), a large bulk of evidence, derived both from randomized trials and from observational cohorts proved the increased risk of myocardial infarction in patients on highly active antiretroviral treatment (HAART
). Despite the recognition of this risk, only in the last decade several studies have assessed the underlying histopathology and impact of this condition on worldwide cardiovascular health.
The HOPS and DAD trials, two large prospective observational cohort studies conducted between 1996 and 2008, have shown that HIV-infected patients receiving HAART have considerably longer life expectancy with early recognition and treatment (similarly to HIV-negative subjects), thus increasing the life span for HIV-related chronic comorbidities including cardiovascular, renal and bone diseases. A premature ageing process and a high prevalence of comorbidities (and therefore treatment with several medications) have been described and contribute to the increased frailty and mortality that are recognized in HIV-positive subjects. Furthermore, antiretroviral drugs (ARVs) have been associated directly with increased cardiovascular risk (such as abacavir or PIs) or to imbalances in several cardiovascular risk factors (such as insulin resistance and dyslipidemia). The increasing availability of ARVs, the improvement in life expectancy and risk factors prevalence together with the growing “westernization” of sub Saharan African countries, suggest that cardiovascular disease will become a leading cause of death in patients with HIV even in limited-resource settings, stressing how much crucial is a thorough knowledge and understanding of cardiac manifestations of HIV/AIDS for any European cardiovascular specialist.
In such a complex yet not completely understood scenario, interaction among traditional risk factors, comorbidities, antiretroviral medications and the pro-inflammatory role of HIV emerges and it represents a novel interplay in the key model of infectious agent-host environment.
Short term benefits of specific antiretrovirals prevent cardiovascular disease in HIV patients, but long term benefits need more data and longer-term follow-up to be correctly assessed. The results of ongoing trials will provide important information on how to manage timing of HAART initiation with the ultimate goal of optimizing the risk-benefit balance. The START
trial includes antiretroviral-naive HIV-positive people with CD4 counts greater than 500 cells/mm3. It is taking place in about 90 sites in nearly 30 countries where participants are randomized to either receive antiretroviral treatment immediately or to defer treatment until their first CD4 count less than 350 cells/mm3 or they have clinical signs of advanced HIV disease. Such a randomized study will therefore address the question if the purported benefits of early therapy (as it is suggested by U.S. Department of Health and Human Services - DHHS guidelines) may overcome the expected drug-associated side-effects.
Others challenges and open issues remain concerning the best time to start antiretroviral therapy, the best regimen in patients with established coronary artery disease (CAD), the role of anti-inflammatory and anti-thrombotic drugs as well as the long-term clinical outcomes in HIV-positive patients, previously considered “doomed”, and now predicted to live longer and face age-related morbidities.
Since 1998, when Keith Henry, in a letter to The Lancet, reported two cases of myocardial infarction in young HIV men on protease inhibitors (
) scientific sessions, held this year for the first time in Miami, are still roaring,
other randomized clinical trials recently provided more and clinically relevant knowledge on different important
Focusing on regenerative therapy and the infusion of bone marrow stem cells in ischemic heart disease,
trial showed that in
patients with ST-elevation myocardial infarction (STEMI), intracoronary infusion of bone marrow stem cells did
not provide any significant
advantage after successful primary percutaneous coronary intervention (PCI) on cardiac remodeling indexes.
More positive results on cardiac regenerative therapy came however from
In this trial, infusion of cells (both allogenic and autologous) in subjects with chronic ischemic cardiomiopathy with a median
ejection fraction of 27% provided a significant improvement in functional and left ventricular remodeling indexes, potentially
offering, although not yet definitevely demonstrated, also a prognostic benefit.
Another debated topic has been platelet responsiveness to antithrombotic agents, with several studies potentially suggesting
that suboptimal response to aspirin, clopidogrel, or other agents may represent a negative prognostic feature.
A question has loomed however: how should we manage it,
especially with novel drugs?
