Category Archives: Cardiology

Doctors form new coalition focused on reducing private equity’s role in cardiology, other healthcare specialties – Cardiovascular Business

March 19, 2024 medical

Thousands of U.S. physicians have joined forces to launch the Coalition for Patient-Centered Care (CPCC), a new organization focused on reducing the involvement and influence of private equity in the American healthcare system.

CPCCs members include more than 5,000 physicians from 46 U.S. states. The OrthoForum, a Tennessee-based group of private orthopedic practices, the Association for Independent Medicine (AIM) and PELTO are also listed as founding members on the organizations website.

According to the newly formed group, it wants to eliminate tax breaks associated with private equity-funded acquisitions and close loopholes that allow private equity-backed groups to circumvent the ban on the corporate practice of medicine. The group also aims to ensure private equity-funded acquisitions of physician practices are regulated just as closely as any other healthcare merger or acquisition.

Independent physicians across specialties including radiology, anesthesiology, cardiology and more will have a better chance of influencing policy in the right direction than any one specialty standing alone, AIM President Marco Fernandez, MD, a veteran cardiac anesthesiologist and CPCC founding member, told Cardiovascular Business.

When private equity takes over, they often hire less-expensive, less-experienced providers and make them work harder, added surgeon Stephen McCollam, MD, another founding CPCC member. From what Ive seen, this results in lower quality care, higher utilization rates of expensive specialty testing due to a lack of experience and lack of confidence in their clinical abilitiesand higher burnout rates. Ultimately, these effects of private equity ownership cost the patient more while providing lower quality care.

Beth Israel Deaconess Medical Center cardiologist to be honored by American Heart Association – American Heart Association

March 19, 2024 medical

BOSTON The American Heart Association will present the 2024 Paul Dudley White Award to Dr. Robert E. Gerszten in recognition of his contributions to the field of cardiovascular medicine and outstanding record of mentoring the next generation of researchers, educators and health care professionals.

Dr. Gerszten is chief of the Division of Cardiovascular Medicine at Beth Israel Deaconess Medical Center and the Herman Dana Professor of Medicine at Harvard Medical School. He will receive the award at the Boston Heart and Stroke Ball on May 4.

The Paul Dudley White Award has been presented annually since 1974 to a Boston-based medical professional who has made extraordinary contributions to cardiovascular or stroke care. It is named after one of the citys most revered cardiologists, Dr. Paul Dudley White, a founder of the American Heart Association who is regarded as the father of preventive cardiology.

Dr. Gerszten was selected to receive this years award by a committee of area physicians. In choosing Dr. Gerszten, the committee praised him for his work around predicting, preventing, and treating patients with cardiovascular disease. They also credited his more than 30 years as a volunteer for the American Heart Association and his extensive record of mentorship.

Several colleagues nominated Dr. Gerszten for the award. Among them was Dr. Robert W. Yeh, a cardiologist at Beth Israel Deaconess Medical Center and the Smith Family Professor of Medicine at Harvard Medical School. In his nominating letter, Dr. Yeh commended Dr. Gerszten for dedicating his life to preventing and treating cardiovascular disease.

He has done this through his groundbreaking research, through the mentorship of multiple generations of physician scientists, through a consistent presence at the bedside caring for critically ill patients, and through his leadership of one of the countrys premier cardiovascular divisions, said Dr. Yeh. He has carried out his lifes work with honesty, integrity, professionalism, grace, good humor and relentless determination.

Dr. Gersztens contributions to the scientific community are extensive. He has played a significant role in our understanding of how metabolic issues impact cardiac health. His research has consistently been published in top scientific journals, and his laboratory has continually been funded by prestigious organizations including the National Institutes of Health.

Dr. Gerszten has also served in various volunteer roles for the American Heart Association throughout his career. This includes participating in working groups, grant review activities, and the coordination of community-based fundraising through the Beth Israel Deaconess Medical Center Boston Heart Walk team. Additionally, he has played a pivotal role in planning Scientific Sessions, an annual American Heart Association conference dedicated to highlighting the latest breakthroughs in cardiovascular research.

Dr. Gerszten is also known for being an exceptional mentor, showing an unwavering commitment to training the next generation of leaders in cardiovascular science. Colleagues credit him for fostering a collaborative work environment and for being an exemplary role model.

