Author Interviews, Heart Disease, NEJM, Stanford / 31.03.2020 Interview with: David J. Maron, MD, FACC, FAHA Clinical Professor of Medicine Chief, Stanford Prevention Research Center Director, Preventive Cardiology Stanford University School of Medicine What is the background for this study? Response: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. The goals of treating patients with stable coronary disease are to reduce their risk of death and ischemic events and to improve their quality of life. All patients with coronary disease should be treated with guideline-based medical therapy (GBMT) to achieve these objectives. Before the widespread availability of drug-eluting stents, strategy trials that tested the incremental effect of revascularization added to medical therapy did not show a reduction in the incidence of death or myocardial infarction. In one trial, fractional flow reserve–guided percutaneous coronary intervention (PCI) with drug-eluting stents, added to medical therapy, decreased the incidence of urgent revascularization but not the incidence of death from any cause or myocardial infarction at a mean of 7 months, whereas the 5-year follow-up showed marginal evidence of a decrease in the incidence of myocardial infarction. (more…)
Author Interviews, Heart Disease, Psychological Science / 11.03.2018 Interview with: Dr. Alexander Fanaroff MD Duke University School of Medicine What is the background for this study? What are the main findings? Response: Among patients with chronic angina, there are strong associations between depression and clinical outcomes, which illustrates the important interplay between psychosocial symptoms and physical symptoms in this condition. But depressive symptoms are distinct from expectations and optimism regarding recovery and returning to a one’s normal lifestyle. Patients with chronic angina may not be optimistic about their outlook for a number of reasons, including uncertainty about their prognosis or lack of medical knowledge, but for many patients with chronic angina, the outlook is actually quite good. We examined data from RIVER-PCI, a clinical trial that randomized patients with chronic angina and incomplete revascularization to ranolazine or placebo, and were followed for the primary outcome of ischemia-driven hospitalization or revascularization. Patients were asked at baseline, 1 month, 6 months, and 12 months how much they agreed with the phrase, “I am optimistic about my future and returning to a normal lifestyle.” We categorized patients by their responses at baseline – we coded “strongly agree” as very optimistic, “agree” as optimistic, “neutral” as neutral, and “disagree” and “strongly disagree” as not optimistic – and evaluated the association between baseline optimism and the primary outcome over long-term follow-up. We found that most patients were optimistic at baseline – 33% were very optimistic, 42% were optimistic, 19% were neutral, and 5% were not optimistic – and the majority remained optimistic over long-term follow-up. The most optimistic patients had a lower prevalence of prior myocardial infarction, heart failure, diabetes, and chronic kidney disease and less severe angina at baseline than less optimistic patients. The rate of the ischemia-driven hospitalization or revascularization was higher in neutral (32.8%) and not optimistic (35.0%) patients compared with the most optimistic patients (24.4%). Even after adjusting for baseline comorbidities and angina frequency, the most optimistic patients had a 30% lower risk of ischemia-driven hospitalization or revascularization compared with neutral or not optimistic patients. (more…)
Author Interviews, BMJ, CT Scanning, Heart Disease / 27.10.2016 Interview with: Professor Marc Dewey Heisenberg professor of radiology Vice Chairman of the Department of Radiology at Charité (Campus Mitte) Berlin Germany What is the background for this study? Response: Over 3.5 million cardiac catheterisations are performed in Europe each year. This study, jointly conducted by radiologists and cardiologists at Charité – Universitätsmedizin Berlin and published in today’s issue of The BMJ, compares computed tomography (CT) with cardiac catheterisation in patients with atypical chest pain and suspected coronary artery disease (CAD). What are the main findings? Response: CT reduced the need for cardiac catheterisation from 100% to 14% in the group of patients who received CT first instead of catheterisation. If catheterisation was needed in the CT group, the proportion of catheterisations showing obstructive CAD was 5 times higher than in the catheterisation group. Over a period of 3.3 years, the patients in the CT group neither had more cardiac catheterisations nor an increase in cardiovascular events. Moreover, CT shortened the length of stay by 23 hours and 79% of patients said they would prefer CT for future examinations of the heart. Overall, the results of the BMJ study show that CT is a gentle test for reliably ruling out CAD in patients with atypical chest pain who are currently being referred for cardiac catheterisation in routine clinical practice. (more…)
Author Interviews, Heart Disease / 13.08.2014

Professeur Philippe Gabriel Steg Département de Cardiologie Hôpital Bichat, Assistance Publique - Hôpitaux de Paris Université Paris-Diderot, Sorbonne Paris Cité, Paris, Interview with: Professeur Philippe Gabriel Steg Département de Cardiologie Hôpital Bichat, Assistance Publique - Hôpitaux de Paris Université Paris-Diderot, Sorbonne Paris Cité, Paris, France Medical Research: What are the main findings of this study? Prof. Philippe Steg:
  • Due to increasing use of angiography and revascularization, as well as improved drug therapy, the prevalence of angina and ischemia has diminished.
  • Most of the events (Cardiovascular death or Myocardial Infarction) occur in patients without angina or ischemia. This is very novel and important and stresses the importance of proper secondary prevention over "testing". We cannot be reassured by having a negative test for angina and ischemia.
  • Additionally, angina appears associated with a consistently greater risk than ischemia alone (having both is worse), so we need to pay attention to angina as a dire prognostic marker.
  • Findings should be no different in the US.
  • Most studies of silent ischemia antedate the advent of modern effective therapies or used very liberal definitions for "silent ischemia". (see our discussion)
Author Interviews, BMJ, Heart Disease, Pharmacology / 17.06.2014 Interview with: Professor June-Hong Kim, Division of Cardiology Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital Yangsan, South Korea; MedicalResearch: What are the main findings of the study? Dr. Kim: In vasospastic angina, the cilostazol group significantly reduced relative ireduction of of weekly incidence of chest pain compared with placebo group (−66.5±88.6% vs −17.6±140.1%, respectively, p=0.009).. Other clinical parameters such as a change in the frequency of chest pain (−3.7±0.5 vs −1.9±0.6, respectively, p=0.029), a change in the chest pain severity scale (−2.8±0.4 vs −1.1±0.4, respectively, p=0.003), and the proportion of chest pain-free patients (76.0% vs 33.3%, respectively, p=0.003) also significantly favored cilostazol. (more…)