Cardiovascular Revascularization Medicine

Editorial Note

Ron Waksman — 2010-07-01

The US health care reform bill has passed, and it may significantly impact the interventional cardiology field, technology innovation, and day-to-day practice. Several aspects of the bill are related to comparative effectiveness studies that will be initiated to determine optimal interventional strategies. Let us know what you think about the new bill, as we would like to publish articles pertaining to this issue in an upcoming CRM issue. As in previous issues, we have selected a variety of topics for the current issue which we hope you find interesting and stimulating.

Vascular responses to the multiple overlapped paclitaxel-eluting stents for the treatment of bare-metal in-stent restenotic lesions: angiographic and intravascular ultrasound analysis from the TAXUS-V ISR Trial

2010-07-01

Abstract: Background: Although effective coverage of coronary diffuse in-stent restenosis (ISR) lesions has warranted the use of multiple drug-eluting stents, the vessel response to paclitaxel-eluting stent (PES) overlap is not fully understood.Methods and materials: In the TAXUS-V ISR, i.e., comparing PES versus brachytherapy for the treatment of bare-metal ISR, angiographic analyses at 9-month follow-up were available in 184 ISR lesions treated with PES.Results: In-stent late loss in entire stented segment of multiple PES (n=50) was 0.45±0.48 mm, whereas that of single PES (n=134) was 0.3±0.47 mm, P=.06. No aneurysm was observed at overlapping PES segments at 9 months. Stent thrombosis up to 9 months was observed in one in each group (single PES, 0.7% vs. multiple PES, 1.8%; P=.47). In a subset of 30 patients, volumetric intravascular ultrasound analysis demonstrated that in-stent net volume obstruction was 12.3±12.4 in single PES (n=20) and 14.9±9.8 in multiple PES (n=10), P=.60. The changes of vessel and lumen at the overlapping PES segment were similar to those of the adjacent 5-mm segments (Δminimum lumen area, mm2: −1.2±1.0, −1.1±1.1, −0.8±0.9, P=.48; Δvessel volume, mm3/mm: −0.2±1.4, 0.1±1.7, 0.3±1.3, P=.37; proximal, overlap, distal segment, respectively). There was no late incomplete stent apposition at overlapping PES segments.Conclusions: No in vivo evidence of adverse local vessel response at the site of overlapping PES for the treatment of bare-metal ISR has been demonstrated.

Impact of thrombus aspiration use and direct stenting on final myocardial blush score in patients presenting with ST-elevation myocardial infarction

2010-07-01

Abstract: Background: Many studies have reported that low final thrombolysis in myocardial infarction (TIMI) flow and/or myocardial blush grade (MBG) are independent predictors of mortality in patients with ST-elevation myocardial infarction (STEMI). In addition, distal coronary embolization is a major pitfall of conventional percutaneous coronary intervention (PCI) in such a context.Aim: This study aimed to assess the impact of thrombus aspiration (TA) use before primary PCI on final myocardial reperfusion in patients presenting with STEMI.Methods: From January to December 2006, 100 patients presenting with STEMI in our catheterization laboratory were considered for the present study. During this time period, 50 patients underwent TA before primary PCI for treatment of STEMI and were then matched 1:1 to 50 controls who underwent conventional primary PCI for treatment of STEMI without TA. Patients of the control group were chosen after matching on age±3 years, sex, history of diabetes, and distribution of the infarct related coronary artery during the same period.Results: Baseline clinical characteristics, initial TIMI flow and initial MBG of both groups were similar. There was a trend for a better final TIMI flow in the group with TA and the final MBG was significantly improved in the group with TA compared to the group without TA: final MBG of two or three in 70% versus 30% of the cases (P=.001). In addition, direct stenting was significantly more often used in the TA group (92% versus 64%, P=.001). There were four patients with evident distal embolizations in the group without TA and none in the group with TA.Conclusion: TA use before primary PCI for STEMI treatment resulted in improved final myocardial reperfusion. Of importance, TA use may have led to a better choice of the stent size and more frequent direct stenting. This benefit may directly improve patient outcomes.