Over the past year of working daily with Dr. Gerszten in a leadership capacity, I have found him to represent every single humanistic quality that I might imagine distinguished Paul Dudley White, said Dr. Jennifer E. Ho, a cardiologist at Beth Israel Deaconess Medical Center and associate professor of medicine at Harvard Medical School. He cares deeply about the people around him, whether they be colleagues, trainees or patients.

Dr. Gerszten received his bachelors degree from the University of Virginia and his medical degree from Johns Hopkins University. He completed his residency at the University of Pennsylvania and his clinical fellowship in cardiology at Massachusetts General Hospital.

He lives in Brookline with his wife Elena. He is happiest while fishing off Marthas Vineyard, or even while losing to his two sons in tennis. His career has been deeply impacted by his parents, both of whom dedicated their lives to academic medicine as a physician educator and as a social worker.

The Boston Heart and Stroke Ball is a celebration of the year-round Heart of Boston campaign, which supports the American Heart Associations 2024 Health Equity Impact Goal to reduce barriers to health care access and quality. It will be held on Saturday, May 4, at the Omni Boston Hotel at the Seaport.

Dr. Gersztens commitment to the mission of the American Heart Association has been instrumental in our efforts to ensure that every person has the opportunity to live a full, healthy life, said Eric Green, chair of the Heart of Boston campaign and senior vice president and head of development programs at Alnylam Pharmaceuticals. We look forward to honoring his contributions to cardiology and health when we gather at the Heart and Stroke Ball in May.

For more information about the Heart and Stroke Ball, visit heart.org/BostonHB or contact Rachel Adjemian, associate vice president of development, at rachel.adjemian@heart.org.

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About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the publics health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us onheart.org,Facebook,Xor by calling 1-800-AHA-USA1.

For Media Inquiries:

Chris Camire, Marketing Communications Director

chris.camire@heart.org

For Public Inquiries:

1-800-AHA-USA1 (242-8721)

heart.org and stroke.org

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Beth Israel Deaconess Medical Center cardiologist to be honored by American Heart Association - American Heart Association

Cardiology

March 19 Doctors on Call Will Focus on Cardiology – KRSL

March 19, 2024 medical

Local

Written By: Press Release Posted by David Elliott Published Date: 03-18-2024

Doctors on Call, a local production of Smoky Hills PBS, will feature Dr. David Battin with the Heart Center at Salina Regional Health Center on Tuesday, March 19 at 7 PM and will focus on cardiology.

Doctors on Call is a program that provides medical information on a variety of different topics. Medical professionals from throughout the state travel to Bunker Hill to provide information and answer questions from the viewing audience. The doctors presenting each week have expertise in the topic chosen for that program. Questions can be called in during the show or emailed prior to the broadcast.

The program airs live on Smoky Hills PBS at 7 PM on Tuesdays. You can also stream each episode live on the Smoky Hills PBS YouTube channel at http://bit.ly/StreamSmokyHillsPBS.

A schedule of programs and past episodes are available at http://www.SmokyHillsPBS.org.

To submit questions electronically on a specific topic, viewers can send an email to doctors@shptv.org. Questions submitted through email must be received by Noon on the day of the show. During the program, viewers can call 1-800-337-4788.

(Information courtesy SHPBS.)

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March 19 Doctors on Call Will Focus on Cardiology - KRSL

Cardiology

Cardiologist shares his long journey from Libya to United States – Cardiovascular Business

March 19, 2024 medical

Almanfi found himself starting from scratch upon arrival in the United States. The U.S. medical system is notoriously rigorous and closed, requiring foreign-trained physicians to undergo a comprehensive evaluation and certification process. This involved passing standardized exams such as the USMLE (United States Medical Licensing Examination) steps, followed by applying for residency through the National Resident Matching Program (NRMP).

For Almanfi, this journey encompassed nearly a decade of dedicated effort, including three years of internal medicine residency and additional training in cardiology and interventional cardiology. The process demanded resilience and persistence, as foreign-trained physicians often encounter bureaucratic roadblocks and lengthy timelines in obtaining licensure and certification to practice medicine in the U.S. The requirement to meet the U.S certifications can be a significant deterrent for individuals who have already established careers in their home countries or seek expedited pathways to practice medicine in the U.S.

