The Heart Beat

The latest American College of Cardiology meeting in New Orleans has passed, and I wanted to update you on some of the answers to the research questions that I explored in my last blog post. Here’s a quick update.

1) Can we replace heart valves without surgery? Yep. The PARTNER study evaluated nearly 700 elderly individuals with aortic stenosis. Aortic stenosis is a progressive deterioration of aortic valve function associated with restricted opening and sometimes closing of this heart valve. Without valve replacement, it tends to become symptomatic (chest pain, shortness of breath, passing out) and can ultimately be fatal. Researchers evaluated a catheter-based procedure that essentially “inflates” a new valve within the diseased one in a short duration procedure that does not require open heart surgery. The result? The catheter-based procedure was not significantly different from surgery in terms of mortality, but there were more strokes with the catheter-based procedure. One benefit of the newer procedure was fewer bleeding complications.

2) Are coronary stenting procedures performed through blood vessels in the wrist as safe and effective as those done via the groin in urgent situations (i.e. heart attacks)? They actually might even be safer. While fewer than 5% of angiograms in the United States are performed through the wrist’s radial artery, the RIVAL study showed that wrist-based procedures are not only safe and effective, but they are associated with greater than 50% reduction in bleeding complications as compared to groin-based procedures. They are also preferred by patients. The benefits may even be more significant in the sickest of patients having heart attacks, but researchers caution that cardiologists need to be experienced in this approach to achieve the benefits. Look for training programs cropping up in the next year, and ask your cardiologist about this approach if you will be undergoing a heart catheterization.

3) Are we placing too many coronary stents? Yes, but not as many as you might have suspected. Cardiologists have developed “Appropriateness Criteria” to help guide the decisions we make regarding the invasive procedures we do. A study of over 500,000 cases served as our report card. It found that for more emergent procedures, we are doing a pretty good job, with only about 1% of procedures deemed inappropriate. But for elective procedures, over 10% were inappropriate. Not great. The other interesting finding was that there is quite a bit of variability depending on the hospital, from less than 10% to over 30%. I actually find that a bit more concerning. The takeaway is that stents should be reserved for symptomatic patients, and we should consider more aggressive medication interventions before relying too heavily on stents.

There were many other exciting research findings, and I invite you to learn more at the American College of Cardiology’s website,