Mechanism of lumen gain with a novel rotational aspiration atherectomy system for peripheral arterial disease: examination by intravascular ultrasound

2010-07-01

Abstract: Objective: The purpose of this study was to evaluate the mechanism of luminal gain with a novel atheroablation system (Pathway PV) for the treatment of peripheral artery disease using intravascular ultrasound (IVUS).Methods: The atherectomy system is a rotational atherectomy device, which employs expandable rotating blades with ports that allow flushing and aspiration of the plaque material or thrombus. In this first-in-man clinical study, IVUS analysis was available in 6 patients with lower limb ischemia treated with this device. The treatment results were assessed using IVUS at pre and post atherectomy. Lumen beyond burr size (LBB) was defined as lumen gain divided by the estimated burr area determined by the burr-size.Results: IVUS analysis was available in six patients (superficial femoral artery n=3, popliteal artery n=2, posterior tibial artery n=1). Atheroablation achieved a significant increase in lumen area (LA) (preintervention 3.9±0.4, postatheroablation 8.0±1.7 mm2, P<.05), and significant reduction in plaque area (27.5±4.0, 23.7±3.1 mm2, P=.001), while there was no change in the vessel area (31.3±4.2, 32.1±2.8 mm2, P=.4). LBB was 57.4±51.3%.Conclusion: This novel rotational aspiration atherectomy device achieved significant luminal gain by debulking in the absence of vessel stretching. The LA was greater than burr-sized lumen expectancy at cross-sections along the treated segments, suggesting a complimentary role of aspiration in luminal gain in atherosclerotic peripheral artery lesions.

Early and late outcomes of clopidogrel and Coumadin combination for patients on oral anticoagulants undergoing coronary stenting

2010-07-01

Abstract: Background: In patients under oral anticoagulant requiring percutaneous coronary intervention (PCI) with stent implantation, the optimal association between aspirin, clopidogrel and oral anticoagulant (OAC) remains cumberstome. Triple therapy and dual therapy using aspirin and OAC have been evaluated and are associated with a high frequency of major bleedings. The combination of clopidogrel and OAC has never been evaluated.Objective: We aimed to investigate the safety and efficacy of clopidogrel and OAC in patients requiring OAC undergoing PCI for acute coronary syndrome.Methods: A monocenter retrospective study was undertaken between 2000 and 2006 and included all patients undergoing PCI with stent implantation on OAC. On discharge dual therapy with clopidogrel and OAC was prescribed. The primary end-point was the frequency of major TIMI bleedings. Secondary end-points were major cardiovascular event (MACE). Results are reported as rate of events with 95% confidence intervals (CI).Results: Two hundreds and nine patients were followed for 71 ± 22 months. The indication for oral anticoagulation was atrial fibrillation in 80% of patients, a valvular prothesis in 18% and a history of pulmonary embolism in 5%. The rate (95%CI) of major bleeding was 2.4% (0.9%-5.8%) 2.87% (1.17%-6.44%) and 3.8% (1.79%-7.68%) at 1 month, 12 months and 71 months respectively, which represent 8 events among which 2 were fatal. The MACE rate (95%CI) was low: 0% at one month, 3.8% (1.79%-7.68%) at 12 months and 24.4% (19.07%-30.65%) at 71 months of follow up. Only one stent thrombosis was recorded at the ninth month. The overall rate of death was 9.5% (6.28%-14.32%) among which 2.87% (1.17%-6.44%) were of cardiovascular origin.Conclusion: The use of clopidogrel and OAC combination in patients on OAC undergoing coronary stenting is safe and efficient at the short-term. At the long-term, this combination is probably not safe, with a relatively high incidence of fatal stroke.

