Mark Twain, in his delightful tongue-in-cheek style, reminds his readers of the paradoxical nature of humanity, as we often perseverate on the habits of our peers, as opposed to looking inward. Yet, he also speaks to the difficulty of changing deeply entrenched habits. In cardiology, several clinical trials emerged that may challenge veteran practitioners to change the method in which they diagnose and treat their cardiovascular patients.
Late last week, the Lancet published the COMPARE trial, which found that Abbott’s Xience V everolimus-eluting stent is better than Boston Scientific’s second-generation Taxus Liberte paclitaxel-eluting stent in unselected patients undergoing PCI in terms of safety and efficacy.
Based on their findings, the Dutch authors made the bold statement that “paclitaxel-eluting stents should no longer be used in everyday clinical practice.” If U.S. practices adopt this advice, it could mean an even wider margin between Xience and Taxus in the drug-eluting stent market divide.
Yesterday, the Lancet released the results of a new PLATO analysis, revealing that AstraZeneca’s ticagrelor (Brilinta) reduces death rates without increasing bleeding, compared with the current standard treatment of clopidogrel (Plavix) in a large MI patient population.
The reversible antiplatelet agent ticagrelor is not yet approved in the U.S., as AstraZeneca only submitted its new drug application in November 2009.
However, based on the PLATO findings, the well-respected interventional cardiologist Dr. Gregg W. Stone wrote in an accompanying editorial that ticagrelor’s introduction would be a “landmark event that should redefine the care of patients with acute coronary syndrome.”
Finally, JACC published a study this week, suggesting patients who are determined to have a normal-appearing initial stress SPECT do not require additional rest imaging, as they have a similar low mortality rate as those who undergo stress and rest imaging.
The accompanying editorial, written by Dr. Ami Iskandrian, emphasized that these findings demand a “change in imaging protocols,” as the “status quo is no longer tenable.”
Another paradigm-changing technique receiving much attention these days is the transradial approach to PCI. Our Web Exclusive interview with Dr. Sunil Rao breaks down reasons why this change is happening and why it needs to continue.
With the American College of Cardiology conference right around the corner, along with a flurry of other boutique meetings, this late winter and spring is sure to be filled with practice-questioning data, but as Twain says: “Old habit of mind is one of the toughest things to get away from in the world. It transmits itself like physical form and feature.”
On these topics, or any others, feel free to contact me.