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VIDEO: Examples of Artificial Intelligence PE Response Team Apps

Artificial Intelligence | January 13, 2022

Here are two examples of artificial intelligence (AI) driven pulmonary embolism (PE) response team apps featured by vendors Aidoc and Viz.AI at the 2021 Radiological Society of North America (RSNA) 2021 meeting.

The AI scans computed tomography (CT) image datasets as they came off the imaging system and looked for evidence of PE. If detected by the algorithm, it immediately sends an alert to the stroke care team members via smartphone messaging. This is done before the images are even loaded into the PACS. The radiologist on the team can use a link on the app to open the CT dataset and has basic tools for scrolling, windowing and leveling to determine if there is a PE and the severity. The team can then use the app to send messages, access patient information, imaging and reports. This enabled them all to be on the same page and can communicate quickly via mobile devices, rather than being required to use dedicated workstations in the hospital. 

Both vendors showed similar apps for stroke at RSNA 2019. That idea for rapid alerts, diagnosis and communications for acute care teams has now expanded to PE and also for aortic dissection and abdominal aortic aneurysms (AAA). AI.Viz and Aidoc are looking at expanding this type of technology for other acute care team rolls, including heart failure response. 

Read more about this technology in the article AI Can Facilitate Automated Activation of Pulmonary Embolism Response Teams.

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Conference Coverage

Artificial Intelligence | January 13, 2022

Here are two examples of artificial intelligence (AI) driven pulmonary embolism (PE) response team apps featured by vendors Aidoc and Viz.AI at the 2021 Radiological Society of North America (RSNA) 2021 meeting.

The AI scans computed tomography (CT) image datasets as they came off the imaging system and looked for evidence of PE. If detected by the algorithm, it immediately sends an alert to the stroke care team members via smartphone messaging. This is done before the images are even loaded into the PACS. The radiologist on the team can use a link on the app to open the CT dataset and has basic tools for scrolling, windowing and leveling to determine if there is a PE and the severity. The team can then use the app to send messages, access patient information, imaging and reports. This enabled them all to be on the same page and can communicate quickly via mobile devices, rather than being required to use dedicated workstations in the hospital. 

Both vendors showed similar apps for stroke at RSNA 2019. That idea for rapid alerts, diagnosis and communications for acute care teams has now expanded to PE and also for aortic dissection and abdominal aortic aneurysms (AAA). AI.Viz and Aidoc are looking at expanding this type of technology for other acute care team rolls, including heart failure response. 

Read more about this technology in the article AI Can Facilitate Automated Activation of Pulmonary Embolism Response Teams.

Find more AI news

Find more RSNA news and video

 

 

Coronavirus (COVID-19) | December 14, 2021

Jean Jeudy, M.D., professor of radiology and vice chair of informatics at the University of Maryland School of Medicine, presented a late-breaking study at the 2021 Radiological Society of North America (RSNA) meeting on COVID-19 linked myocarditis in college athletes. 

A small but significant percentage of college athletes with COVID-19 develop myocarditis, a potentially dangerous inflammation of the heart muscle, that can only be seen on cardiac MRI, according to the study Jeudy presented. Myocarditis, which typically occurs as a result of a bacterial or viral infection, can affect the heart’s rhythm and ability to pump and often leaves behind lasting damage in the form of scarring to the heart muscle. It has been linked to as many as 20% of sudden deaths in young athletes. The COVID-19 pandemic raised concerns over an increased incidence of the condition in student-athletes.

For the new study, clinicians at schools in the highly competitive Big Ten athletic conference collaborated to collect data on the frequency of myocarditis in student-athletes recovering from COVID-19 infection. Conference officials had required all athletes who had COVID-19 to get a series of cardiac tests before returning to play, providing a unique opportunity for researchers to collect data on the athletes’ cardiac status.

Jeudy serves as the cardiac MRI core leader for the Big Ten Cardiac Registry. This registry oversaw the collection of all the data from the individual schools of the Big Ten conference. He reviewed the results of 1,597 cardiac MRI exams collected at the 13 participating schools. 

Thirty-seven of the athletes, or 2.3%, were diagnosed with COVID-19 myocarditis, a percentage on par with the incidence of myocarditis in the general population. However, an alarmingly high proportion of the myocarditis cases were found in athletes with no clinical symptoms. Twenty of the patients with COVID-19 myocarditis (54%) had neither cardiac symptoms nor cardiac testing abnormalities. Only cardiac MRI identified the problem.

Read more details in the article COVID-19 Linked to Heart Inflammation in College Athletes.

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Cardiovascular Ultrasound | November 24, 2021

Examples of TrueView and GlassView 3D cardiac ultrasound visualization and artificial intelligence (AI) assisted automated measurements on the Philips Healthcare Epiq CV version 9.0 echo system. The latest version of the system was FDA cleared in October 2021 and shown at the 2021 Radiological Society of North America (RSNA) meeting for the first time. The Epiq is an AI-based platform, starting with anatomical intelligence to identify the anatomy being images automatically. The latest version of the system adds additional AI auto measurements and quantification to save time, speed workflow and reduce intra-operator variability. 

The short video shows photo-realistic rendering of the mitral valve and a new feature where the opacity of the tissue can be dialed in our out to show glass-like ghost view of the tissue. This can make it easier to navigate or see anatomical landmarks without rotating or slicing through the image planes in the 3D rendering.

Find more RSNA news and video

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EP Lab | November 22, 2021

Christine Albert, M.D., MPH, professor, chair of the Department of Cardiology and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology, and former president of the Heart Rhythm Society (HRS). She spoke at the American Heart Association (AHA) 2021 meeting on innovations in electrophysiology (EP) technologies. 

Advances she discusses include:
   • Leadless pacing and CRT systems  
   • Wearable patch heart monitors and that are largely replacing traditional Holter monitors.
   • Pulsed field ablation (also called electroporation) that may improve cardiac ablations and prevent damage to underlying tissues.
   • Cryo-ablation balloons.
   • Improved EP mapping technologies.
   • and left atrial appendage (LAA) occluders.

