Keeping you up to date on recent headlines in cardiovascular healthcare:

MRG report finds DES penetration lowest in Arkansas ... Millennium Research Group (MRG; Waltham, Massachusetts) reported that Arkansas has the lowest coronary drug-eluting stent (DES) penetration rate in the U.S. at 49%, followed closely by Montana, Utah, and South Dakota. According to MRG, these numbers contrast the national picture, in which DES represent an overwhelming 70% of coronary stent procedure volumes and, due to their high price premium, 84% of coronary stent revenues. The penetration of DES at the hospital level depends heavily on hospital profile, according to MRG's new analytics tool, Procedure Finder: Interventional Cardiology. Urban hospitals, which are more likely to have elevated bed counts, budgets, and patient volumes, are more likely to use premium-priced DES in their coronary stenting procedures. In contrast, rural hospitals with smaller bed counts, tighter budgets and lower patient volumes are more likely to use bare metal stents (BMS), if they perform coronary stenting procedures at all. Nowhere is this more evident than in Arkansas, where BMS are used in an overwhelming 64% of cases performed in rural hospitals (compared to 35% nationally), MRG reported. "There are only five rural facilities performing coronary stenting procedures in Arkansas and the busiest of those – White River Medical Center in Batesville – uses BMS almost exclusively," said Aaron Dickson, co-president of MRG. "Similarly, the state's largest stenting facility – the Arkansas Heart Hospital in Little Rock – performs nearly 4,000 stenting procedures annually and is using DES in less than 20% of them." The relatively low urbanization of the state is likely affecting even those facilities located in urban areas, leading to low overall DES penetration in the state compared to more densely populated regions, MRG noted.

Mount Sinai first in U.S. to ablate AFib via new balloon catheter ... Doctors at The Mount Sinai Medical Center (New York) became the first in the U.S. to ablate atrial fibrillation using a visually guided laser balloon catheter. The procedure was performed Sept. 15 by Vivek Reddy, MD, professor of medicine and director of the Cardiac Arrhythmia Service at Mount Sinai Heart, and his colleague, Srinivas R. Dukkipati, MD, director of Mount Sinai's Experimental Electrophysiology Laboratory. According to CardioFocus (Marlborough, Massachusetts), the company that makes the device, the procedure marks the first time the Endoscopic Ablation System has been used in human clinical trials in the U.S. Reddy is the principal investigator for the national study. The new device features a built-in camera that allows physicians to directly see the heart tissue that needs to be ablated, the company said. Doctors can then guide an internal laser in a continuous arc around the origin of the vein, creating more uniform scar tissue. "By directly seeing the tissue that we are ablating, there is less chance of a gap in the encircling ablation line," said Dukkipati. The patient was a 58-year old man with a history of paroxysmal atrial fibrillation. According to the company, the man had been treated with a number of drugs which failed to control the atrial fibrillation. Therefore, he elected to undergo a catheter ablation procedure to eliminate his symptoms. The procedure was performed in a cardiac catheterization laboratory and did not require surgery or cardiopulmonary bypass.

Heart risk factors cut life span by up to 15 years ... Research published in the British Medical Journal concluded that middle-aged men who smoke have high blood pressure and raised cholesterol levels can expect a 10-15 year shorter life expectancy from age 50 compared with men without these risk factors. Researchers led by Robert Clarke, from the University of Oxford, assessed life expectancy in relation to cardiovascular risk factors recorded in iddle age. Their findings are based on more than 19,000 men aged 40-69 years and employed in the civil service in London when they were first examined in 1967-1970 as part of the Whitehall study. Participants completed a questionnaire at entry about previous medical history, smoking habits, employment grade and marital status. The initial examination recorded height, weight, blood pressure, lung function, cholesterol and blood glucose levels. The records of 18,863 men were traced and 7,044 surviving participants were re-examined in 1997 (around 28 years after their initial examination). At entry into the study, 42% of the men were current smokers, 39% had high blood pressure and 51% had high cholesterol. At the re-examination, about two thirds had quit smoking and the mean differences in levels of blood pressure and cholesterol had also declined by two thirds over this period. Despite changes in heart disease risk factors, the presence of three heart disease risk factors recorded on a single occasion in middle aged men compared to men with no risk factors predicted a three times higher risk of vascular mortality and a two times increased risk of non-vascular mortality. Compared with men without any risk factors, the presence of all three risk factors at entry was associated with a 10-year shorter life expectancy from age 50 (23.7 versus 33.3 years). The authors conclude that continued public health strategies to lower heart disease risk factors should result in further improvements in life expectancy.

Study looks at stroke risk among heart surgery patients ... Among patients undergoing cardiac surgery, post-operative stroke occurring in roughly 2%, was not correlated with significant carotid artery narrowing, but was more common among patients who had combined cardiac and carotid procedures, according to a report in the September issue of Archives of Neurology. Complications involving the blood vessels leading to the brain – most often resulting in stroke – are a major source of illness and death following heart surgery, according to background information in the article. Factors causing post-operative stroke may include carotid artery stenosis, low blood pressure, irregular heartbeat, atherosclerosis or plaque buildup in the aorta and a temporarily increased tendency for blood to clot. Yuebing Li, MD, PhD, John Castaldo, MD, and colleagues at Lehigh Valley Health Network (Allentown, Pennsylvania), studied 4,335 patients undergoing coronary artery bypass grafting, aortic valve replacement or both between 2001 and 2006. Of those, 3,942 (90.9%) underwent ultrasonography to evaluate the carotid artery before their procedure. A total of 76 patients (1.8%) had a clinically definitive stroke following surgery. Stroke was more common in individuals with carotid stenosis than in individuals without (7.5% vs. 1.8%). However, most strokes (76.3%) occurred in patients without significant carotid stenosis and 60% of strokes were not confined to a single carotid artery. "According to clinical data, in 94.7% of patients, stroke occurred without direct correlation to significant carotid stenosis," the authors wrote. In a subgroup of 53 patients who had significant carotid stenosis (artery narrowed by 70% or more) before surgery and underwent combined cardiac and carotid procedures, eight patients had post-operative strokes (15.1%). Among 51 patients who had a similar level of carotid stenosis but did not undergo a combined procedure, zero had a postoperative stroke. "We confirmed a higher incidence of stroke in the subgroup of patients with significant carotid stenosis," the authors concluded. "However, most strokes have no direct causal relationship with the diseased carotid artery. Combined carotid and cardiac procedures result in a significantly higher incidence of post-operative stroke and should be avoided. Pre-operative studies such as echocardiography or computed tomography or magnetic resonance imaging of the heart and aorta could identify disease-free areas for manipulation and clamping to prevent postoperative strokes."

—Compiled by Amanda Pedersen, MDD