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February 1, 2015

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  • Revascularization for Isolated Proximal LAD Disease: PCI is Easiest, but is it Best?

    Among patients with obstructive coronary disease requiring revascularization, guidelines would suggest a clear preference for coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) only in certain defined subsets, including those with left main disease and in diabetics with multi-vessel disease. Patients with isolated proximal LAD disease represent a unique high-risk subset of those with single-vessel disease, in that the size of the affected territory and associated ischemic risk makes CABG a viable option. In fact, U.S. guidelines currently assign a slight advantage to CABG with a left internal mammary graft to the left anterior descending (LAD) for such patients, rating this as a IIa indication vs a IIb recommendation for PCI. This is despite a relative paucity of data on this subset of patients, at least using contemporary treatments. In fact, of the nine randomized, controlled trials forming the basis for 17 published studies examining this question, most are quite small, and all but one were performed using bare-metal stents; the single small RCT incorporating drug-eluting stents (DES) used first-generation devices that are no longer part of the treatment landscape.

  • Spironolactone & the Potential Benefit for HFPEF Patients

    No treatment has been shown to improve outcomes in heart failure with preserved ejection fraction.

  • Coronary Stents and Noncardiac Surgery

    Contemporary data suggest that approximately one in every five patients will require non-cardiac surgery within two years of coronary stent implantation.

  • Late Tricuspid Regurgitation After Heart Valve Surgery

    Due to the success of left heart valve disease surgical corrections, patients may experience late tricuspid regurgitation.

  • Risk of Stroke with Intracardiac Devices and Patent Foramen Ovale

    After some case reports of stroke due to electrophysiology (EP) device thrombosis in patients with a patent foramen ovale (PFO), concern has been raised about the risk of stroke with intracardiac devices in patients with known PFO. Thus, these investigators from the Cleveland Clinic did a retrospective database study of 2921 echocardiography-detected PFO patients and categorized them as having an EP device (231) or not.