In the OASIS-5 trial (Organzation to Assess Strategies in Acute Ischaemic Syndromes), fondaparinux was found to be non-inferior to enoxaparin for the primary outcome, but was noted to halve major bleeding, leading to a significant mortality reduction. However, a small but significant increase in catheter-related thromboses was also seen, therefore the FUTURA/OASIS-8 trial was set […]
Category: Interventional cardiology
TAVI reduces mortality and morbidity
At least 30% of patients with severe symptomatic aortic stenosis are not deemed surgical candidates owing to advanced age, left ventricular dysfunction, or the presence of multiple coexisting conditions. In the perceived absence of effective alternative treatment options, Transcatheter Aortic-Valve Implantation (TAVI), which was first demonstrated in 2002, has been rapidly adopted as a treatment […]
Meta-analysis of carotid stenting highlights risk in the elderly
In the majority of trials performed to date, carotid stenting has been associated with a higher periprocedural risk of stroke than endarterectomy, particularly in patients with symptomatic stenosis. However, no individual trail has been large enough to examine the effect of either treatment in any particular patient subgroup with any certainty. […]
No role for routine balloon pump in high-risk percutaneous coronary intervention (PCI)
In patients with severe left ventricular dysfunction, PCI is associated with significant morbidity and mortality, particularly if large amounts of viable myocardium are supplied by the diseased coronary arteries. Although observational studies have suggested that intra-aortic balloon pump (IABP) insertion may decrease patient risk in this setting, no previous randomised controlled trial has examined this […]
No role for routine balloon pump in high-risk percutaneous coronary intervention (PCI)
In patients with severe left ventricular dysfunction, PCI is associated with significant morbidity and mortality, particularly if large amounts of viable myocardium are supplied by the diseased coronary arteries. Although observational studies have suggested that intra-aortic balloon pump (IABP) insertion may decrease patient risk in this setting, no previous randomised controlled trial has examined this […]
Next generation coronary stents go head to head
First generation drug eluting stents (DES) are now a decade old, and several second generation DES have now entered the market. The Xience V or Promus everolimus-eluting stent has been accruing impressive data to suggest improved outcomes for restenosis and major adverse cardiac events, coupled with significantly improved deliverability. The Endeavour zotarolimus eluting stent however […]
Second generation everolimus stent raises the stakes
Drug eluting stents, generally coated with either paclitaxel or sirolimus, have revolutionised the practice of interventional cardiology, markedly reducing the incidence of restenosis and the need for repeat procedures. Nevertheless, restenosis still occurs and the slower re-epithelialisation associated with these stents mandates the prolonged use of dual antiplatelet therapy to avoid potentially catastrophic stent thrombosis. […]
Optimal Duration of Dual Antiplatelet Therapy Remains Unclear
Dual antiplatelet therapy with aspirin and clopidogrel has become the cornerstone of the treatment of acute coronary syndromes. While 12 months has become the standard treatment time for most patients, it remains unclear whether longer durations of treatment may provide additional benefit, and in particular whether it allay fears regarding the risk of late stent […]
Preconditioning Prior to Primary PCI shows benefit
Remote ischaemic preconditioning, induced by brief periods of limb ischaemia (for example by inflating a blood pressure cuff), has previously been shown to reduce ischaemic damage in the heart if applied prior to predictable ischaemia (e.g. cardiac surgery). However, it has not previously been investigated whether remote ischaemic preconditioning can be used to reduce myocardial […]
Everolimus proves superior in real-world analysis
Although drug-eluting stents (DES) are known to reduce the risk of restenosis, and hence the need for reintervention, in patients at high risk of restenosis enrolled in randomised clinical trials, there is little ‘real-life’ data currently available. The COMPARE study (second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice) aimed to compare the safety and efficacy […]