Reader feedback, imaging in the cath lab, AF ablation to relieve anxiety, and some possible help in hypertension are the topics John Mandrola, MD, discusses in this week's podcast.
. I also wrote commentary on the first CTO-PCI trial called DECISION CTO in 2017. The link is in the notes. The short story is that CTO -PCI needs a lot more data.New England Journal of MedicineI cover this as a neutral Martian looking at the data. There are corollaries in electrophysiology , as we have a number of costly add-on tools to use in our labs that the profit-driven companies say will improve our procedural success.
Brief background: PCI has come a long way from the days of the plain old balloon angioplasty. Stents have iterated a lot. But another way to improve PCI results is not just in the actual stent, but its placement in the coronary arteries, which are far from inert tubes. The clinical endpoint was a composite called target-vessel failure at 2 years. This includes important things like cardiovascular death,The first primary endpoint favored the OCT arm. Minimum Stent area was 0.36 mmThe clinical endpoint however was not different statistically. Target-vessel failure within 2 years occurred in 88 patients in the OCT group and 99 patients in the angiography group; hazard ratio , 0.90; 95% confidence interval , 0.67 to 1.
The results favored OCT. At 2 years, 10.1% of pts in the OCT arm had a primary outcome vs 14.1% in the angiography alone arm. HR 0.70; CI ranged from 0.50-0.98. And theAll components of the primary outcome contributed. And definite or probable stent thrombosis here were low and similar in both arms.Steve Stiles covered these sessions.
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