The TRILOGY ACS
trial showed actually that in patients
with acute coronary syndromes (ACS) not undergoing revascularization,
platelet reactivity is reduced in the prasugrel cohort, but this finding was not associated
with a more positive clinical outcome. Similarly, the
trial showed that in stable patients
(not with a recent ACS), a strategy based on addition of a bolus of prasugrel or clopidogrel
for patients with high on-treatment platelet reactivity did not offer major benefits in terms of reduction of ischemic events.
From bone cells and platelets to surgery: mitral regurgitation less than severe in grade is a
common finding in ischemic cardiomiopathy, yet without a clear indication for repair.
showed that mitral repair associated with surgical revascularization
again may offer a significant improvement in functional indexes and left ventricle volumes.
While news from the Transcatheter Cardiovascular Therapeutics
) and Transcatheter Cardiovascular Therapeutics
) scientific sessions, which have provided important insights on the management of
patients with coronary artery disease (CAD), resistant hypertension, structural heart disease, and patent forame ovale (PFO).
First and foremost, the saga of PFO has not ended yet. Actually, two trials,
, although with some methodological pitfalls,
did not reach statistical significance to reduce stroke, even if the event-free survival curves
in the device versus medical therapy arms seem to go on and diverge at long-term follow-up. Thus,
we now need to wait and see, especially for the complete and peer-reviewed articles, which may probably shed light on many unclear points.
From scientific fog to sun, the
showed, similarly to the ST-elevation myocardial infarction (STEMI) substudy of
trial and to
that radial approach is associated with a significant lower incidence of major bleeding and access
site complications, leading to a significant better net clinical benefit in patients undergoing primary
percutaneous coronary intervention (PCI). Another deeply discussed topic was the clinical impact and applicability of
trial, which was the first randomized clinical study to
demonstrate a net clinical benefit (that is a reduction in the need for urgent revascularization)
in patients with stable CAD randomized to percutaneous coronary intervention guided by fractional flow
reserve versus aggressive medical therapy only.
But while interventional cardiologists were satisfied with FAME 2, data stemming from
the 5-year outcomes in the
were fare less generous, showing thant patients with diabetes and/or multivessel disease perform better
with surgical revascularization, in terms of death, myocardial infarction and revascularization. Another
minor but interesting finding was the accuracy of
score in FREEDOM.
Specifically, in the second tertile coronary artery bypass surgery (CABG) was superior to PCI, but not
in the third. Was this just due to play of chance? Or are we (and guidelines) overestimating the accuracy
of such a complicated angiographic tool?
After some interval, we are back with several striking results from the American Heart Association
Among the many interesting pieces of news reported in Paris, at least two trials demonstrated that often in medicine "less is more". First, the
Prolonging Dual Antiplatelet Treatment after Grading Stent-induced Intimal Hyperplasia
trial demonstrated that dual antiplatelet therapy after drug eluting stenting for 24 months when compared with 6 months does not reduce the risk
of ischemic events, but on the contrary doubles the bleeding risk.
Further confirmations of these findings in different clinical settings and patients (e.g. those with stable angina or acute coronary syndromes) and
for new antiplatelet agents are warranted
The Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction (CRISP AMI
) trial failed to demonstrate a benefit on infarct
size or other clinical end-points of intra-aortic balloon pump in patients with acute ST-elevation myocardial infarction without shock.
But sometimes "more is indeed more". The Italian Elderly ACS
trial demonstrated that in patients older than 75 years with non-ST-elevation acute coronary syndromes coronary angiography and early revascularization
within 48 hours is superior to an initially conservative strategy at least in those with positive myocardial biomarkers.
Finally, the quest for the optimal treatment of left main coronary artery disease has gained by the presentation of the 3-year follow-up of the CREDO-Kyoto
registry, in which PCI resulted a predictor of adverse events for all tertiles of SYNTAX score.
