Benjamin S. Carson, Sr., M.D., is an emeritus professor of neurosurgery, oncology, plastic surgery and pediatrics at the Johns Hopkins School of Medicine, where he directed pediatric neurosurgery at the Johns Hopkins Children’s Center for 29 years. Carson holds more than 60 honorary doctorate degrees and has received literally hundreds of awards and citations. His first four books, Gifted Hands, THINK BIG, The Big Picture and Take the Risk: Learning to Identify, Choose and Live with Acceptable Risk, provide inspiration and insight for leading a successful life.
Al Gore was referred to by Time magazine as “a businessman who is out to change the world.” An environmental, business, and tech visionary recognized as one of the world's leading activists, Vice President Al Gore offers a unique perspective on national and international issues, including the threats of climate change and the future of tech.
Although the safety and efficacy of ticagrelor and prasugrel has been established, a head-to-head comparison of the two drugs has not been undertaken. The PRAGUE-18 study has randomized 1230 patients to either prasugrel or ticagrelor prior to PCI and at 30-days did not show any difference between the two agents with regards to CV death, non-fatal MI or stroke.
In contrast to IVUS guided PCI, few studies have addressed the potential benefit of OCT guidance in PCI. The ILUMIEN III: OPTIMIZE PCI study was designed to examine whether or not a novel OCT-based stent sizing strategy would lead to a minimum stent area similar to or better than that achieved with IVUS and better than that achieved with angiography alone in 450 patients. The study has indicated that OCT guided PCI is non-inferior to IVUS guided PCI and not superior to angiography guided PCI.
The prognostic implication of post-procedural high-sensitivity troponin T (hs-TnT) in patients undergoing elective PCI and whose baseline hs-TnT is known has not been studied. A study of 5,626 patients has indicated that an increase in post-procedural hs-TnT does not provide any additional information with regards to 3-year mortality beyond that provided by the baseline level of this biomarker.
The utility of lipidomics in predicting CV events in type-2 diabetic patients has not been studied. Measurements of 310 plasma lipid species in such patients has shown that sphingolipids, phospholipids, cholesteryl esters and glycerolipids are associated with future CV events and CV death above and beyond traditional risk factors.
Conduction abnormalities following TAVR are common and may require implantation of a permanent pacemaker (PPM). Analysis of data from 9,785 patients included in the US STS/ACC TVT Registry has indicated PPM placement rates of 6.7% within 30 days of TAVR with age, previous conduction abnormality, and use of self-expanding valve as positive predictors of PPM requirement. PPM requirement was associated with longer hospital stay, increased mortality and a composite of mortality or heart failure admission at 1-year.
The prognostic implication of periprocedural myocardial injury (PMI) following PCI for chronic total occlusions (CTO) is uncertain. Examination of 1,058 CTO Patients undergoing PCI for CTO has revealed PMI occurring in 11.4% of cases with renal impairment, retrograde approach, concomitant non-target lesion intervention, and stent number being predictors of PMI. PMI was associated increased risk of mortality.
The effect of stenting intermediate SVG lesions to reduce major adverse cardiac events has not been studied. The VELETI II investigators randomized 125 patients with at least 1 intermediate SVG lesion to either optimal medical therapy (OMT) or OMT plus PCI and demonstrated no differences in the composite of cardiac death, MI, or coronary revascularization over a median follow-up of 3.4 years.
The incidence and determinants of complications in rotational atherectomy (RA) is poorly understood. Data from the J-PCI registry of 13,335 cases has reported incidence of important procedure-related complication rate of 1.3%, which included death, cardiac tamponade, and emergency surgery. Age, impaired renal function, previous MI, emergency PCI, and 3-vessel disease were associated with adverse outcomes.
Nicole Lou Reporter, MedPage Today/CRTonline.org
Nicole Lou Reporter, MedPage Today/CRTonline.or
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Y Chan, et al.; JACC 2016; 68:2272-2283
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E Barbato, et al.; JACC 2016; 68:2247-2255
How will the results of the EXCEL and NOBLE trials affect your approach to using PCI for unprotected left main disease?
I'll increase the use of PCI for left main disease
I'lI wait for updated guidelines that incorporate the results of EXCEL and NOBLE
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