FDA Delays Approval Of First Agent To Reverse Effect Of New Anticoagulants

  Portola Pharmaceuticals announced late on Wednesday evening that it had received a complete response letter (CRL) from the FDA regarding its Biologics License Application (BLA) for AndexXa (andexanet alfa). Approval for the drug had been widely expected earlier in the day, which was the drug’s PDUFA date. The drug had been on an accelerated…

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Pioneering Interventional Cardiologist Defends Unorthodox Practices

–Bernhard Meier explains why he seals plaques and thinks PFO closure is ‘the best procedure in interventional cardiology’ (Updated) Recently I wrote about an article by Bernhard Meier, a top interventional cardiologist, in which he rejected the idea that evidence based on randomized controlled trials should be the basis for the practice of interventional cardiology….

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Eminence Based Medicine And Cardiac Surgery

Did a top surgeon perform a nonrandomized, semi-prospective, historically controlled clinical trial without IRB approval or patient consent? I don’t want to only pick on interventional cardiologists. Last week I wrote about a breathtaking case of interventional cardiology hubris. In response a prominent interventional cardiologist shared with me a fascinating anecdote about cardiac surgery. Here’s…

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Interventional Cardiology And The Rejection Of Science

–Prominent interventional cardiologist says clinical trials are slowing progress In their eagerness to embrace a glorious future of ever more spectacular technology-based advances, interventional cardiology— a subspecialty never exactly known for caution, patience, or self reflection— is poised to reject science, evidence-based medicine, and randomized controlled trials. “Generating and publishing evidence is a tedious job,”…

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Reality Check On The ‘Noninferior’ Abbott Bioresorbable Stent

–The slippery slope of noninferiority. Last week the big news in interventional cardiology was the approval of Abbott’s bioresorbable stent, Absorb. There’s no doubt that this represents a remarkable technical achievement, propping open a clogged artery and then gradually disappearing. There are all sorts of theoretical reasons why this might represent an important advance over traditional stents that…

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On Road To Bankruptcy A Stent Company Invested in Marty Leon’s VC Fund

More questions are being raised about the research and financial activities of Palmaz Scientific, the bankrupt medical device company founded by Julio Palmaz, the co-inventor of the stent. In the middle of severe financial troubles that eventually brought the company to  bankruptcy Palmaz Scientific found enough money to invest in a venture capital fund. The VC Fund,…

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Stent Pioneer’s Company In Bankruptcy And Under Investigation

–Julio Palmaz hasn’t been able to recreate his earlier success A company founded by stent pioneer Julio Palmaz has declared bankruptcy and is being investigated for misconduct, according to the San Antonio Express-News. Palmaz, along with Richard Schatz, was the inventor of the enormously successful Palmaz-Schatz stent marketed by Johnson & Johnson. In March Palmaz…

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After a Decade, CABG Pulls Ahead of Meds for HF

–Life-saving benefit of CABG now clear in long-term trial follow-up Finally, after 10 years of follow-up, the life-saving benefits of coronary artery bypass graft (CABG) surgery in heart failure patients with coronary artery disease are clear. More than 15 years ago, the NIH funded the original STICH trial to answer a question that was already…

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At the FDA Rob Califf Will Champion Clinical Trials

Everyone wants to know what Rob Califf is going to do at the FDA. His critics say he’s going to hand the car keys over to industry and allow them to drive the agenda. Or, as one reporter tweeted: Hey, is that the sound of the FDA approving things faster? Must be because the Senate…

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Vulnerable Plaque: The Paradigm That Failed

Is it a hallowed paradigm or a hype-othesis? The “holy grail” of cardiology is to stop heart attacks before they happen by identifying– quickly, noninvasively, and specifically– those coronary artery lesions that result in heart attacks. The key theoretical underpinning driving this goal has been the vulnerable plaque hypothesis, which holds that the vast majority…

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Study Shows Why Sham Controls Are Necessary For Device Trials

— If we can melt the ice-caps then surely we can understand our own fallibility, says one UK cardiologist. The strongest known force in the universe is the ability of the human mind to deceive itself. If we know something to be true then we find the evidence to prove it. There is no better…

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Encouraging Results Found In Long Term TAVR Registry

Since it’s first FDA approval in late 2011 the use of transcatheter aortic valve replacement therapy (TAVR) has grown dramatically– but not dangerously or explosively– in the US. Now accumulating data from a central national registry provides the best picture yet of the evolution and current status of TAVR. The TVT Registry, which is run by the Society of Thoracic Surgeons (STS)…

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CMS Proposal Would Plug Up Watchman Reimbursement

Medicare is proposing to put severe constraints on reimbursement for percutaneous left atrial appendage closure using the Boston Scientific Watchman device to prevent stroke in patients with nonvalvular atrial fibrillation. On Tuesday afternoon the Centers for Medicare & Medicaid Services (CMS) issued the draft of a restrictive national coverage determination (NCD) for Watchman that would almost certainly apply the…

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Waiting For ISCHEMIA: Why Won’t Cardiologists Enroll Patients?

