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Pioglitazone Improved Endothelial Function
Treatment with the oral antidiabetic agent pioglitazone improved coronary endothelial function in patients with coronary artery disease. None of the participants in the prospective, placebo-controlled trial had diabetes.
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Detection of Vulnerable Plaque Crucial to MI Prevention
New technologies such as bevacizumab-eluting stents, vulnerable plaque-specific stents and photodynamic therapy may help prevent myocardial infarctions and mortality due to vulnerable plaque, according to Gregg W. Stone, MD, chairman of the Cardiovascular Research Foundation and Professor of Medicine at Columbia University Medical Center.
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DES Questions Continue
A main complication of drug-eluting stents is delay in the healing process, said Renu Virmani, MD, Medical Director of the CVPath Institute, Inc., in Gaithersburg, Md. This process is difficult to visualize even with intravascular ultrasound because the technology does not recognize proteoglycans and fibrin, presenting a challenge to understanding what is occurring on the vessel wall and what the long-term effects will be.
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DEScover Registry: DES Outperformed Bare Metal Stents
One-year data from the DEScover registry showed that drug-eluting stents performed better than bare-metal stents at reducing the rates of death, myocardial infarction (MI) and bypass surgery. “There were significant differences in outcomes in the bare-metal and drug-eluting stent groups at one year,” said lead researcher David O. Williams, MD, of Rhode Island Hospital in Providence.
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Oral Sirolimus Reduces In-stent Hyperplasia
Oral sirolimus (Rapamune, Wyeth) safely and effectively inhibited in-stent intimal hyperplasia in an open randomized study from Sao Paulo Hospital in Brazil. The researchers, led by Valter C. Lima, MD, PhD, a cardiologist at the hospital, found the percent volumetric obstruction reduced in 36% of patients who received a dose of 2 mg/day and in 40% who received a dose of 5 mg/day.
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TCT Abstracts Move into the Electronic Era
Attendees at TCT 2006 will notice that the traditional poster sessions are missing. In their place will be electronic versions of both the poster and oral abstract presentations accepted for TCT, explained George D. Dangas, MD, PhD, Director of Academic Affairs and Investigational Pharmacology at the Cardiovascular Research Foundation (CRF).
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Scholarship Recipients Gear Up for TCT 2006 and Their Futures
As experienced cardiologists from around the world gather at the annual TCT symposium, three up-and-coming cardiologists are present because of their well-researched and distinctive case studies.
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Clopidogrel Resistance, Low Response Not Clearly Defined
Clopidogrel resistance is an important predictor of adverse cardiovascular events, but resistance or nonresponsiveness has not been clearly defined. “There are a series of definitions in the literature, and obviously when we’re working with different definitions, we’re going to have a different prevalence of clopidogrel [Plavix, Bristol-Myers Squibb] response or nonresponse,” said Dominick J. Angiolillo, MD, Associate Director of Cardiovascular Research at the University of Florida School of Medicine.
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Gene Therapy Yet to Yield Convincing Results in Myocardial Collaterals
Therapeutic angiogenesis — in which angiogenic growth factors, encoding genes, or stem cells are employed to encourage collateral blood vessel growth — have proven effective in animal models and in unblinded phase-1 trials, but placebo-controlled trial results are not as convincing. Timothy D. Henry, MD, Director of Research for the Minneapolis Heart Institute Foundation, gave an overview of blinded gene therapy trials during a presentation yesterday.
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TCT 2006 Introduces Structural Heart Disease Track
Structural heart disease makes its debut as an official track of course content at this year’s TCT meeting. The evolving area was included “because it was the right time to give the area its own identity within TCT’s structure,” explained TCT Course Co-Director Gary S. Mintz, MD, the Director of Publications and Editorial Services at the Cardiovascular Research Foundation and Medical Director of TCTMD.com.
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Optional Side Branch Stenting as Effective as Mandatory
Stenting the main vessel and optionally stenting the side branch can be recommended as the routine bifurcation stenting technique, according to results from the Nordic Bifurcation trial. At eight months follow-up, the rate of main vessel in-lesion stenosis with diameter greater than 50% was 5.3% with optional side branch stenting and 5.1% with mandatory side branch stenting.
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ZOMAXX I: Mixed Results With Zotarolimus-eluting Stent
The ZoMaxx zotarolimus-eluting stent (Abbott Vascular Devices) failed to achieve its noninferiority endpoint of in-segment late loss in a comparison with the paclitaxel-eluting Taxus stent, according to Bernard Chevalier, MD, of the Centre Cardiologie du Nord in St. Denis, France.
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Clinical Judgment Important When Using Imaging with DES
Sound clinical judgment, the most essential tool available to the cardiologist, is the single best method for determining the usefulness of intravascular ultrasound (IVUS) and fractional flow reserve (FFR) when using a drug-eluting stent, according to TCT Course Co-director Gary S. Mintz, MD, of the Cardiovascular Research Foundation/Columbia University Medical Center.
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FAST: No Advantage to Nitinol Stents in Short Lesions
The FAST trial failed to achieve the expected 44% relative risk reduction for restenosis in patients receiving the Bard Luminexx nitinol stent compared with patients undergoing percutaneous transluminal angioplasty (PTA).
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Cypher More Effective for Long Lesions
The rate of in-segment restenosis was 77% lower among patients with long native coronary lesions treated with sirolimus-eluting stents (Cypher, Cordis/Johnson & Johnson) compared with patients treated with paclitaxel-eluting stents (Taxus, Boston Scientific).
