TCTMD’s Top 10 Most Popular Stories for November 2019

More than half of our top 10 stories for November stemmed from the American Heart Association 2019 Scientific Sessions, led by the blockbuster ISCHEMIA trial. Also on the list were two recent moves by the Centers for Medicare & Medicaid Services (CMS): the first was the CMS decision to allow reimbursement of PCIs performed at ambulatory surgical centers, while the second covers CMS cuts to payments for cardiac CT. Rounding out the top 10 was a story from the VIVA meeting looking at radiation in the cath lab and a study addressing the role of upfront cardiac MRI and CT to reduce the number of invasive angiograms in patients with an unclear NSTEMI diagnoses.

1) ISCHEMIA: Invasive Strategy No Better Than Meds for CV Events

Both the “expanded” endpoint and death/MI were no different between arms, but QoL was significantly better with PCI/CABG.

2) Swift Angiography in Cardiac Arrest Without STEMI: No 1-Year Survival Benefit

Angiography remains “essential” but its timing is not, long-term COACT data confirm.

3) More Adverse Events, Higher Costs With Impella: New Observational Studies

Experts point to pitfalls in these kinds of data and say halting Impella use is not the answer—quality and patient selection are key.

4) ISCHEMIA-CKD: Routine Invasive Approach No Help in CKD Patients With Stable CAD

The results in this high-risk population show no impact on clinical outcomes or quality of life.

5) CMS Finalizes Rule Allowing Reimbursement of PCI in Ambulatory Centers

Seen as a possible way to save money, the rule, supported by the ACC and SCAI, will go into effect on January 1, 2020.

6) TAVR Valve Face-off: Two French Observational Studies Suggest Inherent Differences

Randomized trials will be needed to confirm these findings, physicians said at AHA 2019.

7) CMS Confirms Substantial Cuts to Cardiac CT Reimbursement in 2020

In response, professional societies like SCCT, ACC, and ACR are committing to continued advocacy efforts.

8) Upfront Imaging Reduces Invasive Angiography in Patients With Unclear NSTEMI Diagnosis

Chest pain, a positive hs-cTnT, and a nondiagnostic ECG together pose a quandary for physicians. A study suggests CMR and CTA can help.

9) Clinicians Get Real on Radiation: ‘Don’t Do Dumb Things’

Awareness of surroundings and others in the room are key to proper cath-lab radiation safety, a VIVA “roundtable” concluded.

10) Inclisiran Slashes LDL in ASCVD Patients: ORION-10

Compared with placebo, the novel siRNA injectable reduced LDL cholesterol by 56% over 18 months.

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SEE ALSO: Our top ‘opinion’ piece of November 2019 was our latest Conversations in Cardiology, hosted by Morton Kern, MD. Top in Features was a story by Yael Maxwell on the concerns over subtherapeutic heparin.

Conversations in Cardiology: Should Interventional Cardiologists Get Paid for Being On Call?

Morton Kern, MD, engages his colleagues via email in brief, informal dialogue on clinically relevant topics in interventional cardiology.

Subtherapeutic Heparin: As Stories Multiply, Concerns Mount

Reports are widespread about operators having trouble reaching adequate ACTs, but the FDA has not yet confirmed a problem.