Cath Lab Digest - February 2008 - (Page 66)

66 CLINICAL AND INDUSTRY NEWS FEBRUARY 2008 CABG Best for Multivessel Disease B ypass surgery remains the best option for heart patients with more than one clogged artery, according to the first big study to compare coronary artery bypass graft (CABG) surgery with drug-eluting stents. The new research dims hopes that the less drastic stent procedure would prove to be just as good for people with multiple blockages. In the study, heart attack and death rates were lower among people who had surgery than those given balloon angioplasty and stents. A second study gave stent makers some good news, finding that using these devices “off label,” in non-approved situations, is not as dangerous as many had feared. Both studies were published in The New England Journal of Medicine. Neither is definitive enough to resolve these issues, but they help guide physicians and patients confused about which treatment is best for whom. The CABG study is “a sobering reality check” for people hoping that the newer drug-eluting stents “would level the playing field” and make these treatments equally effective, Harvard University cardiologist Dr. Joseph Carrozza wrote in an accompanying editorial. CABG has become less common as angioplasty has risen dramatically. In 2005, about 469,000 bypasses were performed on 261,000 patients. More than 1.2 million angioplasties were done, though many people had more than one procedure. In 2005, Edward Hannan of the State University of New York at Albany published a study that found CABG to be better than angioplasty with bare metal stents for patients with multiple blockages. His new study makes a similar comparison, but with the newer drug-eluting stents, which came out in 2003. Researchers analyzed two state databases of 17,400 New York residents treated for multiple blockages in 2003 and 2004, and compared deaths and complications 18 months later. Survival rates for both treatments were excellent, but CABG still showed a significant advantage after researchers took into account differences in how sick or old the patients were. People with three clogged arteries had a survival rate of 94 percent after bypass compared with about 93 percent after stenting, which translated to a 20 percent lower risk of death. Those with two blockages had a survival rate of 96 percent after the operation compared with roughly 95 percent after stenting — about a 30 percent lower risk of death. The CABG group also needed fewer repeat procedures and suffered fewer heart attacks after treatment. The New York State Department of Health helped pay for the study. The research covered the period in 2004 when former President Bill Clinton had quadruple bypass surgery, but it isn't known if his case was included, or if angioplasty was an option. Stents still might be better for older patients and others who face greater risks from surgery, or for people who strongly prefer a less drastic treatment, Carrozza wrote. Some types of blockages also cannot be treated with stents. In the second study, a team of U.S. and Canadian scientists looked at 6,551 patients who received either drug-eluting stents or plain metal ones. Among those who received stents off-label, no difference in heart attacks or deaths was seen, though the bare-metal stent group needed more repeat procedures. The findings “appear to validate off-label use” of drug-eluting stents, but this single observational study is not enough to declare that safe, Carrozza wrote. To read the studies online (abstracts are free to view), visit www.nejm.com. HemCon Medical Technologies’ Battle-Tested Bandages Called to Action in Hospitals HemCon® Bandage and ChitoFlex® Dressings Improve Wound Care Solutions for Patients A new hemorrhage control bandage from HemCon Medical Technologies Inc., first used on the battlefields of Afghanistan and Iraq, is in use by health care professionals in emergency rooms, trauma care and cardiac catheterization labs around the world. The bandages, synthesized from chitosan, a natural substance found in shrimp shells, offer a new and more effective wound care alternative. HemCon dressings control bleeding within two to five minutes by becoming extremely adherent when in contact with blood. The adhesive-like action seals the wound and attracts red blood cells to the bandage, forming a seal that stops hemorrhaging independent of the body’s natural clotting process. The bandages are antibacterial and effective on highpressure, high-flow arterial bleeds. Current methods of hemorrhage control can involve gels, granules or thrombin, which can lead to severe health risks like second degree burns or increased risk of infection. The hemostatic HemCon Bandages and stuffable ChitoFlex dressings are already being used in numerous medical facilities across the nation such as UNC Memorial Hospital in Chapel Hill, NC, Vanderbilt Medical Center in Nashville and Rush University Medical Center in Chicago. “I have used the HemCon Bandage for a number of cardiac procedures at Rush University Medical Center,” said Dr. Ziyad M. Hijazi, director of the Center for Congenital & Structural Heart Disease at Rush University Medical Center. “I’m impressed with the product and believe it improves patient care by offering medical staff an effective and safe way to quickly control bleeding.” HemCon products have been used by the U.S. military since 2003, and according to the U.S. Army Surgeon General’s office, the HemCon Bandage has a 97 percent effective rate in controlling bleeding on the battlefield. The HemCon Bandage is credited with saving more than 100 lives on the battlefield, and the company recently redesigned its bandages to meet the specific needs of civilian trauma and emergency medicine. All HemCon dressings are fabricated from chitosan, a naturally occurring, biocompatible polysaccharide derived from shrimp shells. The shrimp shells are processed, chemically treated, made into bandage form and then sterilized. The HemCon® Bandage was developed in collaboration with the Oregon Medical Laser Center and Providence St. Vincent’s Hospital. HemCon’s manufacturing and corporate headquarters are located in Portland, Oregon. For more information, please visit www.hemcon.com. ■ Boston Scientific Announces Upgrade to ilab® Ultrasound Imaging System B oston Scientific Corporation announced a third software enhancement to its iLab Ultrasound Imaging System, which was launched in May of 2006. The iLab System 1.3 System Software Enhancement is designed to strengthen physician confidence in the diagnosis and intervention of percutaneous coronary intervention (PCI) and increase workflow efficiency. The company said the software upgrade is available effective immediately in the U.S. Continued on next page http://www.nejm.com http://www.hemcon.com

Table of Contents Feed for the Digital Edition of Cath Lab Digest - February 2008

Cath Lab Digest - February 2008 Bay Regional Medical Center ENDEAVOR IV: A Zotarolimus-Eluting Stent Versus a Paclitaxel-Eluting Stent in a Randomized Clinical Trial A 3D CT Vessel “Roadmap” Over Live Fluoroscopy for Chronic Total Occlusions Contents Clinical Editor’s Corner An Evaluation of Cath Lab Turnaround Time Commentary: An Evaluation of Cath Lab Turnaround Time Excerpts from Chapter 19. STEMI Interventions – Future Perspectives The Potential Clinical Utility of Intravascular Ultrasound Guidance in Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents The Ten-Minute Interview with…Debbie Charlton, RN The Society of Invasive Cardiovascular Professionals (SICP) at Transcatheter Cardiovascular Therapeutics (TCT) 2007 The Cath Lab is a Business: Do You Have the Knowledge to Stay Afloat? Incidence and Predictors of Vascular Complications after Invasive Coronary Procedures: A Prospective Analysis Ask the Clinical Instructor: A Q&A Column for those New to the Cath Lab Volunteer Survey SICP* Section Meetings Calendar What Do You Think? CEU Education Center Clinical & Industry News Classifieds Advertisers Index

Cath Lab Digest - February 2008

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