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THUNDER: Paclitaxel-Coated Balloon Lowers Restenosis
The paclitaxel-coated balloon catheter Paccocath was safe and reduced restenosis in the superficial femoral artery, according to six-month data from the prospective, randomized THUNDER trial. Gunnar Tepe, MD, of the department of diagnostic radiology at the Eberhard-Karls-University of Tubingen in Germany, presented primary and secondary data from THUNDER.
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DES: Risk of Delayed Healing, Late-Stent Thrombosis
Drug-eluting stents reduce restenosis but also delay or prevent vascular healing, according to a presentation by William Wijns, MD, from the Cardiovascular Center Aalst in Aalst, Belgium. Wijns’ presentation, which was an overview of safety concerns with drug-eluting stents, also addressed the timeline and predictive factors for stent thrombosis.
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MEDISTRA: Low Risk of Adverse Events with Excel Stent
The lower-cost Excel sirolimus-eluting stent was associated with improved long-term outcomes compared with other commercially available drug-eluting stents, according to the MEDISTRA trial. Teguh Santoso, MD, from the University of Indonesia Medical School in Jakarta, said Monday that “the preliminary Excel results are encouraging. The rate of major adverse clinical events was low, and there is a ‘clean’ angiographic appearance to the stent.”
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New Trials Set to Examine Drug-eluting Stents
Three new trials were announced to help better examine the long-term effects of drug-eluting stents following recent reports of risks associated with the devices. Gregg Stone, MD, Chairman of the Cardiovascular Research Foundation and a Professor of Medicine at Columbia University Medical Center in New York, discussed the controversies regarding drug-eluting stents at a morning plenary session yesterday. He said new studies with larger cohorts are needed to better understand the long-term risks and benefits of drug-eluting stent treatment.
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Drug-eluting Stent Technology Continues its Evolution
Many of the same issues that arose with earlier treatment interventions are resurfacing with drug-eluting stent technology and outcomes. “We’re looking for the safety we enjoyed with bare metal stents, and we want the efficacy of the drug-eluting stents,” said Peter J. Fitzgerald, MD, Professor of Medicine at Stanford University, Stanford, Calif.
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Award-winning TeachImage Program Featured at TCT 2006
Building on last year, Teach-IMAGE will once again provide Web-based training for physicians in analyzing intravascular ultrasound (IVUS), fractional flow reserve (FFR) and computed tomographic angiography (CTA).
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Cardiology Vet Marvin L. Woodall Named CEO of CRF
A long-standing veteran and pioneer in the cardiovascular device field, Marvin L. Woodall was named chief executive officer (CEO) of the Cardiovascular Research Foundation (CRF) Aug. 9, 2006. The position of CEO was newly created in an effort to both manage CRF’s continuing growth and provide leadership for the organization going forward.
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Post-treatment Platelet Activity Predicts Ischemic Event
Post-treatment platelet function may be a better predictor of ischemic events than platelet inhibition or responsiveness after a stenting procedure, according to Paul A. Gurbel, MD, from the Sinai Center for Thrombosis Research in Baltimore.
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Aspirin Nonresponsiveness Variable, Unpredictable
The wide variability of measurements of nonresponsiveness to aspirin therapy has important clinical implications. Future studies should aim to determine an accurate measurement of aspirin resistance and answer the question of how to treat patients who do not respond to aspirin therapy.
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Multifactorial Treatment Is Essential For Type 1 and Type 2 Diabetic Patients With Cardiovascular Disease
Patients with type 1 or type 2 diabetes need multifactorial management, said Michael E. Farkouh, MD, MSc, director of the Mount Sinai Heart Clinical Trials Unit. According to Farkouh, diabetes has reached epidemic proportions in this country. Diabetic cardiovascular patients are different from those without diabetes and need to be treated accordingly, he said. They may have hyperlipidemia, inflammatory challenges, accelerated atherosclerosis and worse clinical outcomes than other cardiac patients.
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TCT Expands Self-assessment Board Review Course
Doctors preparing for their boards can attend a more comprehensive review at this year’s TCT than in past years. The four-day, self-assessment review course will cover both interventional cardiology and endovascular fields.
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Intracoronary Bone Marrow-derived Progenitor Cells Improved Contractility
A number of studies have shown no change in global contractility after bone marrow-derived progenitor cell transplant for acute myocardial infarction (MI), but results published in a recent article in the New England Journal of Medicine have shown increased contractility. Andreas M. Zeiher, MD, Senior Researcher of the REPAIR-AMI trial, yesterday reconciled these promising data against previous, less optimistic results.
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Triple Antiplatelet Therapy Improves Outcomes after PCI
Triple antiplatelet therapy with aspirin, clopidogrel, and cilostazol improved short-term outcomes compared with standard dual antiplatelet therapy in patients who underwent percutaneous coronary intervention (PCI), according to two studies from Northern Hospital in Shenyang, China.
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More and Better Options Needed for Patients with Resistance to Triple Antiplatelet Therapy After PCI
There is a need for a proper therapeutic modality for patients with resistance to aspirin or clopidogrel administered as part of triple antiplatelet therapy after percutaneous coronary intervention (PCI), according to researchers from Yonsei University College of Medicine, Seoul, South Korea.
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New Scoring Balloon Catheter Effective for Complex Lesions
Clinical experience from two international studies demonstrated that a new scoring balloon catheter (AngioSculpt Scoring Balloon Catheter, AngioScore, Fremont, Calif. [Figure 1]) can be used effectively and safely to treat complex lesions. Treatment was successful in all patients in a study in Brazil and Germany, which found no evidence of major adverse cardiac events (MACE) after 30 days of follow-up.
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