Cath Lab Digest - November 2007 - (Page 4)

4 CLINICAL EDITOR’S CORNER NOVEMBER 2007 EDITORIAL Paradigm Shifting: Clinical analysis impact of measuring fractional flow reserve A comment on the discussion by Dr. Fadi Matar in this month’s issue of CLD MORTON KERN, MD Clinical Editor Clinical Professor of Medicine Associate Chief Cardiology University of California Irvine Orange, California LAURIE GUSTAFSON Executive Editor REBECCA KAPUR Managing Editor ELIZABETH MCTAMNEY Layout/Production Manager I n The Clinical and Economic Impact of Measuring Fractional Flow Reserve (page x), Dr. Matar has presented an insightful discussion on his use of physiologic measurements in his very busy clinical practice, specifically, the pressure-wire derived fractional flow reserve (FFR). It is worth noting that as an expert, experienced interventional cardiologist, his previous highly aggressive approach of “just stent it” to nearly all lesions has given way to a thoughtful and more objective approach of “measure and decide.” Dr. Matar elegantly discusses some of the major issues with regard to the clinically relevant aspects of using in-lab coronary physiology in his clinical decision-making. Addressing the key indicator for the use of FFR, i.e. the uncertainty regarding angiographic lesion significance, Dr. Matar uses this additional objective data to decide whether or not to give his patient drug-eluting stent. Although data supporting this approach has been available for more than 10 years, one of the most important and long-awaited studies has recently been published. As an extension to the original studies testing the appropriateness of stenting a non-functional stenosis, Pijls et al1 report on the 5-year follow up results of the DEFER study. In this study, 325 patients scheduled for percutaneous coronary intervention (PCI) of an intermediate stenosis were examined by FFR before intervention. HMP Communications PAUL MACKLER President/CEO PETER NORRIS Executive Vice President/General Manager JEFFREY MARTIN Vice President/Group Publisher Cardiology Division ALEX SLONIM Vice President/Associate Publisher of Cardiology CARSON MCGARRITY National Account Manager NICK OTRANTO Account Manager LUCINDA BESKA Classified Advertising Sales Manager FRED KLUMPP Manager of Information Systems KATHY MURPHY Production Director STEFANIE TULEYA RENEE OLSZEWSKI Special Projects Editors KIMBERLY B. CHESKY Production Director, Special Projects PATRICIA LEVY Director of NACCME MORTON KERN, MD Clinical Editor Clinical Professor of Medicine Associate Chief Cardiology University of California Irvine Orange, California mortonkern005@hotmail.com If the FFR was above the ischemic threshold (≥ 0.75), patients were randomly assigned to: • The Defer group (n=91, medical therapy without PCI); • Or the Performance group (n=90, PCI despite a normal FFR and intermediate lesion). If the FFR was <0.75, PCI was performed in a standard fashion and these patients comprised the Reference group (n=144). Clinical follow-up for major adverse cardiac events over 5 years was then recorded. For the three groups, complete follow-up was obtained in 98% of patients. • Event-free survival was not different between the Defer and Perform groups with 80 and 73% respectively (p=0.52), but was significantly worse in the Reference group, 63%; (p=0.03). • With regard to cardiac death and acute myocardial infarction over a 5-year period, the Defer and Reference groups had rates of 3.7% and 7.9% respectively versus 15.7% for the Perform group, which was higher than either of the other two groups. • The percentage of patients free from chest pain at follow-up was not different between the Defer and Perform groups. The data indicated that the 5-year outcome of deferring PCI for intermediate stenosis based on coronary physiology is excellent. The risk of cardiac death or infarction continued on next page related to target stenosis was less than 1% per year and not decreased by stenting. Editorial Correspondence: Rebecca Kapur, Managing Editor, HMP COMMUNICATIONS Cardiology Editorial Offices, 7427 Winding Way, Brecksville, OH 44141 Tel. (800) 459-8657 Fax: (216) 393-0445 Email address: RKapur@hmpcommunications.com Circulation: Bonnie Shannon, BShannon@hmpcommunications.com, tel. (800) 237-7285, ext. 246 Advertising: Jeffrey Martin, Vice President/Group Publisher, tel. (800) 237-7285, ext. 238, Email: jmartin@hmpcommunications.com Alex Slonim, Vice President/Associate Publisher, tel. (800) 237-7285, ext. 245, Email aslonim@hmpcommunications.com Carson McBrayer, National Account Manager, tel. (800) 237-7285, ext. 234, Email: cmcbrayer@hmpcommunications.com Nick Otranto, Account Manager, tel. (800) 237-7285, ext. 270, Email: notranto@hmpcommunications.com Advertising address: HMP COMMUNICATIONS, 83 General Warren Blvd., Suite 100 Malvern, PA 19355 Tel. (800) 237-7285. Cath Lab Digest (ISSN# 1073-2667) is issued 12 times per year by HMP COMMUNICATIONS, 83 General Warren Blvd., Suite 100, Malvern, PA 19355. Periodicals postage paid at Malvern, Pennsylvania and additional mailing offices. Printed in USA at Publisher’s Press, 100 Frank E. Simon Ave., Shepherdsville, KY 40165 Modifying risk factors and adequate medical treatment in such patients is of greater value than the mechanical intervention. CIRCULATION: Bonnie Shannon Tel: (800) 237-7285, ext. 246 or (610) 560-0500 ext. 246 E-mail: BShannon@ hmpcommunications.com SUBSCRIPTION INFORMATION CATH LAB DIGEST is sent to all non-physician cath lab personnel working in the United States (international subscription is $60 for 1 year). 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Table of Contents Feed for the Digital Edition of Cath Lab Digest - November 2007

Henry Ford Heart and Vascular Institute Treating Patients with Complex Vascular Disease with a Multi-Disciplinary Approach Improving Patient Compliance with Antiplatelet Medications Clinical Editor’s Corner Cath Lab Nurse/Tech Vascular Access and Closure Using the StarClose® Device The Clinical and Economic Impact of Measuring Fractional Flow Reserve FFR and Choosing an Optimal Revascularization Strategy Finally! The New Registered Cardiac Electrophysiology Specialist (RCES) Credential Use of a Mobile Lab to ‘Test the Waters’ at a Rural Hospital Remembering a Cardiac Cath Lab History ACVP• Membership Page What Do You Think? The Ten-Minute Interview with… Ernie Livingston, RN, BSN SICP* Chapter Updates Who’s in Charge? Working to Eliminate Bottlenecks: Florida Hospital’s Cardiac Cath Lab Achieves Greater Efficiency and Higher Satisfaction Preserving Left Ventricular Function during Percutaneous Coronary Intervention Ask the Clinical Instructor: A Q&A Column for Those New to the Cath Lab Making the Most of Your First Impression: Interviewing Tips and Techniques CEU Education Center Clinical & Industry News Meetings Calendar

Cath Lab Digest - November 2007

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