"I think if someone has a goal in mind and has determination to do this, maybe they can go through the process. I know it's painful, it can be long, but it can get you to your dream and get you to have a job and have a living and even become a U.S. citizen. That's probably the longest way and probably the official way," Almanfi said.

Almanfi suggests exploring alternative avenues for skill development, such as attending conferences, participating in hands-on training programs and leveraging online resources and simulators to enhance clinical proficiency.

Almanfi's own experiences underscore the significance of networking and utilizing social media platforms as valuable tools for professional advancement. As a social media ambassador for prestigious medical conferences, he has leveraged digital platforms to connect with colleagues worldwide, share insights, and collaborate on educational initiatives. Social media serves as a gateway for international physicians to engage with the global medical community, facilitating knowledge exchange, networking opportunities, and professional development.

"I think social media has became a central part of almost everything in our life nowadays. Not only in politics but also in medicine. I have been doing this for 10 years, which I think has impacted my career. And so I became more involved with physicians not only within the United States, but also outside the United States. Social media, it became like a window for the people there to look at the outside world. And so if you're traveling to the United States, you could see everything through social media, especially if you are connected with people or organizations that have a presence on social media," Almanfi explained.

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Cardiologist shares his long journey from Libya to United States - Cardiovascular Business

Cardiology

Cardiologists share historic research that led to FDA’s long-awaited approval of coronary DCB – Cardiovascular Business

March 19, 2024 medical

Overall, clinical procedural success rates (92.1% for DCB patients vs. 88.7% for uncoated balloon patients) and technical success rates (93.4% for DCB patients vs. 89.7% for uncoated balloon patients) were similar. Bailout stents, meanwhile, were required for three patients treated with a paclitaxel-coated balloon and one patient treated with an uncoated balloon.

Target lesion failure after 12 months was seen in 17.9% of DCB patients and 28.6% of uncoated balloon patients. This difference was primarily attributed to lower rates of ischemia-driven revascularization and target vessel myocardial infarction among patients in the DCB group.

Drug-coated balloons have emerged internationally as an alternative treatment option, but despite promising international data, they have not been previously evaluated or approved for use in the United States, lead investigator Robert W. Yeh, MD, MSc, MBA, director of the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology and section chief of interventional cardiology at Beth Israel Deaconess Medical Center, said in a statement. Even with advances in stent technology, patients with coronary in-stent restenosis continue to comprise approximately 10% of individuals undergoing angioplasty interventions each year. In particular, patients with multiple prior stents have very poor long-term outcomes. There's growing sentiment that drug-coated balloons could address an unmet clinical need among patients with coronary artery disease in the United States.

Click here to read the full analysis in JAMA, a journal from the American Medical Association.

When the initial positive results from AGENT IDE were presented at TCT 2023, cardiologists were thrilled that a coronary DCB could finally be on its way toward FDA approval.

Our European colleagues have had these devices for a decade, Ajay J. Kirtane, MD, an interventional cardiologist with the Columbia University Department of Medicine, said during a TCT press conference in October 2023. In the United States, we basically tell patients routinely that we can use a peripheral balloon that is too big for your coronary and try to put it in your coronary to prevent the restenosis from happening, or you can buy a ticket to London and go over there to get this treated. Its embarrassing.

American College of Cardiology President B. Hadley Wilson, MD, meanwhile, described the new analysis as a game changer.

For 25 years, weve been trying to peel back this restenosis problem, he said during the same press conference. Now we can see light at the end of the tunnel.

Boston Scientific said the Agent DCB should be available on the U.S. market in the coming months.

In addition, AGENT IDEs researchers will be tracking patient data for up to five years, so expect updates on their findings as time goes on.

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Cardiologists share historic research that led to FDA's long-awaited approval of coronary DCB - Cardiovascular Business

Cardiology

Most physicians think private equity is bad for healthcare – Cardiovascular Business

March 19, 2024 medical

Overall, 60.8% of physicians said they view the involvement of PE in healthcare in a negative light. Just 10.5% of physicians said they have a positive opinion about PE, and the remaining 28.8% said they were neutral. In addition, 52% of respondents said they think PE ownership is worse than being owned by a not-for-profit hospital or health system.

