Archive for the 'Miscellaneous' Category
May 25th, 2007 7:05:29
Dissolving Stents
A new kind of stent is showing promise… dissolving stents.
The new stents are designed to dissolve in the artery three
years after being implanted.
The new stent is made of lactic acid molecules. The research
has not been rigorously tested yet, and the trial has only
been presented at a medical meeting (not in a peer reviewed
journal).
COMMENT: maybe this will work… maybe. We just don't know
yet. For now, aggressive medical therapy is looking good for
early disease, and stents good for moderate to severe
disease. The field is changing so rapidly that the best bet
is to have a frank discussion with both your cardiologist
and your primary care clinician. Ask plenty of questions,
and work together to come to a solution that seems
reasonable to everyone.
http://www.medicalnewstoday.com/healthnews.php?newsid=66048
May 24th, 2007 23:05:07
COURAGE Trial Unlikely to Change Stent Usage
[press release from the Society for Cardiovascular
Angiography and Interventions] 3/27/2007 - Results
of the COURAGE trial, presented today at the
American College of Cardiology Annual Scientific
Session, are unlikely to alter the approach that
interventional cardiologists take in treating most
patients with chronic stable angina, say leaders
from the Society for Cardiovascular Angiography
and Interventions (SCAI), the leading professional
society for interventional cardiologists in the
United States.
Percutaneous coronary intervention (PCI) typically
involves placement of a stent to relieve a
blockage within a coronary artery and thus relieve
the symptom of chest pain. Preliminary results of
the Clinical Outcomes Utilizing Percutaneous
Coronary Revascularization and Aggressive
Guideline-Driven Drug Evaluation (COURAGE) trial,
announced during a press conference yesterday,
focused on the finding that, when added on top of
an optimal drug program, PCI reduces neither
mortality nor heart attack in patients with
chronic stable angina.
Chronic stable angina is a condition that causes
patients to experience symptoms such as chest pain
and shortness of breath when engaging in various
levels of activity. Data from the landmark
Framingham Heart Study have shown that these
patients have an average annual mortality of only
4 percent, making it difficult for any therapy to
show a substantial improvement.
"Patients with chronic stable angina represent a
minority of those treated by interventional
cardiologists, perhaps up to 30 percent," said
SCAI President Gregory J. Dehmer, MD. "More
frequently, patients treated by interventional
cardiologists have heart attacks or another
serious problem called unstable angina. The
COURAGE study did not evaluate this type of
patient; however, the study's investigators
acknowledged that PCI is the best therapy for
patients suffering heart attack."
It is important to put the results of the COURAGE
study into the proper perspective, stressed Dr.
Dehmer. "We are concerned that many seem to be
interpreting this study as part of a huge battle
among cardiologists that will shift therapy in a
dramatic way, but I don't really see it shaping up
that way. Although PCI is life-saving in the
setting of a heart attack, it has never been
promoted in any of the national treatment
guidelines as saving lives or preventing heart
attacks in patients with chronic stable angina.
Although it is tempting to pick apart the COURAGE
trial for its flaws, and there are some, doing so
would remove the focus from how the results can
best be used to improve patient care," said Dr.
Dehmer.
SCAI leaders view the COURAGE study results as a
contemporary update of how much the treatment of
coronary artery disease has advanced, whether by
use of medications, PCI, or both. While some
patients with chronic stable angina can be managed
safely with medications, such therapy may not be
the best fit for every patient.
"The right therapy for an elderly patient with a
limited lifestyle may not work for a younger, more
active individual. It is always challenging to
extrapolate trial results to the 'real world,' and
real-world questions about individual patients'
ability to comply with aggressive drug therapies
apply here," said Dr. Dehmer. "We agree that
medical therapy has come a long way, but a simple
question reveals the challenges that accompany
relying too heavily on medications – The last time
you got a prescription for a 14-day course of
antibiotics, did you take every pill on schedule?
Or did you stop when you started feeling better?"
Given the COURAGE findings, SCAI is reminding
physicians to talk in detail with their patients
and clearly explain therapeutic goals, whether the
treatment is medical therapy or PCI. "I feel
certain that most interventional cardiologists
already do this, but it is worth repeating.
Patients with chronic stable angina should
understand the purpose of whatever treatment is
being proposed and know that they do have options
– both good options – for the treatment of their
chronic stable angina," said Dr. Dehmer.
May 22nd, 2007 7:05:10
Percutaneous Coronary Intervention of No Benefit as Initial Therapy
From the New England Journal of Medicine: in patients with stable coronary artery disease, it was found that percutaneous coronary intervention as the initial therapy did not decrease the risk of death, myocardial infarction, or other major cardiovascular events.
Comment: this study reflects the great advances that have been made in medical therapy.
http://content.nejm.org/cgi/content/short/NEJMoa070829