After the summer holidays, the European Society of Cardiology Congress has brought us back to work.
meeting, we are happy to be back with the
METCARDIO newsletter. Several news are worth discussing, including the recent identification of the recipient of the METCARDIO Award
Pivotal trials recently reported at the American College of Cardiology
scientific sessions include the
Cohort A study has demonstrated the non-inferiority of transcatheter aortic valve replacement (TAVI) in comparison to standard surgical therapy in subjects
with severe aortic stenosis at high operative risk, despite a short term increase in the risk of stroke.
trial has compared radial versus femoral access for coronary procedures in 7021
patients with acute coronary syndromes, finding similar overall results for the primary end-point (a composite of death, myocardial infarction, stroke, or non-coronary artery bypass graft-related major bleeding at 30 days), even if
a benefit was demostrated in selected groups (such as those with ST-elevation myocardial infarction and experience operators).
Finally, the STICH
trial has compared best medical therapy plus coronary artery bypass grafting
versus best medical therapy only in 1212 patients with heart failure and left ventricular systolic dysfunction. Despite failing to meet the primary study
end-point (namely all cause death), bypass grafting did still provide meaningful benefits on patient-relevant clinical end-points.
After a long delay, and awaiting the upcoming
versus traditional surgical aortic valve replacement, not only focusing on inoperable patients, as already happened in the
but also on subjects with high yet not exceedingly high operative risk.
Another important news comes from the trial by Rodes-Cabau et al
In this non-randomized study,
comparing transcatheter aortic valve implantation versus traditional surgical aortic valve replacement in patients with reduced left ventricular ejection fraction
(LVEF), transcatheter aortic valve implantation proved superior to surgery as up to 58% of patients undergoing transcatheter intervention recovered their
systolic function (left ventricular ejection fraction above 50% at follow-up) versus only 20% of those undergoing sugery. These are very important results,
although not coming from a properly randomized experimental trial, given that this transcatheter technique was moving its first steps just a few years ago.
Shifting from macro to micro, contrasting evidence has been produced about specific cytochrome alleles interfering with clopidogrel metabolism (i.e. the CYP2C19 genotype) and the risk-benefit of
clopidogrel. Whereas Parè et al
have shown no negative effect of loss of function alleles
among patients presenting with acute coronary syndromes in the CURE trial and those with atrial fibrillation drawn from the ACTIVE A study, a comprehensive
meta-analysis by Mega et al
has shown that carriage of only reduced-function alleles
appears to be associated with a significantly increased risk of adverse outcomes, particularly stent thrombosis. These differences probably are related to
different populations and analytical tools (especially robustness of multivariable models). A possible solution, especially for physicians without an access
to genetic testing, will be an increasing shift to new antiplatelet agents,
such as prasugrel
both with specific pros and cons
Another challenging set of patients are those with a cancer history, and treated with drugs with potential cardiotoxicity. Recently,
Yoon et al
that patients exposed to anthracycline or trastuzumab and developing left ventricular dysfunction are often treated with a suboptimal heart failure therapy,
despite the fact that the Food
and Drug Administration
has recently warned
on the increased risk of diabetes and heart disease derived from gonadotropin releasing hormone agonists used for prostate cancer.
A possible solution is the development of a close collaboration between cardiologists and oncologists,
as outlined recently in the Third International Symposium of the Cardiology Oncology Partnership
Incoming news have depicted evolving scenarios for cardiologists, both from clinical and interventional points of view. The Food and Drug
Administration (FDA) has finally approved a randomized clinical trial comparing transcatheter aortic valve implantation (TAVI) with the
) meeting and awaiting the
upcoming Società Italiana di Cardiologia Invasiva-Gruppo Italiano Studi Emodinamici (SICI-GISE
it is appropriate to review some key studies that have been recently published.