What is it about PE involvement that worries physicians the most? Its potential impact on physician well-being, healthcare prices/spending and health equity were the three most common concerns.

The authors also noted that the small subset of physicians who are owned by a PE-backed group were less likely to report high professional satisfaction and autonomy than physicians not owned by a PE-backed group. They were also less likely to say they would likely remain with their employer.

While this survey had a limited sample size and is not generalizable to non-ACP members, our findings add to the dearth of evidence on PEs perceived effects on physicians, the authors wrote. Our estimates of PE-involved physicians mirror those in the literature and suggest new areas for inquiry around clinical practice and workplace experience.

Read the full research letter in JAMA Internal Medicine here.

The rise of PE continues to be one of the biggest trends in all of healthcare, and its presence in cardiologyseems to be growing by the day. Cardiovascular Associates of America, Cardiovascular Logistics and other PE-backed cardiology management groups are acquiring more and more practices, and the trend has shown no signs of slowing down.

Click here and here for additional insights into PE's impact on cardiovascular care in the United States.

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Most physicians think private equity is bad for healthcare - Cardiovascular Business

Cardiology

Meth-Related Cardiomyopathy: Where the Biggest Clusters Are – Medpage Today

March 19, 2024 medical

The American West has seen the biggest surge of cardiomyopathy-associated hospital admissions among methamphetamine users, based on 13 years of the latest available hospital admission data.

The National Inpatient Sample (NIS) showed that methamphetamine-related cardiomyopathy admissions spiked by 231% from 2008 to 2020 nationwide -- whereas overall admissions for heart failure increased just 12% during this period, according to Mohammad Bhuiyan, PhD, of Louisiana State University Health Sciences Center at Shreveport, and colleagues.

They reported various geographical and social disparities evident across methamphetamine-related cardiomyopathy admissions:

"Demographically, cardiomyopathy among methamphetamine users occurs predominantly in middle-aged patients and men and tends to be concentrated more in the western region of the United States," Bhuiyan's team reported in JACC: Advances.

Methamphetamine (popularly known as "meth") is a highly addictive psychostimulant drug. It is available as a prescription drug for obesity and attention deficit-hyperactivity disorder, while illegal versions are derived from over-the-counter drugs. An estimated 1.6 million U.S. adults reported past-year methamphetamine use in 2015-2018, the CDC estimates.

Methamphetamine has known links to cardiovascular disease (CVD), including cardiomyopathy, heart failure, pulmonary hypertension, and coronary artery disease.

"Given the rapidly increasing global burden of methamphetamine-associated cardiomyopathy, this work ... should be a call to action for researchers, healthcare providers, and policymakers to fight this growing epidemic. Importantly, the healthcare system must also acknowledge and address its bias towards patients with substance use disorders," urged cardiologist Nisha Parikh, MD, MPH, of University of California San Francisco Health, and two colleagues.

In an accompanying editorial, the trio said the present NIS study extends prior work showing that meth-associated heart failure (MethHF) hospitalizations increased at an exponential rate between 2002 and 2014, particularly on the West Coast and among men, younger patients, and lower socioeconomic groups. Also disproportionately affected were people of Hispanic, Native American, and Asian/Pacific Islander descent.

"This work should lead us to interrogate why certain geographic areas and populations suffer a disproportionate burden of MethHF and the ways in which local public policies, differential availability of psychostimulant drugs, and socioeconomic disparities have shaped the epidemic," Parikh and colleagues wrote.

They stressed the importance of targeted interventions -- development of a pharmacotherapy for methamphetamine use disorder (MAUD), for example -- and recognition of the "competing health and life priorities relevant for this vulnerable patient population."

"We should also consider employing innovative, multidisciplinary approaches to co-manage heart failure and MAUD. For example, the development of specialty heart failure clinics that also offer contingency management -- a highly effective, evidence-based behavioral treatment for MAUD -- deserves further study and potential scale up," the editorialists wrote.

The NIS study relied on hospital records from all 50 states and captured over 12.8 million cardiomyopathy-associated hospital admissions (59.3% men, over 57% were older than 65) during the study period.

