Cardiovascular disease and bridging the diagnostic gap.

Cardiovascular disease (CVD) is now the leading cause of death worldwide. It continues to be on the rise and has become a true pandemic that has no respect to borders.' Coronary artery disease (CAD) is the most common type of CVD. It continues to be the leading cause of mortality both in men and women in the U.S.' Approximately every 25 seconds, an American will suffer an acute coronary syndrome, and approximately every minute someone will die of one. Risk stratification and early disease detection continue to be the bedrock of most preventative strategies. Risk assessment tools like Framingham Heart Score (FHS used in the U.S.), prospective cardiovascular monster (PROCAM used in Germany), or systemic coronary risk evaluation (SCORE used in Europe) are among the common and widely available estimators of a multi-factorial absolute risk of developing CVD.6 Recently, coronary artery calcium (CAC) has emerged as a non-invasive modality that might improve prediction of future cardiovascular events. We have conducted a comprehensive review of CVD risk factors, risk assessment and screening tools being applied to aid in early detection of CVD. As we work on bridging the diagnostic gap of the leading cause of mortality across the globe, utility of accurate and sensitive risk assessment and screening tools for early CVD detection is vital. This will aid in our goal of early detection, modifying risk factors and prevention of CVD incidence.

The State of the Absorb Bioresorbable Scaffold: Consensus From an Expert Panel.

Significant progress has been made in the percutaneous coronary intervention technique from the days of balloon angioplasty to modern-day metallic drug-eluting stents (DES). Although metallic stents solve a temporary problem of acute recoil following balloon angioplasty, they leave behind a permanent problem implicated in very late events (in addition to neoatherosclerosis). BRS were developed as a potential solution to this permanent problem, but the promise of these devices has been tempered by clinical trials showing increased risk of safety outcomes, both early and late. This is not too dissimilar to the challenges seen with first-generation DES in which refinement of deployment technique, prolongation of dual antiplatelet therapy, and technical iteration mitigated excess risk of very late stent thrombosis, making DES the treatment of choice for coronary artery disease. This white paper discusses the factors potentially implicated in the excess risks, including the scaffold consideration and deployment technique, and outlines patient and lesion selection, implantation technique, and dual antiplatelet therapy considerations to potentially mitigate this excess risk with the first-generation thick strut Absorb scaffold (Abbott Vascular, Abbott Park, Illinois). It remains to be seen whether these considerations together with technical iterations will ultimately close the gap between scaffolds and metal stents for short-term events while at the same time preserving options for future revascularization once the scaffold bioresorbs.