Low ejection fraction documented during cardiac catheterization is significantly associated with long-term, all-cause mortality

Mohammad Reza Movahed, Sudhakar Sattur — 2010-07-01

Abstract: Background: Decreased ejection fraction (EF) has been found to be a strong predictor of mortality. However, this association has not been studied in patients undergoing ventriculography over a long period of time. Using a large database of patients who underwent coronary angiography for clinical reasons, we evaluated any association between severity of EF impairment and 10 year mortality.Methods: Retrospective angiographic data of 1,937 patients between 1993 to 1997 from the VA Long Beach Health Care System were studied. Decreased EF was defined as EF<50%. Using chi-square test and Cox survival analysis, we evaluated any association between decreased EF with mortality. Furthermore, we evaluated different degrees of decreased EF with all-cause mortality using uni- and multivariate analysis.Results: Total mortality was 22.9% of the cohort. Decreased EF was a strong predictor of death over a period of 10 years. (All-cause mortality occurred in 21.6 % of patients with normal EF vs. 41.7 %, OR 2.59, CI 2.06-3.26, P<.001). After adjustment for left main coronary artery disease, mitral regurgitation, three-vessel coronary disease, and clinical risk factors (diabetes, hypertension, hyperlipidemia, and smoking), decreased EF remained independently associated with all cause-mortality regardless of ethnicity.Conclusion: Decreased EF measured during coronary angiography is a strong independent predictor of all-cause mortality over a period of 10 years.

Aortic arch atheroma: when do we say no to percutaneous coronary intervention?

Samuel Wright, Andris Ellims, Andrew E. Ajani — 2010-07-01

Aortic atheroma is a common finding in patients with ischemic heart disease and is associated with traditional risk factors for atherosclerosis, such as increasing age, hypertension, dyslipidemia, and smoking. It is frequently observed during coronary angiography, but rarely precludes the passage of endovascular equipment required to engage the coronary ostia. Can it provide a physical barrier to percutaneous coronary intervention (PCI)?

Late renal stent thrombosis

Nadia Dobbeleir, Paul Vermeersch, Pierfrancesco Agostoni — 2010-07-01

Abstract: A patient with previous implantation of two stents in the left renal artery (because of refractory arterial hypertension) developed, 7 months after implantation, a renal infarction due to late renal stent thrombosis. The early diagnosis by means of computed tomography of the abdomen and the rapid intervention by means of percutaneous balloon angioplasty lead to a favorable outcome.

Simultaneous dual coronary very late stent thrombosis following noncardiac surgery

Shailja V. Parikh, Ashish Parikh, Emmanouil S. Brilakis, Subhash Banerjee — 2010-07-01

Abstract: Challenges arise in the care of patients with drug-eluting stents (DES) undergoing noncardiac surgery. The risk of bleeding during surgery must be balanced with the risk of stent thrombosis from interrupted dual antiplatelet therapy. We report a case of a patient with simultaneous stent thrombosis in two coronary arteries following discontinuation of clopidogrel for an elective noncardiac surgery 3 years after DES placement.

A case of successful intervention without a contrast agent for a chronic totally occlusive lesion of the superficial femoral artery

Makoto Utsunomiya, Yoichi Nozaki, Shigeru Nakamura — 2010-07-01

Abstract: Peripheral artery disease (PAD) and chronic kidney disease (CKD) commonly occur together and are known to lead to poor long-term survival. Furthermore, it is not yet known whether percutaneous catheter intervention for PAD using contrast agents is beneficial or not for such patients. The risk of CKD patients contracting contrast-induced nephropathy due to the use of contrast agents is frequent. We report a patient with diabetes and CKD in whom a chronic total occlusion lesion of superficial femoral artery was successfully managed with catheter treatment without the use of contrast agents, using various modalities.

Coronary angiography of pregnancy-associated coronary artery dissection: a high-risk procedure

2010-07-01

Abstract: Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome occurring predominantly in young women without any cardiovascular risk factors, especially during the peripartum and early postpartum period. Here, we report a case of a 28-year-old pregnant woman who was found to have an isolated distal SCAD of the left anterior descending artery (LAD). Coronary angiography was complicated by extensive LAD and circumflex arteries dissection, requiring an emergency coronary artery bypass grafting associated with ventricular assist device implantation and underlying the extreme fragility of coronary arteries in pregnant women.

