and may have further generalized results in a misleading manner.

But let's hold off on reacting, look at the debate surrounding this particular study and also place the findings in a wider context (part two). Note: this isn't the first time it has been suggested that stents are overused.

Continue reading Stents not effective? Study sparks debate pt. 1

Working in the Cath Lab Causes Heart Disease

Radiation Safety (Still) Matters

In February, ACVP blog reported on a survey that showed non-physician Cath Lab employees, ACVP members, reporting higher levels of musculoskeletal pain due to radiation exposure and lead apron use.

In April, SCAI released a membership survey with almost 50 percent of responders reporting orthopedic injuries, and there has been "no discernible improvement" since a similar survey was collected in 2004.

There's more bad news. A new study published this week links radiation in the Cath Lab to subclinical atherosclerosis. That's right, working in the Cath Lab can cause cardiovascular disease.

The study calculated a radiological risk score based on proximity to radiation source, caseload, and the length of employment, and there was a significant correlation between this measure and carotid intima-media thickness on the left side, not on the right, which provides "further support for a causal connection."

What's being done?

Continue reading Working in the Cath Lab Causes Heart Disease

What Patients SHOULDN’T get TAVR?

A new sub-study from the CoreValve U.S. Trial published in February's issue of JACC: Cardiovascular Interventions marks a step closer to a model for deciding what extreme surgical risk patients should NOT undergo Transcatheter Aortic Valve Replacement (TAVR).

While a majority of extreme-risk patients did see significant positive change in disease-specific, general health and quality-of-life metrics following TAVR, a large minority—39 percent of patients—had a poor outcome post-TAVR.

Continue reading What Patients SHOULDN’T get TAVR?