Similar to the mantra of this old Irish proverb in honor of St. Patrick's Day, clinical research and randomized controlled trials within the medical field begin with a hypothesis and more often than not end with an answer, or at least add to the growing body of evidence surrounding disease, devices and procedures.
In fact, two studies this week examined in-stent restenosis after drug-eluting stent implantation. One study published in JACC: Cardiovascular Interventions showed that the initial pattern of restenosis is the most important predictor of recurrent restenosis and that patients with occlusive and diffuse lesions saw the highest rates of restenosis.
Latib and colleagues found that when in-stent restenosis was treated with DES, there was a reduction in recurrent restenosis that did not influence late stent thrombosis. Additionally, while the optimal percutaneous treatment of DES in-stent restenosis is unturned, the authors noted that operators should treat a DES restenosis optimally so they do not fail a second time.
In another study, Lee et al found that the incidence of in-stent restenosis reached almost 20 percent after DES stenting for left main coronary disease. Results showed that rates of adverse events did not differ no matter the treatment strategy—repeat PCI, bypass surgery or medical treatment; however, the researchers said that it is still undecided as to whether or not routine angiography should be mandated after LMCA stenting because these patients are at high risk for adverse events.
In other news, a study published in Annals of Internal Medicine proved that evidence-based protocols and processes may not be the only answer to success. In fact, researchers from Yale found that values and goals were most important and improved acute MI outcomes.
Curry et al found that rather having protocols such as rapid response teams, it is more a matter of strong communication and coordination, solving problems and addressing root causes and having a strong engagement from staff members that may help reduce the risk of death within 30 days of admission for AMI patients.
Lastly, a Circulation study found that in a subset of patients with acute unstable or new-onset angina, coronary CT angiography defined features of plaque disruption including ulceration and intraplaque dye penetration, which are markers of complex plaque.
The study showed that of the almost 300 plaques identified with CCTA, the sensitivity of CCTA to demonstrate features of disruption was between 53 and 81 percent while specificity was 82 to 95 percent.
Dr. James A. Goldstein of the William Beaumont Hospital in Michigan, told Cardiovascular Business News that "These unstable lesions are the precursors to vulnerable lesions, those which are about to rupture. CCTA could potentially be used as a tool to identify unstable plaques.”
Clinical trials help provide truth when there may be a sense of doubt in terms of which device, procedure or therapy may be best for a certain patients population, disease or condition. But, like the Irish proverb states, “Truth stands when everything else falls.”
On these topics or others, please feel free to contact me.