Find more EP lab technology news

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Genetic Testing | November 22, 2021

Susan Cheng, M.D., MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at Cedars-Sinai, moderated the Best Science in Cardiovascular Genetics and Genomics: Building Blocks to Better Outcomes, at the American Heart Association (AHA) 2021 meeting. She is an expert in cardiac genetic testing and said tailoring LDL-lowering drug therapy based on routine genetic tests is coming, but is still a few years off.

Find more AHA 2021 late-breaking studies and video

Pharmaceuticals | November 22, 2021

Susan Cheng, M.D., MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at Cedars-Sinai and the Erika J. Glazer Chair in Women's Cardiovascular Health and Population Science, led a discussion at the American Heart Association (AHA) 2021 meeting on novel therapeutics for the lipid lowering treatments. 

She discusses bempedoic acid, inclisiran to reduce LDL-C, icosapent ethyl and the use of genetic testing to further reduce high low-density lipoprotein (LDL) in patients were statin therapy is not enough.

Cheng discusses more in the VIDEO: Use of Genetic Testing to Tailor Lipid Lowering Therapies.

Find more AHA 2021 late-breaking studies and video

 

Radiation Dose Management | November 17, 2021

Dr. Simon Dixon, MBChB, chair of the Department of Cardiovascular Medicine at Beaumont Hospital Royal Oak, the Dorothy Susan Timmis Endowed Chair of Cardiology, and a professor of medicine at Oakland University William Beaumont School of Medicine, spoke at the 2021 Transcatheter Cardiovascular Therapeutics (TCT) meeting about a study Beaumont performed to lower radiation dose in the cath lab by more than 50%.

Using a new angiographic collimation technology from ControlRad, it helped cut radiation dose to interventional cardiologists by 57%. The device collimates the area of interest where the physicians are working, and reduces the dose significantly to peripheral areas in the image. This reduces exposure to ionizing X-ray radiation scatter from the imaging system. It is one of two new radiation protection systems used at Beaumont.

The ControlRad device, approved for commercial cath lab use by the FDA in December 2020, is retrofitted to X-ray equipment in the catheterization lab. It creates a type of aperture that collimates the image area being viewed. By using a touch pad attached to the table side rail, the cardiologist controls the aperture to narrow or widen the field of view on the X-ray, which in turn reduces the amount of radiation used to produce the images. It works with gloves on.

For the study, cath lab workers wore radiation-detecting badges near their thyroid and inside their lead apron during procedures. Another badge was placed on a wall inside the lab. The study detected a 55% to 57% decrease in radiation exposure at the thyroid position of the main cardiologist, or lead operator, and a 49% decrease in radiation exposure to the cardiologist assisting, or operator 2. The badge on the wall detected a 38% decrease in radiation exposure, reflecting the dose savings to other cath lab staff further away from the imaging system.

Beaumont is also using the the Protego system, which places a barrier wall between the imaging equipment and the operator and staff in the cath lab. While it does not protect the patient from radiation during their procedure, it is designed to allow staff to work in the cath lab without wearing a heavy lead apron.

Find links to all the TCT 2021 late-breakers

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EP Lab | October 04, 2021

Khaldoun Tarakji, M.D., MPH, associate section head, cardiac electrophysiology, Heart and Vascular Institute at Cleveland Clinic, was the lead author on a followup study to the landmark WRAP-IT trial that showed the Tyrx bioresorbable antibacterial envelope was shown it significantly lower infection risk for patients who receive cardiac implantable electronic devices (CIED) and develop hematomas.[1] 

The study results showed an 82% reduction in major infection among patients with hematoma in patients who had received the Tyrx. It is a antimicrobial envelope that is used to place implantable electrophysiology (EP) devices inside prior to closing the device pocket. While the envelope itself did not prevent hemotomas, as the rate was the same in the control group with out it, the Tyrx did lower infection rates in patients with hemotomas.

Read more in the article Tyrx Absorbable Antibacterial Envelope Effectively Reduces Infections in Cardiac Device Patients with Hematomas.

 

Reference:

1. Khaldoun G. Tarakji, Panagiotis Korantzopoulos, Francois Philippon, Jeff D. Lande, Swathi Seshadri, Bruce L. Wilkoff, et al. Infectious consequences of hematoma from cardiac implantable electronic device procedures and the role of the antibiotic envelope: A WRAP-IT Trial Analysis. Heart Rhythm. Punlished online July 16, 2021. DOI:https://doi.org/10.1016/j.hrthm.2021.07.011.

 

Cardiovascular Information Systems (CVIS) | August 31, 2021

One of the trends in cardiovascular information system (CVIS) and radiology PACS at the Healthcare Information Management Systems Society (HIMSS) 2021 conference was the deeper integration of third-party image analysis software and artificial intelligence (AI) into these systems. This eliminates software sitting on top of the CVIS or PACS, separate logins or needing to us a different screen or manually transferring information from the third-party app in into the final report.

A good example of this was Siemens Healthineers, which demonstrated a deep integration with Epsilon Imaging’s echocardiography strain imaging analysis software. The integration eliminates the need for a separate login to the software, and automated quantification and images are carried over directly into the syngo echo report.

Strain can be used to assess cardiac function more precisely than regular cardiac ultrasound exams. It has grown in its use for cardio-oncology programs, assessing a baseline cardiac function and the. Performing serial exams over the course of a cancer patient’s chemotherapy. Strain has seen growing interest and has been a hot topic the past couple years at the American Society of Echocardiography (ASE) meeting. Interest also has expanded greatly recently with reimbursement now available in the U.S.

Siemens said there also has been increased interest in strain this past year because it can show early indicators of cardiac issues in COVID-19 patients and can be used to help monitor COVID myocarditis patients.
 

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Advances in CVIS and Enterprise iImaging at HIMSS 21

VIDEO: Cardiology AI Aggregates Patient Data and Enables Interactive Risk Assessments

Photo Gallery of New Technologies at HIMSS 2021

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Cardiovascular Information Systems (CVIS) | August 31, 2021

The vendor MediCardia demonstrated smart software to aggregate cardiology patient data from numerous locations into one place at the 2021 Healthcare Information Management Systems Society (HIMSS) conference. This enables one dashboard view of the patient's relevant cardiac history, prior exams, imaging, ECGs, labs and procedures. It also uses artificial intelligence (AI) to pull key data elements about the patient to automatically create risk assessments based on current guidelines in a graphical format.