Bhatt et al
conducted a randomized trial including 3873 patients treated already with aspirin and clopidogrel and
allocated to omeprazole versus placebo, and found that omeprazole significantly reduced the risk of gastrointestinal events (1.1% versus 2.9%) without any sign of cardiovascolar
hazard (4.9% cardiovascular events at 6 months versus 5.7%), thus disproving previous works (all actually non-randomized analyses) suggesting that proton pump inhibitors
had a detrimental interaction effect on the risk-benefit profile of clopidogrel. Indeed, this whole clopidogrel-omeprazole controversy too strongly remind us of the
hormone replacement therapy issue, which was wrongly dominated by biased non-randomized trials and could only be settled by much later experimental studies.
The long-term safey of drug-eluting stent implantation for unprotected left main coronary disease has been further confirmed by
investigators. In particular, Park and colleagues compared coronary artery bypass
surgery versus percutaneous coronary intervention in 395 patients followed for at least 5 years, demonstrating that percutaneous coronary intervention has similar rates
of death, myocardial infarction or stroke, but higher rates of repeat revascularization, in comparison to bypass surgery.
Finally, Elias-Smale et al
including Ewout Steyerberg provide compelling evidence
in support of the incremental use of computed tomography coronary calcium score to appraise the cardiovascular risk of asymptomatic elderly subjects. In particular, coronary
calcium score improved the predictive ability of the Framingham risk score by enabling more appropriate reclassification of 50% of patients included in the intermediate
risk stratum (10% to 20% 10-year risk). Whether calcium score can be recommended routinely for risk prediction can however only be demonstrated by a pragmatic randomized
Recovering from the Transcatheter Cardiovascular Therapeutics (
and the Transcatheter Cardiovascular Therapeutics (TCT
) meetings provide several seminal news worth
trial has been probably the most important trial reported at the ESC congress.
In this study, patients with congestive heart failure not reaching adequate heart rate control were randomized to ivabradine versus placebo. At mid-term
follow-up, patients treated with ivabradine had several key clinical benefits, including a significant reduction in cardiac mortality.
trial dominated instead the TCT congress, With a hitherto unheard
absolute reduction of more than 20% in the risk of all-cause death at 12 months in patients undergoing transcatheter aortic valve implantation (TAVI)
compared with best standard therapy for severe aortic stenosis in inoperable patients.
Should we now change altogether our practice and, respectively, add ivabradine to our pharmaceutical armamentarium for congestive heart failure, and
TAVI for inoperable aortic stenosis? Some unresolved issues still loom, including cost-benefit implications, but our informed guess is that these two
therapies will indeed play and ever increasing role in our everyday clinical practice.
What about the other studies reported in the last few weeks? We enjoyed in particular the
trial, which showed that colchicine can reduce by a significant absolute 12% the rate of post-pericardiotomy
syndrome, the ZILVER PTX
trial, which demonstrated the superiority of the polymer-free paclitaxel-eluting
peripheral self-expandable stent Zilver PTX over balloon-only angioplasty or bare-metal stent in patients with femoro-popliteal disease, the DES-BTK
which reported on the superiority of sirolimus-eluting versus bare-metal stents for below-the-knee arterial disease, and the TORPEDO
trial, which showed the superiority
of invasive management of deep vein thrombosis in comparison to anticoagulation only.
After several months of unexpected pause, it's time for our beloved newsletter. The recent European Society of Cardiology (
has recently been organized and plentyful of studies have been reported which are directly relevant for interventional cardiologists. Among the most important
are surely the RESOLUTE All Comers
study, the SPIRIT V
trial, and the TALENT
The RESOLUTE All Comers
trial has compared the zotarolimus-eluting Endeavor Resolute
stent versus the everolimus-eluting Xience/Promus stent in 2300 patients undergoing percutaneous coronary intervention. After a follow-up of 12 months, Endeavor Resolute
was non-inferior to the Xience/Promus stent, with, respectively, 8.2% versus 8.3% target lesion failure. Despite this encouraging result for the primary end-point,
stent thrombosis was significantly more frequent with Endeavor Resolute (1.2% versus 0.3%, p=0.01), thus calling into question previous assumptions of greater safety
of the Endeavor platform.
