Sreekanth Vemulapalli discusses the rationale behind investigating renal denervation in the ongoing clinical trial SYMPLICITY HTN-3.
US-based clinical registries, such as the National Cardiovascular Data Registry and Get With The Guidelines, have been instrumental in identifying and addressing gaps in quality of care for patients across the country. It is fascinating to see approaches in other countries who have developed nationwide clinical registries, inclusive of all citizens. In Sweden, clinical registries like SCAAR and SWEDEHEART, have not only been used to describe trends in nationwide clinical outcomes but are now being used as a platform for the conduct of randomized trials. With rich characterization of patients and longitudinal followup, clinical registries can be used to identify, enroll, and follow patients randomized to treatments or strategies of care that need more investigation. These innovative “randomized clinical registry studies” are being conducted in the US as well. We need more of them.
Greetings from AHA! This is Apu and if you are in cardiology then this week Orlando is the place to be. The first day of the conference was directed primarily towards the Early Career track. For vascular medicine lovers this was a whole day dedicated to the best speakers in the world, covering topics as diverse as venous thromboembolic disease, acute aortic syndromes, peripheral arterial disease, and cerebrovascular disease. The best part of the sessions was the emphasis of interdisciplinary approach. How often does one get the chance to interact with vascular medicine, interventional cardiologists, interventional radiology and vascular surgery on the same podium? The prospect of bringing all these specialties, imaging modalities, and treatment strategies under the unifying umbrella of vascular medicine is very real. The afternoon was livened by the interventional cardiology early careers sessions. I came away with new insight into topics ranging from cath lab basics, such as access and hemodynamics, to complex PCI and TAVI. Still waiting to cap off the evening with the Clinical Cardiology dinner and award presentations. More soon…
One of the best parts about being a diagnostic cath fellow is learning the radial approach from Dr. Sunil Rao. We don’t have to pull sheaths and the patients clearly are as relieved as we are about that. But which approach is ultimately better for patients: radial or femoral?
Dr. Sanjit Jolly presented the results of the RIVAL trial which sought to evaluate the efficacy and safety of radial versus femoral access for PCI in patients with ACS managed with an invasive strategy. In total, 7021 patients with ACS were randomized to either radial or femoral access for angiography/intervention. The primary outcome was the composite of death, myocardial infarction, stroke, or non-coronary artery bypass graft-related major bleeding up to day 30. There was no significant difference between the two approaches in the primary outcome (3.7% radial vs. 4.0% femoral; HR=0.92 (95%CI 0.72-1.17) p=0.50). The major take-home points from RIVAL are that radial access for angiography and PCI is safe and effective but does not appear to reduce MACE. Non-access related bleeding appears very important in predicting outcomes and obviously cannot be reduced by radial access. Practice makes perfect, as the best outcomes with radial access were at high-volume centers. Finally, patients greatly prefer radial access over femoral access and this can drive practice pattern. Today, we now have the largest data yet on radial vs. femoral. I am sure we have not heard the last word.
Hot presentations in New Orleans! Using the NCDR CathPCI registry, DCRI Matt Brennan shed light on an important and controversial issue, PCI in patients with unprotected left main disease.
Using data on > 130,000 patients, he found that PCI is rarely performed in the US for this indication and death and major adverse events are common, influenced by patient and procedural characteristics rather than stent type (BMS vs DES).
Exciting data that we are certain will fuel the discussion. Download Matt Brennan’s slides.
John Vavalle sat down with Dr. Deepak Bhatt to talk about the future of clinical research. John has agreed to carry the torch.
Before heading down to New Orleans for ACC11, John Vavalle had a chance to sit down with Sunil Rao, MD to discuss the RIVAL trial, radial access for PCI, and what the fellows will really be doing in New Orleans.