The interactive system also allows the cardiologist to adjust parameters in the patient risk score to immediately show the patient any impact on their score. This includes if they stopped smoking, began taking statins, etc. The dynamic graphics of the system are also designed to be more engaging with a patient during consultations, rather than plain white pages of reports.

MediCardia HeartChart is a cardiology-focused virtual care platform that serves as a unified and common interface for EHRs and remote technologies including wearables, consumer home medical devices, and implanted cardiac rhythm devices. 

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Cardiovascular Ultrasound | August 17, 2021

A new ultrasound imaging technology that may offer novel ways to diagnose and better understand cardiac diseases using dynamic blood flow imaging. This allows imaging of individual blood cells or contrast bubbles as they travel through the heart and vessels, showing detail in how the blood moves and swirls. These motions, including the formation of vortices, may offer new insight into different disease states and allow earlier diagnosis and a understand better when to intervene.

The examples shown in this short video are from Hitachi and GE Healthcare, both of which have highlighted this technology at the American Society of Echocardiography (ASE) annual meetings over the past four years.

Ultrasound vendors use different technology approaches, including vector flow imaging, particle imaging velocimetry and blood speckle tracking. All of them show small lines or arrows to indicate the direction the blood cells or bubbles are traveling, and color codes to indicate velocity. Some vendors offer quantification for some new measures of blood flow, but as of yet, there are no guidelines or standardized indexes as to what these numbers mean.

This technology has been discussed in research sessions at the IEEE and the ASE over the past several years. However, more research is needed to show the prognostic value of the technology. Research to date shows it is possible that the swirling of blood can indicate less efficient flow, which may have implications in the development of heart failure, pulmonary hypertension and advancement of valvular disease. In the coronary arteries, research has shown there may be a connection between sheer stresses and disrupted blood flow in the formation of plaques on artery walls.

Companies that have developed echo blood flow dynamics imaging on their ultrasound systems to date include Hitachi, GE Healthcare, Fujifilm, Mindray and BK Medical. 

Read more about this technology from ASE 2021 in the article Development of Echo Blood Flow Dynamics Imaging.
 

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EP Lab | August 02, 2021

Jass Brooks, vice president of global strategic marketing, Biosense Webster, explains four over-arching electrophysiology (EP) trends at the 2021 Heart Rhythm Society (HRS) meeting. The vendor is working on developing, or has introduced, new technologies in each of these four areas.  She said the key technology trends include:

   • Pulsed field ablation (also called electroporation) as a new way to ablate cardiac tissue without damaging underlying structures like the esophagus. 

   • The introduction of 3D/4D intra-cardiac echo (ICE) imaging to better guide procedures.

   • High-density electromapping systems that create more accurate maps of the electrical activity in the heart and can do so faster than previous generation mapping systems.

   • The introduction of artificial intelligence (AI) into EP systems to speed workflow.

Key among this company's new product introductions at HRS 2021 was the Octaray high-density electro-mapping catheter, which enables faster mapping with a larger number of points. This enables more detailed maps of the heart's electrical activity and may imporve ablation procedure guidance and outcomes. Recent changes to the Carto electro-mapping system now enables integration of this new technology.

Biosense Webster also introduced the Nuvision 4-D intra-cardiac echo (ICE) ultrasound catheter with imaging support from GE Healthcare Vivid Ultra Edition ultrasound systems. This moved ICE beyond 2-D imaging to real-time 3-D and 4-D imaging inside the heart to enable better procedural navigation and visualization of the catheters within in the heart.

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EP Lab | August 02, 2021

Samir Saba, M.D., co-director of the University of Pittsburgh Medical Center Heart and Vascular Institute, and chief, Division of Cardiology, explains the SMART MSP (Multi-Site Pacing) study. This late-breaking clinical trial was presented at the 2021 Heart Rhythm Society (HRS) meeting. It evaluated the safety and effectiveness of multi-site pacing in initial non-responders to conventional cardiac resynchronization therapy with the goal of increasing response cardiac resynchronization therapy (CRT).

CRT nonresponders make up a sizable minority of patients, about one-third. Saba said this trial, was designed to try and chip away and reduce that number. Multi-site pacing has been debated as alternative to single site pacing for several years and this trial offers additional data in support of MSP.

The trial tested the efficacy and safety of the Boston Scientific Resonate X4 CRT-D system. This device allows multi-site pacing to be turned on or off at any time by the electrophysiologist. In the study, patients who did not respond had the multi-site pacing feature turned on, which resulted in 51% of the nonresponders to respond to therapy. 

Find additional HRS 2021 late breaking trials

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Artificial Intelligence | July 01, 2021

Federico Asch, M.D., FASE, director of cardiovascular core labs, cardiovascular imaging, MedStar Health Research Institute, Washington, D.C., was involved in a study that used artificial intelligence (AI) to evaluate echocardiograms to identify COVID-19 patients who were at high risk for complications and mortality. The study also compared human vs. AI variability in reading the stories and found much less variability with the machine reviews. He presented the results from the WASE-COVID Study at the American College of Cardiology (ACC) and American Society of Echocardiography (ASE) 2021 meetings. 

Asch also offers insights about AI applications in echocardiography and how the technology will help improve imaging and reduce the variability in how measurements are made, which will decrease the current level of variability in how exams are performed by human operators. He also explains AI is now available to help guide novice ultrasound users to get optimal cardiac ultrasound images.

Find more content on artificial intelligence in cardiology

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Congenital Heart | May 26, 2021

Tom Jones, M.D., director, cardiac catheterization laboratories, Seattle Children’s Hospital, explains some of the new technologies being used to treat congenital heart disease. He discusses the recent trial he served as principle investigator for the new Harmony transcatheter pulmonary valve, the development of a bioresorbable transcatheter septal occluder device, development of large bioresorbable stents for use in pediatric cases, and use of virtual and augmented reality to better understand and guide very complex congenital heart procedures. Jones also explains a patient case where a 3-D printed heart and vessels from the patient helped the heart team understand all the options and how to tackle a valve replacement in a child with a single ventricle.

Jones shared some of these advances in congenital heart intervention sessions at the Society of Cardiovascular Angiography and Interventions (SCAI) 2021 meeting. 