The SPIRIT V Diabetes
trial focused on 324 diabetics undergoing percutaneous coronary interventio
and randomized to implantation of Xience/Promus versus the paclitaxel-eluting Taxus Liberté stent. After 9 months, the primary end-point of angiographic in-stent late lumen
loss was significantly lower with Xience/Promus than with Taxus Liberté (0.19 mm versus 0.39 mm, p=0.001). Yet, this angiographic superiority did not translate into significant
reductions in repeat revascularizations, which actually appeared to favor Taxus Liberté, with target lesion revascularization in, respectively, 8.4% versus 3.8% (p=0.16). Nonetheless,
Xience/Promus was associated with non-significantly fewer myocardial infarctions, suggesting that thinner struts may confer clinically relevant benefits in patients with diffuse disease
(0.5% versus 1.9% for Q-wave myocardial infarction, 2.8% versus 6.7% for non-Q-wave myocardial infarction).
Finally, Sciahbasi et al reported on the TALENT
trial, which randomized 1540 patients to right versus left
trans-radial access for percutaneous coronary procedures (both diagnostic and interventional). They intriguely found that left radial access reduced fluoroscopy time
(average difference of 19 seconds, p=0.0025) and dose-area product (average difference 1.4 Gray/cm2, p=0.004) for diagnostic procedures. However, statistical significance was no longer
maintained when focusing on interventional procedures only or case performed only by experience operators. Thus, left radial access could be proposed as the access site of choice
for trainees and/or cases unlikely to need intervention.
Widimski et al
investigated acute reperfusion therapy in 30 countries, finding that primary percutaneous coronary intervention (PCI)
is the preferred treatment in 16 countries. However, thrombolysis is still preferred in as much as 8 countries, preferentially located in the Balkans and
Southern Europe. As expected, primary PCI, whenever feasible, was associated with lower in-hospital mortality. The superiority of primary PCI over thrombolysis was
maintained after many years. Nonetheless, time from first medical contact to needle/balloon was higher in primary PCI patients, and the much desired 2
hours or less are still a mirage in many countries.
An update of the largest randomized study on this topic with the longest follow up available, the DANAMI-2 trial, has been
recently reported by Nielsen et al
. After nearly 8 years, the interventional approach to ST segment elevation
myocardial infarction still overcomes pharmacologic treatment for the composite primary endpoint of all-cause mortality or myocardial infarction. Nielsen and colleagues
concluded that primary PCI should be the preferred reperfusion strategy, but stressed the importance of inter-hospital time delay to be less than 120 minutes.
We absolutely agree with this point.
And now, we cannot omit our daily bread, so let's give a look at one of the most interesting meta-analysis recently disclosed. Lee
published on the results of a well done and sleek review on drug-eluting stents (DES)
and bare-metal stents (BMS) for saphenous vein graft (SVG) interventions. A total of 19 studies including 3420 patients was analyzed, and the results
rewarded the DES because patients in this group experienced fewer revascularizations, myocardial infarctions and had a strong trend towards higher survival
after an average follow-up of 20 months. To note, only 2 out of 19 studies were randomized. Thus, DES use in SVG interventions now seems encouraging... awaiting
another randomized clinical trial, maybe with newer generation DES.
How is ST segment elevation myocardial infarction managed in Europe nowadays? A report from the European Association of Percutaneous Cardiovascular Interventions
(EAPCI) of a collaborative analysis from national working groups recently published by
congress and recovering from the exciting news of the American College of Cardiology
, two important and thought-provoking studies have been reported. Both studies challenge apparent dogmas in cardiovascular disease, and should be thus carefully read and analyzed.