Of these admissions, 222,727 were related to methamphetamine users based on medical records (58.5% men, over 55% were ages 41-64 years). Notably, people who used methamphetamine together with other drugs were excluded from the study.

Bhuiyan's group acknowledged that the study lacked individual-level data and any postdischarge information. The authors were also uncertain how people came to be diagnosed as methamphetamine users.

"Further research is warranted to identify high-risk populations and develop strategies to prevent and mitigate CVD among methamphetamine users," they urged.

Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

The study was supported by grants or awards from the National Institutes of Health and Louisiana State University.

Bhuiyan and Parikh had no disclosures.

Co-editorialists reported support from the NIDA and Chan Zuckerberg BioHub San Francisco.

Primary Source

JACC: Advances

Source Reference: Al-Yafeai Z, et al "Cardiomyopathy-associated hospital admissions among methamphetamine users: geographical and social disparities" JACC Adv 2024; DOI: 10.1016/j.jacadv.2024.100840.

Secondary Source

JACC: Advances

Source Reference: Walker SL, et al "Facing a tsunami: methamphetamine heart failure demands novel approaches" JACC Adv 2024; DOI: 10.1016/j.jacadv.2024.100838.

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Cardiology

Gilbert H. L. Tang Appointed Editor-in-Chief of JACC: Case Reports – Diagnostic and Interventional Cardiology

March 19, 2024 medical

March 15, 2024 Renowned cardiovascular surgeon Gilbert H. L. Tang, MD, has been named Editor-in-Chief ofJACC: Case Reports, bringing a wealth of experience and expertise to the helm of one of the top cardiovascular journals published by the American College of Cardiology.

I am both honored and humbled to be a cardiac surgeon among the Editor-in-Chiefs in theJACCfamily of journals, Tang said. It is going to be an exciting time forJACC: Case Reportsto build on a team of multidisciplinary cardiovascular practitioners with diverse backgrounds and experiences, and at different stages of their professional careers, to enhance the journals academic and educational impact globally.

Tang is currently serving as a professor in the Department of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, the surgical director of the Structural Heart Program at the Mount Sinai Health System, and the director of Structural Heart Education at the Mount Sinai Fuster Heart Hospital in New York.

JACC: Case Reportsis one of 10 journalsin the ACCsJACCplatform of journals. It publishes high-quality, educationally valuable case reports, case series, images, and quality improvement projects covering all aspects of cardiology. It serves as a publication vehicle for early career cardiologists and members of the cardiovascular care team, providing a forum for mentorship on the review and publication process.

Widely recognized for pioneering innovative concepts and techniques in TAVR, Tang has set contemporary standards in the field. His impressive international academic collaborations include the establishment of multiple global registries and the training of heart teams in structural heart imaging and procedures worldwide. His research centers on the comprehensive management of patients post-TAVR, transcatheter mitral and tricuspid valve interventions, and advanced imaging techniques in structural heart disease.

In addition to serving on committees in the Heart Valve Collaboratory, and several clinical trials in structural heart, he has served as a member of the ACC Scientific Publications Committee. He is also a member of the ACC/STS TVT Research and Publications Committee, a four-time recipient of theJACCSimon Dack Award for Outstanding Scholarship and has served as an associate editor forCirculation: Cardiovascular Interventions.

Tang is a Diplomat and Fellow of the Royal College of Physicians and Surgeons of Canada (FRCSC), Fellow of the American College of Cardiology (FACC), and the first surgeon fellow of the Society for Cardiovascular Angiography and Interventions (SCAI). He has published over 250 peer-reviewed articles and lectures extensively worldwide.

Together with members of our editorial board and through closer collaborations with international communities and theJACCfamily of journals, we will strive to makeJACC: Case Reportsthe go-to digital resource to improve cardiovascular care and training worldwide, Tang said.

As the new Editor-in-Chief, Tang will officially assume the role of Editor in Chief on August 1, 2024,with his first issue slated for August 7, 2024.