 

Recent Technology Advances in Congenital Heart:

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Robotic Systems | May 18, 2021

Ehtisham Mahmud, M.D., division chief of cardiovascular medicine, director of interventional cardiology and the cardiac cath lab at the University of California at San Diego Health, explains how cath lab robotic systems may soon enable interventionalists to perform emergency stroke thrombectomy in patients hundreds of miles away. Corindus/Siemens Healthineers is developing its Corpath GRX robotic system to enable remote telemedicine procedures. Mahmud said this could help significantly improve access to acute stroke care interventions in rural areas. 

Today, the standard of care for stroke is similar to STEMI heart attacks from 40 years ago where tissue plasminogen activator (tPA) is administered in attempts to break up the clot causing ischemic strokes. Outcomes in STEMI greatly improved in the late 1980s and 1990s with the proliferation of angioplasty and percutaneous coronary intervention (PCI) stenting procedures, which became the standard of care in cardiology. Mahmud said acute stroke interventions are following a similar path, but there just are not enough neuro-interventional operators to create large networks for stroke similar to what is now established for STEMI.

He said the Corpath robotic interventions are already conducted remotely from across the room in the cath lab. The idea is that it does not matter if a patient is 10 feet away in the same room or 200 miles away at a smaller hospital to conduct these procedures. This could go a long way to overcoming vast healthcare disparities in smaller, rural hospitals that are far removed from larger centers that are better equipped, and more importantly, have the specialities needed for these procedures.

Once this technology is cleared for use, Mahmud said cardiologists already have the technical skills to perform emergency thrombectomies, but need to learn more about the neuro-vascular bed and how to deal with any adverse events during or after a procedure. He said this lays the ground for creating neuro-cardiology partnerships or care teams to enable this type of care in the near future. 

 

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Find more news from the SCAI 2021 virtual meeting

 

 

Robotic Systems | May 18, 2021

Ehtisham Mahmud, M.D., division chief of cardiovascular medicine, director of interventional cardiology and the cardiac cath lab at the University of California at San Diego Health, was the principle investigator for a trial that looked at the latest generation of cath lab robotics in a real-world patient population. 

The late-breaking PRECISION GRX Study was presented at the Society of Cardiovascular Angiography and Interventions (SCAI) 2021 meeting. It looked at the use of robotic PCI in real-world patients across a spectrum of lesion complexity. This included use in total chronic occlusions (CTOs), and ostial and bifurcation lesions. 

The robot system allows the operator to sit in a lead-lined booth outside the radiation field to perform the procedures sitting down, and they do not need to wear lead.

Read more on this study — Second Generation Robotic PCI System Performs Well Across Spectrum of Lesion Complexity

 

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Structural Heart | May 13, 2021

Tom Jones, M.D., director, cardiac catheterization laboratories, Seattle Children’s Hospital, and principle investigator of the Medtronic Harmony transcatheter pulmonary valve (TPV) trial 1-year results that were presented as a late breaking trial at  Society of Cardiovascular Angiography and Interventions (SCAI) 2021 Scientific Sessions.

New study results validate the effectiveness of the Harmony TPV system for patients with congenital heart disease (CHD) and severe pulmonary regurgitation (PR). The Harmony TPV is designed to be a less invasive treatment option for patients with a congenital heart defect irregularity in their right ventricular outflow tract (RVOT) that requires a pulmonary valve placement to restore valve function. 

Read more details in th article One-year Results of the Harmony Transcatheter Pulmonary Valve Trial Presented at SCAI 2021. 
 

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Radial Access | May 06, 2021

Arnold Seto, M.D., MPA, FSCAI, chief of cardiology, Long Beach Veterans Affairs Medical Center and director, interventional cardiology research, UCI Health, and Jordan Safirstein, M.D., FSCAI, director of transradial intervention, Atlantic Health's Morristown Medical Center, were involved in a physician-initiated study to find a new way to cut radial artery access site hemostasis by 50 percent. The late-breaking study presented at SCAI 2021 uses a combination of a StatSeal patch and the TR Band compression bracelet.

Cardiac catherization is increasingly bing performed using transradial approach, now making up 50 percent or more of the access used for U.S. interventional procedures. The Terumo TR Band is used to close the vascular access site. Standard protocols require the band to be left on for at least two hours following the procedure. 

Shorter compression times can help reduce complications with radial artery occlusion, so it is desirable to find ways to shorten compression times, Seto said. He explained clinicians often start to deflate the wrist band balloon after an hour and watch for ooze or blood. If there are signs the wound is not completely sealed, the band is reinflated. Reinflations occurs more that 67 percent of the time, he explained.

"We found with the Statseal, you almost never have to reinflate," Seto said. 

This study shows that time can be reduced in half and with fewer complications by using the additional patch device, which helps sped the clotting process. This can save staff time and possibly leading to faster patient discharge for same-day PCI programs. 

Read more in the article Radial Hemostasis Time Cut by 50 Percent With StatSeal in Combination With TR Band.

SCAI 2021 Late-breaking Clinical Study Results

Find more news from the SCAI 2021 virtual meeting

Coronavirus (COVID-19) | May 06, 2021

Payam Dehghani, M.D.,  FRCPC, FACC, FSCAI, co-director of Prairie Vascular Research and associate professor at the University of Saskatchewan, explains the findings of the North American COVID-19 Myocardial Infarction (NACMI) Registry. He presented this late-breaking study data at the at the Society of Cardiovascular Angiography and Interventions (SCAI) 2021 meeting.

The study found one third of patients will die who have COVID-19 (SARS-CoV-2) and suffer a ST-elevated myocardial infarction (STEMI), which is alarming high as compared to four-in-100 patients using a pre-pandemic control group.

 The prospective, ongoing observational registry was created under the guidance of the SCAI, Canadian Association of Interventional Cardiology (CAIC) and American College of Cardiology (ACC). The initial results of the registry were published in the Journal for American College of Cardiology (JACC) on April 27, 2021.

