Monday, May 14, 2007


Interventional cardiology is very interesting, partly because of the tremendous advances being made every week, either in device development and innovations or in the rapidity in which clinical trials are being done and data released. One really has to be on the ball if one wishes to offer the patient  the best possible treatment and treatment strategy. It is really a great challenge to keep up with all that is happening in PCI and interventional cardiology.Well the May 9th issue of the Journal of the American Medical Association carried the results of the SWISSI II study. This was a study undertaken in Switzerland by Dr Paul Erne and colleagues of Luzerne, Switzerland. They studied 201 patients who had suffered a heart attack, and three weeks later had a cardiac assessment to see if they had any ischemia ( lack of heart circulation ). If they had, they were divided, one half receiving PCI and the other half intensive medical therapy. After 10 years of follow-up, those receiving PCI did better, with fewer heart attacks, death and repeat PCIs. This is very encouraging as it tells us that after a heart attack, many are still at high risk and that PCI  is better for patients at high risk. This is obviously in contrast with the earlier released "Courage " trial which compared medical therpay with PCI in chronic stable angina ( note that these are low risk cardiac patients ). I am often told in the staff room that PCIs days are number as medical therapy is just as good, and I have to tell my colleagues that "Courage " was about low risk patients, where medical therapy is just as good as PCI. But in high risk patients ( namely those with acute coronaary symdrome, heart attacks or post heart attacks ), then PCI is obviously better. Put another way, if you are well and hd gone for routine checks, and the doctors sees all kinds of blockages in the cardiac scans, these patients do as well with medical therapy as with PCI. You see how interventional cardiology divides up the CAD segments to that we can better target our therapy to exactly the right patients. This also means that interventional cardiologist must spent alot of time to keep up with everything that is happening and it also requires that patients find doctors who has that knowledge, so that you can get the best from the best. Interventional cardiologist are not all the same. I am certain that in the next week or so, more clinical trials results will be forthcoming, as the Euro{CR meets in Barcelona.

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