Fowkes et al
have provided another blow to the hypothesis that aspirin can be beneficial at large in the primary prevention of cardiovascular disease, by randomizing over 29,000 patients
with peripheral artery disease to low-dose aspirin or placebo, and following them for more than 8 years. Despite such large sample size and long-term follow-up, no significant change in the rate of
cardiovascular events occurred in favor of aspirin, despite an evident trend for an increase in bleeding. Thus, given also the indidivual patient data meta-analysis by Patrono et al
, aspirin cannot be recommended any longer in the
primary prevention of cardiovascular disease. Nonetheless, we do recommend to consider and discuss individually wiht patients the risks and benefits of aspirin (as well as in the near future of generic clopidogrel), as patients
at high thrombotic risk but low bleeding risk may still benefit from antiplatelet therapy in primary prevention.
Patel et al
also poignantly challenge a common approach in cardiovascular medicine, i.e. diagnostic coronary angiography in patients with suspected coronary artery disease.
In their cross-sectional work including almost 400,000 patients, they show that coronary angiography disclosed absence of or only mild coronary artery disease in almost 40% of subjects.
Thus, they conclude that a substantial portion of these tests are unnecessary and thus should be preceded by more thorough risk stratification. Whereas risk stratification is always beneficial, as long
as it does not inappropriately delay life-saving treatment, the idea that negative coronary angiograms are non-contributory is wrong, as many tests in the whole realm of medicine are ordered to exclude a disease or a condition,
rather than just to confirm it. Indeed, evidence based medicine experts, including those of the Centre for Evidence Based Medicine
do recommend both tests with high specificity to rule in disease (SpIn) and tests with high sensitivity, such as coronary angiography, to rule out disease (SnOut).
American College of Cardiology Scientific Sessions
have confirmed their role as probably one of the most authoritative North American cardiological conferences.
Among the key trials just recently reported, a number have provided very important and seminal findings.
Specifically, the ACCORD
trial compared a target of systolic blood pressure lower than 120 mm Hg
versus a target of 140 mm Hg in 4733 patients with diabetes mellitus at high risk of cardiovascular events. The investigators found no important difference in the rate of death, but a sensible reduction in the risk of
stroke with a more stringent blood pressure control, despite more frequent serious adverse events.
The fenofibrate substudy of the very same ACCORD
fenofibrate versus placebo on top of simvastatin in 5518 patients with type 2 diabetes mellitus at high risk of cardiovascular events, finding no meaningful benefit of fenofibrate on the risk of death, or on the
composite end-point of death, myocardial infarction or stroke.
The twin randomized trials by Park et al
have begun addressing the issue of
the most appropriate duration of dual antiplatelet therapy following drug-eluting stent implantation. Despite a sound rationale for the superiority of a treatment regimen lasting more than 12 months after revascularization, this trial did not show
any significant benefits of continuing clopidogrel plus aspirin beyond 1 year.
The EVEREST II
trial has provided much awaited results of
percutaneous mitral valve repair versus surgical repair in
279 patients with mitral regurgitation. The study demonstrated that percutaneous repair with the MitraClip device has similar safety and efficacy in
comparison to open surgery, thus providing a momentous paradigm shift in the management of this frequent cardiovascular condition.
Finally, the RACE II
Investigators have confirmed the benefit of a conservative approach
in the management of heart rate in patients with chronic atrial fibrillation. Specifically, 614 patients were randomized to a soft rate-control strategy (resting rate less than 110 beats per minute) versus
a strict one (resting rate less than 80 beats per minute), and following the patients for 2 years. The rate of adverse clinical events was similar in the two groups, thus demonstrating that there is no need to routinely pursue
a low heart rate in stable patients with permanent atrial fibrillation.
February should not be considered an interlocutory month. In fact, scientific journals keep on publishing the results of very
interesting studies in our area of interest. The reader will thus understand how, as usual, the selection is not easy.
