Eagerly awaiting upcoming scientific conferences such as JIM, ACC, and EuroPCR, February should not be considered an interlocutory month. In fact, scientific journals keep on publishing the results of very interesting studies in our area of interest. The reader will thus understand how, as usual, the selection is not easy.
First of all, we would like to highlight the results of a well conducted meta-analysis from Valgimigli et al published in the European Heart Journal (2010;31:35-49). These authors sought to evaluate the impact of tirofiban versus placebo or abciximab on the outcome of 20,000 patients with acute coronary syndrome undergoing percutaneous coronary intervention, and found that tirofiban significantly reduced mortality and mortality plus myocardial infarction in comparison to placebo. When tirofiban was compared to abciximab, it showed similar results regarding 30-day mortality (confidence interval: 0.53-1.54, p=0.70), however a trend towards an increase of death or myocardial infarction was found in the tirofiban group (confidence interval: 0.96-1.45, p=0.11). The investigators hypothesized this result was due to the "old" regimen of drug used in less recent trials such as TARGET, as in fact no differences were found when a 25 mg/kg bolus regimen was used. Both minor bleeds (but not major) and thrombocytopenia were reduced in the tirofiban group.
It is worth mentioning the 1-year results of the multicenter prospective randomized trial CARDIA, just published in the Journal of the American College of Cardiology by Kapur et al (2010;55:432-40), where 510 patients with multivessel coronary artery disease and diabetes were randomized to bypass grafting or percutaneous coronary intervention. The primary study end-point was a composite of mortality, myocardial infarction, or stroke at 12 months and resulted similar in the two arms (10.5% versus 13%, confidence interval: 0.75-2.09), although the prespecified 1.3 noninferiority margin of confidence interval was exceeded. Those patients who were treated with drug-eluting stents, however, (70% of the total) well matched with the bypass population (11.6% versus 12.4%, confidence interval: 0.51-1.71).
Finally, we want to disclose the results of a study from De Labriolle et al, European Heart Journal 2010, that investigated the impact of platelet drop in an all-comers single-center population of patients undergoing percutaneous coronary intervention. Authors interestingly discovered that moderate (25-49%) or severe (?50%) thrombocytopenia developed in 16% of patients, and these patients experienced a significantly higher risk of death or myocardial infarction at 30-day and 1-year follow up. As expected, the worst performance was achieved in the severe thrombocytopenia arm. The authors concluded that among the risk factors for thrombocytopenia, some are modifiable, as thigh-osmolar contrast agents and bivalirudin seem to reduce this risk.

The new year has just begun, yet few major novel studies have been reported in the last few weeks on interventional cardiology topics.
These include the COMPARE trial, by Kedhi and colleagues, which has shown that, among 1800 unselected patients with coronary artery disease, everolimus-eluting stents proved significantly superior to paclitaxel-eluting stents in terms of the composite rate of major adverse cardiac events (6% versus 9% at 12 months), as well of stent thrombosis (1% versus 3%), myocardial infarction (3% versus 5%), and repeat revascularization (2% versus 6%), despite similar rates of all-cause death (2% versus 2%). We also wish nonetheless to focus the attention of visitors of this website on 2 recent publications which can prove very interesting. In the first article, Holmes et al provide a thorough viewpoint on the importance and details of the mentor-mentee relationship, crucial in both clinical practice and clinical research, and often disregarded or approached in an inappropriately informal way, especially in European countries. The other interesting work is the study by Hannan et al, comparing the clinical suggestions given by interventional cardiologists after completion of coronary angiography to those of other colleagues. This study poignantly shows that, among 16142 patients with significant coronary artery disease, those managed by interventional cardiologist were more likely to receive recommendations for percutaneous revascularization and fewer recommendations for coronary artery bypass surgery, often in disagreement with explicit American College of Cardiology/American Heart Association guidelines.
Finally, we wish to compliment ourselves with Hlatky et al, authors of the meta-analysis entitled "Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials", and winner of the 2009 METCARDIO Award, explicitly aimed at awarding the most influential and rigorous meta-analysis published in 2009 on interventional cardiology topics.