Important key findings from the registry data include:
   • Minorities were disproportionally affected: 55 percent of the STEMI patients had minority ethnicity, which was about evenly divided between Hispanics and blacks.
   • In-hospital mortality was high: 33 percent (4 percent for controls without COVID).
   • Symptoms were unique: majority (54 percent) presented with respiratory symptoms (shortness of breath) rather than chest pain.
   • Significant proportion of COVID-positive patients presented with high-risk STEMI: cardiogenic shock (18 percent) and cardiac arrest (11 percent), which may explain the high fatality rate.
   • Primary angioplasty remained the dominant revascularization modality during the pandemic with small treatment delays (at about 15 minutes). 
   • Diabetics are known to have some of the worst outcomes if they contract COVID, and this was reflected in the study, with 45 percent of patients having diabetes. 

Read more in the artice Third of COVID Patients With STEMI Heart Attacks Die.

Find more COVID-19 news and video

SCAI 2021 Late-breaking Clinical Study Results

Find more news from the SCAI 2021 virtual meeting

 

Cath Lab | May 05, 2021

Ashwin Nathan M.D., a cardiology fellow in the division of Cardiovascular Medicine at the Hospital of the University of Pennsylvania, presented a late-breaking study at the Society of Cardiovascular Angiography and Interventions (SCAI) 2021 meeting that looked at hospital-level percutaneous coronary intervention (PCI) performance data and simulated if what would happen if hospitals removed their highest risk patients. The findings suggest this risk avoidance strategy does not necessarily mean the hospital will get higher performance scores.

Read more in the article Avoiding High-risk Cath Lab Procedures Does Not Necessarily Improve Hospital Scores.

SCAI 2021 Late-breaking Clinical Study Results

Find more news from the SCAI 2021 virtual meeting

Structural Heart | April 30, 2021

Ashwin Nathan M.D., a cardiology fellow at the Hospital of the University of Pennsylvania, presented a late-breaking study on the socioeconomic and geographic access to transcatheter aortic valve replacement (TAVR) programs at the Society of Cardiovascular Angiography and Interventions (SCAI) 2021 Scientific Sessions.

The findings reveal inequitable access to TAVR programs for non-metropolitan or lower income areas across the country. Between 2012 and 2018, 554 hospitals developed new TAVR programs including 543 (98%) in metropolitan areas, and 293 (52.9%) in metropolitan areas with pre-existing TAVR programs. Compared with hospitals that did not start TAVR programs, hospitals that did start TAVR programs treated patients with higher median household incomes (difference $1,305, 95% CI $134 to $12,477, p=0.03). Furthermore, TAVR rates per 100,000 Medicare beneficiaries were higher in areas with higher median income, despite adjusting for age and clinical comorbidities.

The authors also acknowledge that increasing access to TAVR and structural heart programs will require foresight into how clinical trials and approval for procedures and technologies at hospitals are distributed.

Read more about this study

Find more news from the SCAI 2021 virtual meeting

Cardiogenic Shock | April 28, 2021

William O’Neill, M.D., medical director of the Center for Structural Heart Disease at Henry Ford Hospital, Detroit, explains final data from the National Cardiogenic Shock Initiative Study (NCSI), The study, presented as a late-breaker at the  Society for Cardiovascular Angiography and Interventions (SCAI) 2021 Virtual Scientific Sessions today, showed NCSI protocols increased cardiogenic shock survival from 50% to 72%. This involves using Impella hemodynamic support prior to percutaneous coronary intervention (PCI).

Find more news from the SCAI 2021 virtual meeting

 

Related Cardiogenic Shock Content:

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SCAI Releases New Consensus Document on Classification Stages of Cardiogenic Shock

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VIDEO: Cardiogenic Shock Initiative Continues to Reduce Mortality by 50 Percent — Interview with William O’Neill, M.D.

10 Reasons Why it is Time to Learn More About Cardiogenic Shock — by Emmanouil S. Brilakis, M.D.

New Approaches to Reduce Cardiogenic Shock Mortality

VIDEO: Overview of the National Cardiogenic Shock Initiative — Interview with William O’Neill, M.D.

Cath Lab | February 04, 2021

Cindy Grines, M.D., MSCAI, FACC, president of the Society for Cardiovascular Angiography and Interventions (SCAI), and chief scientific officer of the Northside Cardiovascular Institute in Atlanta, explains a survey showing patients fear catching COVID-19 more than heart attacks. The SCAI survey found this fear is now seen as playing a role in preventing people from going to the hospital if they do have a heart attack or stroke, or even seeing their doctors for checkups or for cardiac complaints they might be having. This is leading to an increase in patients showing up very late after the onset of heart attacks, leading to serious cardiac damage and worse outcomes.  This was a concern early on in the U.S. spread of the virus, but this recent survey shows patients attitudes and fears have not improved much since last spring.
 

SCAI Study Shows COVID Fears Continue to Cause Americans to Avoid Doctor Visits

VIDEO: Where Have all the STEMI Cases Gone Amid COVID-19? — Interview with Thomas Maddox, M.D.

Rapid Drop in Heart Attacks and Stroke at Hospitals Concerns ACC 

Find more cardiology related COVID content

FFR Technologies | December 16, 2020

This is an example of the Medis Medical Imaging Quantitative Flow Ratio (QFR) system that offers a fractional flow reserve (FFR) blood flow measure in coronary vessels based on angiography imaging analysis alone. The FDA-cleared product allows the FFR-angio derived analysis to be performed table side in the cath lab when the patient is on the table for a procedure to determine if a patient requires a stent.

The QRF technology uses two angiography images with contrast, shot from different angles are used to create a 3-D model of the vessel segment and calculate FFR flow past a lesion. The model also can help plan for stenting.

This example was recorded by DAIC Editor Dave Fornell at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting.

Read more about this technology 

Robotic Systems | December 16, 2020

This is an example of the Siemens Corindus CorPath Cath lab robotic system being used for a percutaneous coronary intervention (PCI) stent implant simulation on the expo floor at the 2019 Transcatheter Cardiovascular Therapeutics (TCT) meeting. The system is mounted to the rail of the cath lab patient table and is manually loaded with catheters. The operator sits in a lead-lined booth outside the radiation field of the C-arm and uses joysticks to manipulate the catheters and advance them through vessels. The operators has the same controls for contrast and C-arm movement as they do using the tableside controls.

The main advantages of this systems are very precise catheter movements and removing the operator from the radiation field, so they can perform the procedure sitting down and without the need to wear heavy protective aprons.