First of all, we would like to highlight the results of a well conducted meta-analysis from Valgimigli et al
published in the
European Heart Journal
(2010;31:35-49). These authors sought to evaluate the impact of tirofiban versus placebo or abciximab
on the outcome of 20,000 patients with acute coronary syndrome undergoing percutaneous coronary intervention, and found that tirofiban significantly reduced
mortality and mortality plus myocardial infarction in comparison to placebo. When tirofiban was compared to abciximab, it showed similar
results regarding 30-day mortality (confidence interval: 0.53-1.54, p=0.70), however a trend towards an increase of death or myocardial
infarction was found in the tirofiban group (confidence interval: 0.96-1.45, p=0.11). The investigators hypothesized this result was due to the "old"
regimen of drug used in less recent trials such as TARGET
, as in fact no differences were found when a 25 mg/kg bolus
regimen was used. Both minor bleeds (but not major) and thrombocytopenia were reduced in the tirofiban group.
It is worth mentioning the 1-year results of the multicenter prospective randomized trial
, just published in the Journal of the American College of Cardiology
by Kapur et al (2010;55:432-40), where 510 patients with multivessel coronary artery disease and diabetes were randomized
to bypass grafting or percutaneous coronary intervention. The primary study end-point was a composite of mortality, myocardial infarction, or stroke
at 12 months and
resulted similar in the two arms (10.5% versus 13%, confidence interval: 0.75-2.09), although the prespecified 1.3 noninferiority margin of confidence interval
was exceeded. Those patients who were treated with drug-eluting stents, however, (70% of the total) well matched with the bypass population
(11.6% versus 12.4%, confidence interval: 0.51-1.71).
Finally, we want to disclose the results of a study from De Labriolle et al
European Heart Journal
2010, that investigated the
impact of platelet drop in an all-comers single-center population of patients undergoing percutaneous coronary intervention. Authors interestingly discovered
that moderate (25-49%) or severe (?50%) thrombocytopenia developed in 16% of patients, and these patients experienced
a significantly higher risk of death or myocardial infarction at 30-day and 1-year follow up. As expected, the worst
performance was achieved in the severe thrombocytopenia arm. The authors concluded that among the risk factors for thrombocytopenia,
some are modifiable, as thigh-osmolar contrast agents and bivalirudin seem to reduce this risk.
Eagerly awaiting upcoming scientific conferences such as
These include the
Kedhi and colleagues, which has shown that, among 1800 unselected patients with coronary artery disease, everolimus-eluting stents proved significantly
superior to paclitaxel-eluting stents in terms of the composite rate
of major adverse cardiac events (6% versus 9% at 12 months), as well of stent thrombosis (1% versus 3%), myocardial infarction (3% versus 5%), and repeat
revascularization (2% versus 6%), despite similar rates of all-cause death (2% versus 2%).
We also wish nonetheless to focus the attention of visitors of this website on 2 recent publications which can prove very interesting. In the first article,
Holmes et al
provide a thorough viewpoint on the importance and details of the mentor-mentee relationship, crucial in both clinical practice and clinical research,
and often disregarded or approached in an inappropriately informal way, especially in European countries.
The other interesting work is the study by Hannan et al
, comparing the clinical
suggestions given by interventional cardiologists after completion of coronary angiography to those of other colleagues.
This study poignantly shows that, among 16142 patients with significant coronary artery disease, those managed by interventional cardiologist were more likely to receive recommendations for percutaneous revascularization
and fewer recommendations for coronary artery bypass surgery, often in disagreement with explicit American College of Cardiology/American Heart Association
Finally, we wish to compliment ourselves with Hlatky et al
, authors of the
meta-analysis entitled "Coronary artery bypass surgery compared with percutaneous coronary
interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials", and winner of the 2009 METCARDIO Award
, explicitly aimed at awarding the most influential and rigorous meta-analysis published in 2009 on
interventional cardiology topics.
The new year has just begun, yet few major novel studies have been reported in the last few weeks on interventional cardiology topics.