Discussions about Cardiology from theheart.org

On October 2010, the Canadian Cardiovascular Society (CCS) issued guidelines specific to the use of antiplatelet therapy, including their use in multiple settings, such as primary and secondary prevention, as well as following PCI and CABG surgery and in patients with peripheral arterial disease and diabetes.

In the US and Europe, guidelines for antiplatelet therapy follow a more disease-based approach.

Join Drs Bob Harrington, Alan Bell, Keith Fox, and Jean-François Tanguay as they discuss the regional differences in the development of guidelines, the reassuring similarities, and the importance of implementation and outcomes measurement.

Front-page allegations of inappropriate stenting in the US have fueled a storm that has challenged the integrity of various high-profile physicians, shaken the patient-physician bond, and prompted some to doubt the widespread practice of stenting.

How do European interventional cardiologists interpret this debate? Our panel of experts met during the EuroPCR meeting in Paris to share their thoughts on this controversy. While pondering whether inappropriate stenting also occurs in Europe, they examine the role of appropriate-use guidelines, discuss how to effectively oversee PCI in Europe, and debate whether structured auditing or informal peer review is best to ensure optimal patient care.

The ever-evolving field of electronic medical records can be confusing and the thought of selecting an EMR system daunting. What is right for your practice? How much will it really cost? How do you make the transition? What about privacy issues?

Drs Seth Bilazarian, Jay Alexander, Vincent Bufalino, and Ronald Karlsberg share their experiences as early adopters of EMR and offer advice on how to manage the challenges and steer clear of the pitfalls on the path to using EMR to improve quality of care.

What ails the younger woman's heart? What are the obstacles to appropriate treatment for younger women with heart disease? Drs Walton-Shirley, Cook, and Suri took time out from a recent conference cosponsored by the Mayo Clinic, National Heart, Lung, and Blood Institute (NHLBI), and WomenHeart to address heart disease in the younger woman and chart a path to better care.

A small trial testing the appropriate duration of dual antiplatelet therapy suggests that some patients can stop clopidogrel (Plavix, Bristol-Myers Squibb/Sanofi-Aventis) after just six months following drug-eluting-stent implantation. Although the study was not powered for hard clinical end points, such as death, MI, or stent thrombosis, investigators report that one-year rates of target vessel failure (TVF) were equivalent among patients treated with six and 12 months of dual antiplatelet therapy.

Interventionalists Drs David Kandzari, Laura Mauri, and Bob Harrington talk about what the trial results mean for clinical practice and what they hope to learn about dual antiplatelet therapy from future trials.

Dr David Antoniucci (Careggi Hospital, Florence, Italy) discusses high residual platelet reactivity after clopidogrel loading and long-term thrombotic events in patients with acute coronary syndrome undergoing invasive treatment. Filmed in Paris during EuroPCR 2011 on May 18.

Dr Neils Ramsing Holm (Aarhus University Hospital, Denmark) discusses the randomized comparison of manual compression and use of a femoral vascular closure device after femoral-artery-access coronary angiography. Filmed in Paris during EuroPCR 2011 on May 18.

Dr Runlin Gao (Fu Wai Hospital, Beijing, China) discusses the prospective randomized trial of the NOYA sirolimus-eluting stent with a biodegradable coating compared with the Firebird 2 sirolimus-eluting stent with a durable coating in patients with coronary artery disease: Nine-month angiographic and 12-month clinical results. Filmed in Paris during EuroPCR 2011 on May 18.

Dr Didier Carrié (CHU Rangueil, Toulouse) discusses the first randomized trial comparing the reservoir-based polymer-free CRE8 drug-eluting stent with the Taxus Liberté. Filmed in Paris during EuroPCR 2011 on May 18.

Dr SH Hofma (Medisch Centrum Leeuwarden, the Netherlands) discusses the randomized multicenter trial comparing first-generation sirolimus-eluting with second-generation everolimus-eluting stents in acute MI. Filmed in Paris during EuroPCR 2011 on May 18.