The system is being tested to enable remote expert operators at one hospital to use high speed internet connections to perform a robotic PCI at another hospital many miles aways.
Read more 

 

 

Related Cardiovascular Robotics Content:

VIDEO: Standardizing PCI Through Smart Robotic Procedural Automation

Final Results of the Multicenter PRECISION GRX Study of the CorPath in a real-world population across a spectrum of lesion complexity — SCAI 2021 late-breaker

First-in-Human Telerobotic Coronary Intervention Procedures Published in EClinicalMedicine

Robocath Successfully Carries Out First Robotic Coronary Angioplasties in Humans

Corindus Vascular Robotics to Be Acquired by Siemens Healthineers

Corindus CorPath GRX Used in Live Complex Robotic-Assisted Coronary Intervention at EuroPCR 2019

Stereotaxis Announces Next-generation Robotic Magnetic Navigation and Imaging Systems

Reducing Physician Radiation Dose With Robotics

Corindus Seeking Neurovascular Intervention Clearance for CorPath GRX Vascular Robotic System

Corindus CorPath Used in World's First-in-Human Telerobotic Coronary Intervention

Robots in the Cath Lab

 

EP Lab | December 04, 2020

Oussama Wazni, M.D., section head, electrophysiology, Cleveland Clinic, discusses the results of the recent STOP AF First and Early AF trials. Both showed effectiveness in using early catheter ablation rather than drugs in atrial fibrillation (AF) patients. Both trials used cryo-ballon ablation, but Wazni said it is translatable to use of all cather ablation technologies.

Wazni a principal investigator for the STOP AF First trial and he shares information on the Early AF trial presented as a late-breaking study at the 2020 American Heart Association (AHA).

 

Related EP Ablation Technology Content:

VIDEO: Early Ablation Improved Outcomes in Atrial Fibrillation Patients —interview with Oussama Wazni, M.D.

Esophageal Cooling May Help Prevent Injury From Cardiac Ablations

VIDEO: Top New EP Technologies at Heart Rhythm Society 2020 — Interview with Andrew Krahn, M.D.

Biotronik Partners With Acutus Medical to Offer More Efficient Arrhythmia Diagnosis and Treatment

Contact Force Sensing Catheter Improved Outcomes in Persistent Atrial Fibrillation Ablation

New Technologies to Improve Atrial Fibrillation Ablation

VIDEO: Current State of Atrial Fibrillation Ablation Technologies, an interview with Hugh Calkins, M.D., at HRS 2017.

Find more EP technology news and video

 

Coronavirus (COVID-19) | November 18, 2020

Aaron Baggish, M.D., director of the cardiovascular performance program, Massachusetts General Hospital. He was on a 2020 American Heart Association (AHA) meeting panel discussion on the topic of the lingering myocardial involvement after COVID-19 (SARS-CoV-2) infection. He said there appears to be some long-term effects in the body from COVID, including the heart and vascular system, but it is unknown how long these effects may last. These patients are now being referred to as COVID "long-haulers."

The AHA late-breaking studies included four that pertained specifically to COVID-19. Three of these pertained specifically to the AHA COVID-19 Cardiovascular Disease Registry. It has been collecting data on patients with cardiac co-morbiditities or cardiac involvement since April to provide insights into these patients hospitalized with the novel coronavirus. One study was a review of the registry, a second looked at the racial and ethnic disparities in severe COVID patients. The third looked at the association of body mass index and death, mechanical ventilation and cardiovascular outcomes.

Read more about these three studies in the article COVID-19 Cardiovascular Registry Details Disparities Among Hospitalized Patients.

The fourth study looked at the overall of cardiovascular risk factors in more than 14,000 COVID-19 patients. It showed in-hospital mortality ranged from 28.5 percent for patients with hypertension to 28.6 percent for those with diabetes, 25.5 percent for those with coronary artery disease, and 38.4 percent for those with heart failure.

Read more in the article COVID-19 Patients With Cardiovascular Disease Have In-hospital Mortality Rates of 25 to 38 Percent. 

Find more AHA news, video, and late-breakers

VIDEO: What Are The Long-term Cardiac Impacts of COVID-19 Infection — Interview with Todd Hurst, M.D.

COVID-19 Changes Properties Blood Cells

COVID-19 Blood Vessel Damage May Cause Brain Fog and Other Long-hauler Symptoms

Find more cardiology related COVID-19 news

 

 

 

Atrial Fibrillation | November 18, 2020

Steven Lubitz, M.D., MPH, cardiac electrophysiologist, Massachusetts General Hospital, presented the late-breaking VITAL-AF Trial at the 2020 American Heart Association (AHA) virtual meeting this week. The study looked at screening for atrial fibrillation (AF) in older adults at primary care visits using the AliveCor single-lead electrocardiogram (ECG) device that interfaces with a smartphone or iPad.

The study found screening for AF using a single-lead ECG at primary care visits was not associated with a significant increase in new AF diagnoses among individuals aged 65 years or older compared to usual care. However, screening may be associated with an increased likelihood of diagnosing AF among individuals aged 85 years or older. 

Undiagnosed AFib is associated with increased risk of stroke. There is uncertainty about how best to screen for AF and guidelines differ regarding screening using ECGs. Methods: We conducted a cluster-randomized trial to evaluate whether screening using single-lead ECGs at primary care visits is effective for diagnosing AF. 

Sixteen clinics were randomized 1:1 to an AF screening intervention which offered an AliveCor single-lead ECG to patients aged 65 years or older during routine vital sign assessments, or usual care. AliveCor readings were over-read by cardiologists. Confirmatory diagnostic testing and treatment decisions were made by the primary care provider. 

New AF diagnoses were ascertained based on electronic case identification and manually adjudicated by a clinical endpoint committee. Results: 35,308 patients were included in the trial (n=17,643 intervention [91% screened], n=17,655 control). Patient characteristics were well-balanced between the intervention and control groups, including 12.7% versus 13.2% with prevalent AF, respectively. At one year, 1.52% of individuals in the screening group had new AF diagnosed versus 1.39% in the control group (relative risk [RR] 1.10; 95% confidence interval [CI] 0.92-1.30; P=0.30). New AF diagnoses in the screening and control groups varied by age (0.95% versus 1.00% for age 65-74; P=0.74; 1.84% versus 1.70% for age 75-84; P=0.58; 4.05% versus 2.68% for age 85+; P=0.02) (see figure). New anticoagulation was prescribed in 2.98% versus 2.90% of individuals in the screening and control groups, respectively, overall (RR 1.03; 95%CI 0.91-1.18; P=0.61), and in 72.8% versus 71% with new AF diagnoses (RR 1.02; 95%CI 0.92-1.14; P=0.70).