One of the most important unanswered questions in medicine today– the best treatment for stable ischemic heart disease– may never get a satisfactory answer because cardiologists are unwilling to enter their patients in a clinical trial. One major reason why the question is urgent: about a third of the 1 million PCI procedures performed each year in the…

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Clot Extraction For Stroke: Beware The Hype

Clot extraction (thrombectomy) for stroke has been on a roll lately. After the failure of a series of trials a few years ago investigators and industry went back to the drawing board. The result of their efforts– a new and improved thrombectomy– has brought about a dramatic reversal of fortune for the technology. In the past year five newer trials…

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Primary PCI Guideline Update: Multivessel Interventions In, Thrombectomy Out

The guidelines for primary PCI for ST-elevation MI (STEMI) have been updated to reflect major findings from recent trials: PCI of a noninfarct artery is now acceptable for some STEMI patients with multivessel disease. In previous guidelines PCI of noninfarct arteries had been considered unsafe. Routine thrombectomy prior to primary PCI for stent implantation is now…

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New Concerns Raised About Bioprosthetic Aortic Valves

New, potentially important concerns have been raised about bioprosthetic aortic valves, both those  implanted during surgery and those during a catheter-based procedure (TAVR). Investigators from three separate groups reported on their troubling findings in a paper published in the New England Journal of Medicine. The article was accompanied by both an editorial and a perspective from the FDA….

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No Benefit For A Commonly Used Cardiac Device

Once again, after decades of common use, a frequently implanted device has been found to confer no benefit whatsoever over a much less invasive therapy. Cardiologists and radiologists often implant the device, called a retrievable inferior vena cava filter, inside people who are at high risk for developing potentially lethal blood clots. The filter is designed to prevent…

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Medicines Company Drug Finally Gets Nod From FDA Advisory Panel

On Wednesday the FDA’s Cardiovascular and Renal Drugs Advisory Committee voted 9-2-1 to recommend approval of cangrelor during PCI to reduce the risk of periprocedural thrombotic events such as MI, stent thrombosis, and ischemia driven revascularization. … Click here to read the full post on Forbes.  …

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FDA Grants Premarket Approval To AbioMed Heart Pump

The FDA said today that it had approved Abiomed’s Impella 2.5 System. According to the company it is is the first hemodynamic support device to gain FDA premarket approval for use during high risk PCI procedures. The miniature blood pump is designed for temporary use in patients with severe symptomatic coronary artery disease and diminished (but stable) heart…

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A Requiem for Routine Clot Removal During Heart Attacks

Using a stent to open a blocked coronary artery is the treatment of choice in the early period of a heart attack (myocardial infarction). A limitation is the risk of dislodging part of the clot, leading to new downstream blockages of smaller vessels. One strategy that has been under development for a long time is thrombectomy, in…

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Encouraging Long Term Results For Less Invasive Heart Valves

The publications five years ago of the two part PARTNER trial brought a major change in the treatment options available to some people with aortic valve disease, which is often an extremely serious condition with a poor prognosis. The trial demonstrated that transcatheter aortic valve replacement (TAVR) was a reasonable treatment option, first for patients who…

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AstraZeneca Drug ‘Approaching The Point Of Diminishing Returns’

After a heart attack (myocardial infarction or MI) patients remain at high risk for recurrent events. The precise role of blood thinning with dual antiplatelet therapy to lower this risk has been the subject of considerable disagreement.  Now a new study offers fresh evidence that one important strategy, prolonged dual antiplatelet therapy, can lower risk…

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What A Long Strange Trip It’s Been: FDA Approves Watchman Device From Boston Scientific

Finally reaching its destination after an extremely long and strange trip, Boston Scientific gained approval from the FDA today to market its Watchman Left Atrial Appendage Closure Device in the US. The device has been in development for well over a decade and had been turned down by the FDA on several occasions. … Click here to…

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High Risks And Rewards Found With Heart Valve Device From Edwards And Medtronic

Transcatheter aortic valve replacement (TAVR) is one of the most important advances in cardiovascular medicine in recent years. TAVR devices, introduced recently in the US by Edwards Lifesciences and Medtronic, are associated with very high risks, but offer a less invasive alternative to traditional aortic valve replacement surgery. Because of early concerns about potential overuse and misuse of…

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