For more information:www.jacc.org

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Gilbert H. L. Tang Appointed Editor-in-Chief of JACC: Case Reports - Diagnostic and Interventional Cardiology

Cardiology

SS Innovations’ SSi Mantra Surgical Robotic System used to perform Mitral Valve Replacement – Diagnostic and Interventional Cardiology

March 19, 2024 medical

March 18, 2024 SS Innovations International, Inc., a developer of innovative surgical robotic technologies dedicated to making world class robotic surgery affordable and accessible to a global population, today announced that surgeons have successfully performed the worlds first mitral valve replacement using the Made in India, SSi Mantra Surgical Robotic System. This procedure was carried out at the Narayana Hrudayalaya Institute of Cardiac Sciences in Bengaluru, India, and represents a milestone in the treatment of heart disease using the SSi Mantra Surgical Robotic System.

The mitral valve surgery was performed by Dr. Nitin Kumar Rajput from the Narayana Institute of Cardiac Sciences in Bengaluru, Karnataka, and guided by SS Innovations Founder and Chairman, Dr. Sudhir Srivastava, one of the early pioneers of robotic cardiac bypass surgery.

Considering this accomplishment, Dr. Srivastava commented, We are very proud of our team for pushing the envelope to be able to add the field of full spectrum robotic cardiac surgery to all other surgical subspecialties. 90-95% of all cardiac surgeries are still done today using large sternum splitting incisions. Since the inception of the Company, it was always our goal to address the need of offering a highly minimally invasive solution for cardiac patients.

During my practice in the US, I found that patients benefited immensely from surgical approaches which spared splitting of the sternum. Many patients would be discharged the following day and in full functional recovery in just a week to ten days later. The results were inspiring. This led me to develop more complex robotic bypass procedures that were adopted by other surgeons and would ultimately benefit more and more patients who underwent heart surgery.

We are very proud that using our Made in India, SSi Mantra Surgical Robotic System, we have performed a variety of robotic heart surgeries including, Bilateral Internal Mammary Takedowns, Totally Endoscopic Coronary Artery Bypass on a beating heart, Atrial Septal Defect Repair and now a completely robotic Mitral Valve Replacement. I am very pleased that our original goal is now being met in conjunction with the highly talented surgeons at the Narayana Institute of Cardiac Sciences.

Dr. Nitin Kumar Rajput, Consultant Cardiac Surgeon from Narayana Health, the primary surgeon on the Mitral Valve Replacement, commented following the successful completion of the procedure, We have performed more than 60 CABGs (Heart Bypass Procedures) with the SSi Mantra Surgical Robotic System and we just did our first Robotic Mitral Valve Repair a few days back. The surgery went flawlessly, and it was wonderful operating with the Mantra System. Four ports were made for the robotic arm and a tiny 2.5 cm working port for the table side assistant. The surgery was completed quickly; the patient did well in the postoperative period and was discharged with good exercise tolerance three days post-surgery.

Dr. Srivastava said: SS Innovations is dedicated to improving patient access and optimizing surgical outcomes with our accessible and cost-effective surgical robotic system. We recognize the immense opportunity to address the significant unmet need for safe, timely, and affordable cardiac surgical care in India and around the world.

This milestone procedure is a testament to our commitment to advancing cardiac care. The successful operation opens new avenues for treating cardiac conditions, offering patients less invasive options, reduced recovery times, and better results.

The SSi Mantra embodies innovation and excellence and provides unmatched precision and control in robotic-assisted surgeries. Today's success is a proud moment for everyone at SS Innovations and our partners at Narayana Hrudayalaya, concluded Dr. Srivastava.

The mitral valve disease market size was valued at $2.5 billion in 2021 and is estimated to reach $5.7 billion by 2031, growing at a CAGR of 8.8% from 2022 to 2031.

The SSi Mantra Surgical Robotic System, the first surgical robotic system to be made in India, and one of the few cost-effective global options with a wide range of surgical applications, has received regulatory approval in India, Indonesia and Guatemala, and is clinically validated for over 50 different types of surgical procedures. To date, more than 800 surgical procedures have been conducted using the system. SS Innovations has initiated the regulatory approval process in the United States and the EU, with approvals anticipated in the latter half of 2024 or 2025.