Find more AHA news, video and late-breakers

Hemodynamic Support Devices | October 20, 2020

Chuck Simonton, M.D., chief medical officer at Abiomed, discusses some of the new technologies and clinical trials the company is working on and highlighted hemodynamic presentations at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting.

In this interview Simonton discusses:
   • The new Impella 5.5 device
   • The new Impella ECP expandable pump that collapses to a very small diameter to aid vascular access is about to start first-in-human trials.
   • Smart Assist technology that will incorporated artificial intelligence (AI) to better monitor Impella patients.
   • The Door to Unloading (DTU) Trial that is using Impella first in STEMI patients prior to PCI to prevent reperfusion injury
   •The PROTECT III and IV trials. 

Prior Abiomed, Simonton was the CMO at Abbott Vascular, and was a practicing interventional cardiologist for nearly 30 years at Duke University Medical Center and then at the Sanger Clinic. At Sanger he created his own research team to study patient outcomes following the use of new cardiac technologies. He also founded the Carolinas Cardiovascular Research Foundation at the Carolinas Heart Institute, now part of Atrium Health.
 

Find more TCT news, video and the late-breaking studies

Cath Lab | October 19, 2020

Dean Kereiakes, M.D., medical director, The Christ Hospital Heart and Vascular Center, medical director, The Christ Hospital Research Institute, and professor of clinical medicine at The Ohio State University, explains the late-breaking Disrupt CAD III study at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting. 

The trial will likely pave the way for U.S. Food and Drug Administration (FDA) clearance for intravascular lithotripsy to be used in the coronary arteries. He offers details on the data and and use of this technology in the cath lab compared to the current techniques of atherectomy, cutting balloons and high pressure balloons that can cause vessel trauma, leading to poorer outcomes. 

The lithotripsy technology breaks up calcium in the vessel walls without trauma, using a compliant balloon and relying on sonic waves to bust the calcium rather than brute force. He said this could be a paradigm shift in how calcified lesions are treated.

Read more on this trial and the technology in the article Shockwave Technology to Sonically Bust Calcified Coronary Lesions Shows Safety and Efficacy in U.S. Pivotal IDE Trial.

Find additional TCT 2020 news, video and late-breaking studies

 

Stents Drug Eluting | October 19, 2020

Dean Kereiakes, M.D., medical director, The Christ Hospital Heart and Vascular Center, medical director, The Christ Hospital Research Institute, and professor of clinical medicine at The Ohio State University, explains the late-breaking OPTIMIZE Trial at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting. 

OPTIMIZE looked at the safety and efficacy of the novel Svelte drug eluting stent (DES). It is a thin strut cobalt chromium stent that uses a bioresorbable amino acid-based drug carrier to elute sirolimus. It also was designed specifically for transradial access and direct stenting with a very low crossing profile. 

The trial showed the device did not meet non inferiority for existing DES by a small margin, but there were questions raised about the criteria used in the design of the trial being flawed, rather than the device itself. Kereiakes explains these issues in the video. 

Find additional TCT 2020 news, video and late-breaking studies

 

 

 

Antiplatelet and Anticoagulation Therapies | October 19, 2020

The COMPARE CRUSH Trial looked at the effect of per-hospital crushed prasugrel tablets in patients with STEMI planned for primary percutaneous coronary intervention (PCI).[1] This video is of the press conference presention of this late-breaking study by doctor George Vlachojannis, from UMC Utrecht, at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting. 

The idea was to crush the tablets to enable faster anti-later inhibition, but the findings of this study showed it did not improve TIMI 3 flow on first angiography or ST-segment resolution at 1 hour post PCI.

Find additional TCT 2020 news, video and late-breaking studies

 

Reference:

1. Vlachojannis GJ, Vogel RF, Wilschut JM, Lemmert ME, Delewi R, Diletti R, van Vliet R, van der Waarden N, Nuis RJ, Paradies V, Alexopoulos D, Zijlstra F, Montalescot G, Angiolillo DJ, Krucoff MW, Van Mieghem NM, Smits PC. COMPARison of pre-hospital CRUSHed vs. uncrushed Prasugrel tablets in patients with STEMI undergoing primary percutaneous coronary interventions: Rationale and design of the COMPARE CRUSH trial. Am Heart J. 2020 Jun;224:10-16. doi: 10.1016/j.ahj.2020.03.005. Epub 2020 Mar 11.

 

Heart Valve Technology | October 19, 2020

David Cohen, M.D., presents late-breaking data from the STS/ACC Transcatheter Valve Registry (TVT) showing the impact of using cerebral embolic protection devices during transcatheter aortic valve replacement (TAVR). This is the press conference presentation followed by an expert panel discussion at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting.

The stroke rates were initially high in TAVR compared to surgical aortic valve replacement (SAVR), but these rates have decreased in recent years as operators become more proficient during the procedures and the stroke rates are now comparable or lower than SAVR.

Cerebral embolic protection devices were developed to prevent emboli knocked off the aortic walls and from the aortic valve from traveling to the brain. However, this review of embolic protection device performance and use showed 66 percent of the 700 sites in the TVT Registry report not using these devices.

The rate of in-hospital stroke in the embolic protection group of patients was 1.39 percent. The rate of stroke in patients without embolic protection was 1.54 percent. There was no difference inn the rates of death, stroke, major bleeding or device success between these two groups, Cohen said.

The study also included a propensity-weighted analysis where the embolic group has a stroke rate of 1.3 percent and the no protection device group at 1.58 percent. 

Cohen said there was not a significant reduction in in-hospital or 30-day stroke rates. While there its a slight signal toward fewer strokes with embolic protection, he said the findings show clinical equipoise and provide strong rational for ongoing, large-scale randomized, controlled trials to see if embolic protection devices offer meaningful clinical benefit.

