Cardiovascular Business - May/June 2008 - (Page 34)

News & Views á Making sense of stent trial results In his commentary at the ACC meeting, Dariusz Dudek, MD, from Jagiellonian University in Krakow, Poland, said as a result of the finding physicians should re-evaluate the current standard of care for this vulnerable patient population and potentially readjust the existing guidelines. T he world of stents offers a variety of topics that were covered through myriad clinical trials and registries presented at the 2008 American College of Cardiology Scientific Sessions in March. A few of those scientific developments released at the conference might soon impact the way interventional cardiology is practiced. Here is a small sampling. The Xience V drug-eluting stent from Abbott Vascular (above), which is not yet approved for use in the U.S., had favorable results in other countries compared to the Taxus stent from Boston Scientific. (Source: Abbott) NCDR: Surgical Backup In a study using the National Cardiovascular Data Registry of more than 300,000 patients at 465 centers, there was no significant difference between procedural successes at 61 centers without on-site surgical backup (94 percent) and 404 with backup (93 percent). Also, there was no significant difference between the complication rates among the 9,029 patients who had PCI in centers lacking on-site surgical backup (6.4 percent) compared to the 299,132 patients who had PCI at centers with backup (6.3 percent). In response, David Cohen, MD, from St. Luke’s MidAmerica Heart Institute, told Cardiovascular Business that the practice of nonsurgical backup is common and is often effective, as long as the facility complies with regulatory requirements. But lead author Michael Kutcher, MD, of Wake Forest University Baptist Medi- TRANSFER-AMI The ongoing TRANSFER-AMI is the largest randomized trial of its kind, enrolling 1,060 STEMI patients to compare a pharmaco-invasive strategy of transfer for routine PCI within six hours after fibrinolysis with standard treatment after fibrinolysis, including predefined criteria for rescue PCI. The primary endpoint was 30-day composite of death, reinfarction, recurrent ischemia, CHF and shock. The preliminary results found that 16.6 percent of patients in the standard treatment arm experienced these events, while 10.6 percent of patients in the pharmaco-invasive arm experienced these events. The researchers concluded that transfers to PCI centers should be initiated immediately after thrombolysis without waiting to see whether reperfusion is successful. cal Center, cautioned that the findings of the study should not be extrapolated to encourage widespread proliferation of off-site PCI programs. TAPAS The TAPAS trial found the use of the Export Aspiration Catheter (Medtronic) in STEMI patients resulted in better myocardial blush grades compared with patients receiving conventional PCI techniques. The single center, prospective, randomized trial, led by Felix Zijlstra, MD, of the University Medical Center Groningen, found that the rate of death in patients with a myocardial blush grade of 0/1, 2 and 3 was 5.2 percent, 2.9 percent and 1 percent, respectively. The combined rates of repeat MI, repeat procedure in the target artery and death in patients with a myocardial blush grade of 0/1, 2 and 3 were 14.1 percent, 8.8 percent and 4.2 percent, respectively. Prior to TAPAS, the “common wisdom was to only use thrombectomy if you saw a large clot,” said David Cox, MD, co-director of interventional cardiology at the Methodist Hospitals in Gary, Ind. This is a “practice-changing paper,” he said. SPIRIT II After two years of follow up, the Abbott Xience V drug-eluting stent no longer held a statistically significant edge over Boston Scientific’s Taxus, as it did earlier in the SPIRIT II trial. Initial results of the SPIRIT II trial, released in September 2006, showed that the Xience V stent was superior to the Taxus stent in both six-month findings on angiography and oneyear clinical outcomes. The researchers recruited 300 patients from 28 medical centers in Europe, New Zealand and India, who needed stenting of up to two new coronary lesions. 34 Cardiovascular Business May/June 2008

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Cardiovascular Business - May/June 2008 Contents First Word Cover Story - Coronary CTA: Drafting the Strategic Plan Financing New Technologies: Early Adopters, Lease vs. Purchase, and Joint Ventures Clinical Study Digest: ACE or ARB: It's Your Choice Can Off-Hour D2B Times Be Reduced Without Breaking the Bank? Digital Image Management Primer: Integrating Echo SPECT/CT for Cardiac Disease Detection: An Economic Conundrum Integrating the Healthcare Enterprise Connects IT Systems News & Views Calendar Reader's Resources The Back Page

Cardiovascular Business - May/June 2008

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