For more information: http://www.ssinnovations.com

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SS Innovations' SSi Mantra Surgical Robotic System used to perform Mitral Valve Replacement - Diagnostic and Interventional Cardiology

Cardiology

Intravascular imaging during PCI in heart disease patients improves survival, reduces adverse outcomes – News-Medical.Net

March 19, 2024 medical

Using intravascular imaging to guide stent implantation during percutaneous coronary intervention (PCI) in heart disease patients significantly improves survival and reduces adverse cardiovascular events compared to angiography-guided PCI alone, the most commonly used method.

These are the results from the largest and most comprehensive clinical study of its kind comparing two types of intravascular imaging methods (intravascular ultrasound, or IVUS, and optical coherence tomography, or OCT) with angiography-guided PCI. The study, published Wednesday, February 21, in The Lancet, is the first to show that these two methods of high-resolution imaging can reduce all-cause death, heart attacks, stent thrombosis, and the need for revascularization.

Our study, representing a synthesis of all early and recent clinical studies, has shown for the first time that the routine use of intravascular imaging guidance improves survival and enhances all aspects of the safety and effectiveness of coronary stenting, even with excellent contemporary drug-eluting stents."

Gregg W. Stone, MD.,first author

Dr. Stone is Director of Academic Affairs for the Mount Sinai Health System, and Professor of Medicine (Cardiology), and Population Health Science and Policy, at the Icahn School of Medicine at Mount Sinai.

"Prior studies had shown benefits of intravascular imaging, but never to this extent," Dr. Stone adds. "The addition of four recent trials in which 7,224 patients were enrolled now shows that intravascular imaging reduces all-cause death and all heart attacks across the wide range of patients who undergo stent treatment. As such, the routine use of intravascular imaging to guide stent implantation is one of the most effective therapies we have to improve the prognosis of patients with coronary artery disease."

Patients with coronary artery disease-;plaque buildup inside the arteries that leads to chest pain, shortness of breath, and heart attack-;often undergo PCI, a non-surgical procedure in which interventional cardiologists use a catheter to place stents in the blocked coronary arteries to restore blood flow. Interventional cardiologists most commonly use angiography to guide PCI, which involves a special dye (contrast material) and X-rays to see how blood flows through the heart arteries to highlight any blockages.

Angiography has limitations, however, making it difficult to determine the true artery size and the makeup of the plaque, and is suboptimal in identifying whether the stent is fully expanded post-PCI and in detecting other conditions that affect the early and late outcomes of the procedure. Intravascular ultrasound was introduced more than 30 years ago to provide a more accurate and specific picture of the coronary arteries. Even though studies have shown that IVUS-guided PCI is superior to angiography-guided PCI and reduces cardiovascular events, it is only used in roughly 15 to 20 percent of PCI cases in the United States, since the images may be difficult to interpret and the procedure is not fully reimbursed.

Optical coherence tomography uses light instead of sound to create images of the blockages. OCT images are much higher in resolution, more accurate, and more detailed compared to IVUS, and easier to interpret. However, as a newer technique, OCT is used in only 3 percent of PCI cases, partly because of a lack of study data-;a limitation this new study has addressed.

In their study, the researchers analyzed data from 15,964 patients undergoing PCI from 22 trials in hundreds of centers from the United States, Europe, Asia, and elsewhere between March 2010 and August 2023. Patients underwent either angiography-guided PCI or intravascular imaging-guided PCI using either IVUS or OCT. During follow-up ranging from 6-60 months with a mean of two years, patients who received intravascular imaging guidance experienced a 25 percent reduction in all-cause death, 45 percent reduction in cardiac death, 17 percent reduction in all myocardial infarctions, and 48 percent reduction in stent thrombosis compared with angiography guidance. The study also found that intravascular imaging reduced target vessel myocardial infarction by 18 percent and target lesion revascularization by 28 percent. The outcomes were similar for OCT-guided and IVUS-guided PCI.

"With these results, we now need to shift from performing more studies to determine whether intravascular imaging is beneficial, to increasing efforts to overcome the remaining impediments to the routine use of OCT and IVUS, including better training of physicians and staff and increasing reimbursement," Dr. Stone said. "In this regard, we now have better 'hard evidence' that intravascular imaging guidance of PCI procedures makes a greater impact to improving our patients' lives than other routine therapies which are more widely used and reimbursed."