Find additional TCT 2020 news, video and late-breaking studies

 

Related TAVR Content:

VIDEO: Tracking Transcatheter Valve Outcomes in the STS-ACC TVT Registry — Interview with John Carroll, M.D.

Key TAVR Takeaways From ACC 2020

U.S. TAVR Outcomes Need Improvement Based on TVT Registry Analysis

FDA Approves TAVR for Low-risk Patients Creates A Paradigm Shift in Cardiology

 

Antiplatelet and Anticoagulation Therapies | October 19, 2020

Roxana Mehran, M.D., and Marco Valgimiggle, M.D., present the results of the Xience 90/28 trials that evaluated the use of shortened 3-month and 1-month dual-antiplatelet therapy (DAPT) in high-risk bleeding patients. This is the press conference at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting. It is followed by an expert panel discussion on the merits and meaning of the results.

The use of short duration DAPT has been a big topic of discussion at TCT the past few years. The first FDA cleared indication for shortened DAPT was was granted in late September 2020 for the Medtronic Endeavor stent. The data from these two trials will likely lead the Xience to a similar FDA indication expansion. 

Find additional TCT 2020 news, video and late-breaking studies

 

 

Heart Valve Technology | October 19, 2020

Doctor Hans-Josef Feistritzerm, Heart Center of Leipzig, Germany, presents data on the use of general vs. local anesthesia in transcatheter aortic valve implantation (TAVI) from the late-breaking SOLVE-TAVI one-year outcomes trial. This is the press conference at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting. It is followed by an expert panel discussion on the merits and meaning of the results.

The results showed both approaches are safe to use and the outcomes are good.

The trial randomized patients to either self-expandable or balloon-expandable transcatheter aortic valve replacement (TAVR) valves and the procedures used either general or local anesthesia. TAVR centers have been moving toward the procedure becoming a same day surgery to reduce overnight admissions and send them home as an out patient procedure. This can be accomplished using a local anesthesia if transesophageal echo (TEE) is not needed. However, many still use TEE or there are other factors that make this approach more appealing. Local anesthesia generally has a faster recovery time and reduces  potential complications in sicker and older patients.

Find additional TCT 2020 news, video and late-breaking studies

 

Related TAVR Content:

VIDEO: Tracking Transcatheter Valve Outcomes in the STS-ACC TVT Registry — Interview with John Carroll, M.D.

Key TAVR Takeaways From ACC 2020

U.S. TAVR Outcomes Need Improvement Based on TVT Registry Analysis

FDA Approves TAVR for Low-risk Patients Creates A Paradigm Shift in Cardiology

 

Cath Lab | October 17, 2020

Gregg Stone, M.D., presents the results of the PROSPECT ABSORB Trial in a press conference at the 2020 ranscatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting. 

The PROSPECT ABSORB Trial was a randomized evaluation of vulnerable plaques using the Abbott Absorb fully bioresorbable stent. The hypothesis of the trial  was to treat lesions prior to plaque ruptured to avoid heart attacks, rather than treating them after plaque rupture when a potential infarct and permanent heart damage is caused. Patients were randomized to percutaneous coronary intervention (PCI) using an Absorb bioresobable vascular scaffold (BVS) stents vs. guideline directed medical therapy (GDMT).

This is the first study that proactively identifies and preemptively treats vulnerable plaques. 

Lesion related MACE events 4 years showed medical therapy alone resulted in 10.7 percent events and the BVS treat patients were 4.3 percent. Stone said the favorable BVS MACE rates warrants a larger, adequately powered randomized trial to determine if PCI treatment of focal vulnerable plaques improves patient outcomes. 

The study looked at periprocedural anticoagulation during percutaneous corona intervention in AMI patients. There has been conflicting results reported between several trials looking at which drug is best for anticoagulation during cath procedures.

This study pooled data from 8 studies that included more than 27,000 patients. The data included both STEMI and NSTEMI patients.

The pool analysis found STEMI patients, bivalirudin was associated with reductions mortality, serious bleeding and NACE events, despite higher rates of myocardial infarction  (MI) and stent thrombosis compared with heparin. The mortality benefit of bivalirudin was pronounced in patients with a post-PCI bivalirudin infusion to mitigate MI and stent thrombosis risks. 

In NSTEMI patients, bivalirudin was associated with a reduction in 30 day serious bleeding events, but similar rates of mortality, MI and stent thrombosis compared to heparin.

Find additional TCT 2020 news, video and late-breaking studies

 

Antiplatelet and Anticoagulation Therapies | October 17, 2020

Gregg Stone, M.D., presents the results of a pooled analysis of randomized trials of bivalirudin virus heparin in acute myocardial infarction patients in a press conference at the 2020 Transcatheter Cardiovascular Therapeutics (TCT) Connect virtual meeting.

The study looked at periprocedural anticoagulation during percutaneous corona intervention in AMI patients. There has been conflicting results reported between several trials looking at which drug is best for anticoagulation during cath procedures.

This study pooled data from 8 studies that included more than 27,000 patients. The data included both STEMI and NSTEMI patients.

The pool analysis found STEMI patients, bivalirudin was associated with reductions mortality, serious bleeding and NACE events, despite higher rates of myocardial infarction  (MI) and stent thrombosis compared with heparin. The mortality benefit of bivalirudin was pronounced in patients with a post-PCI bivalirudin infusion to mitigate MI and stent thrombosis risks. 

In NSTEMI patients, bivalirudin was associated with a reduction in 30 day serious bleeding events, but similar rates of mortality, MI and stent thrombosis compared to heparin.

Find additional TCT 2020 news, video and late-breaking studies

Heart Failure | October 16, 2020

The late-breaking MitraBridge Study was presented at Transcatheter Cardiovascular Therapeutics (TCT) 2020 meeting showed the transcatheter MitraClip mitral leaflet repair system can be used as bridge therapy to heart transplantation. About 25 percent of patients in this study were actually taken off the transplant list because they became asymptomatic. This is the press conference for the study presented by Cosmo Godino, M.D., an interventional cardiologist from San Raffaele Hospital, Milan, Italy. It is followed by a discussion by several well-known interventional cardiologists and structural heart experts.

Find additional TCT 2020 news, video and late-breaking studies

 

 

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