Acute type A aortic dissection in a patient with ventricular septal defect

2010-07-01

Abstract: We report the case of a 38-year-old man with a long-standing history of a small ventricular septal defect presented with chest pain. Electrocardiography revealed sinus rhythm, ST-segment elevation in leads V1–6. The chest X-ray showed mild cardiomegaly. He underwent cardiac catheterisation laboratory to primary coronary angioplasty. Coronary angiography showed normal coronary arteries. Aortic root angiography revealed type A aortic dissection. Transthoracic and transesophageal echocardiography showed aortic dissection in ascending aorta and a perimembranous ventricular septal defect. Thoracoabdominal CT angiography confirmed the aortic dissection before the surgery.The patient underwent cardiac surgery immediately. The ventricular septal defect and aortic dissection were repaired successfully. The postoperative recovery was uneventful and he has thus far remained asymptomatic at 6 months' follow-up.

Percutaneous coronary intervention for small vessel coronary artery disease

Giuseppe Biondi-Zoccai, Claudio Moretti, Antonio Abbate, Imad Sheiban — 2010-07-01

Abstract: Symptomatic coronary artery disease may be commonly due to significant atherosclerotic disease involving coronary vessels of relatively small caliber (i.e., with reference vessel diameter <2.75 mm). Whenever medical therapy fails and in other selected cases, revascularization by means of percutaneous coronary intervention (PCI) or bypass surgery is indicated even for small vessel coronary disease. However, despite the numerous developments and improvements in devices and techniques, PCI of small coronary vessels is still fraught with a significant risk of midterm restenosis after both balloon-only PCI and bare-metal stent implantation. Drug-eluting stents, especially those associated with very low angiographic late lumen loss (<0.20 mm), appear to significantly improve angiographic and clinical outcomes after PCI of small coronary vessels. The present article provides a concise and updated review on percutaneous coronary revascularization in patients with symptomatic small vessel coronary artery disease.

CYP3A5 Genetic polymorphism in Uzbek hypertensive men (preliminary results)

Amayak G. Kevorkov, Marietta R. Eliseyeva — 2010-07-01

CYP3A5 has been reported to be an important genetic contributor to inter-individual and interracial differences in CYP3A-dependent drug clearance and response. The major determinant for this variation in expression was a single-nucleotide polymorphism in intron 3 at position 6986, which in the g.6986G allele (CYP3A5⁎3) led to alternative splicing of CYP3A5 transcripts and absence of CYP3A5 protein; the g.6986A allele (CYP3A5⁎1) correlated with high expression.

Human mesenchymal stem cell products are superior to VEGF alone in in vivo angiogenesis

2010-07-01

Randomized controlled trials report conflicting data about the beneficial effects of bone marrow cells for treating ischemic cardiovascular disease. Cell therapy also faces technical and practical limitations. Because evidence indicates that stem cells exert their pro-angiogenic functions through paracrine mechanisms, in this study we evaluated the angiogenic efficacy of cell-free secretions of human mesenchymal stem cells (MSCs) and compared it with that of VEGF as a known single potent angiogenic factor.

Asymptomatic firefighters with metabolic syndrome have a high incidence of both coronary and carotid premature atherosclerosis associated with increased thrombotic and inflammatory markers

2010-07-01

The metabolic syndrome (metS), a concurrence of abdominal fat, disturbed glucose and insulin metabolism, dyslipidemia, and hypertension, has been strongly associated not only with subsequent development of type 2 diabetes but also with atherothrombosis.

Framingham risk score is poorly associated with subclinical carotid atherosclerosis: results from firefighter heart disease prevention project

2010-07-01

Framingham risk scores (FRS) are used to estimate the 10-year coronary heart disease (CHD) risk in individuals. Noninvasive assessment of subclinical atherosclerosis by means of carotid intima media thickness (cIMT) could improve patients' risk stratification even though it is not part of current guidelines.

Immediate impact of exercise on arterial stiffness in humans

Jae-Bin Seo, Joo-Hee Zo, Woo-Young Chung, Myoung-A. Kim, Sang-Hyun Kim — 2010-07-01

Increased arterial stiffness is an accepted cardiovascular risk factor. Several studies have shown that regular exercise is associated with reduced arterial stiffness. However, the acute effect is not well known. The aim of this study was to evaluate the immediate impact of exercise on arterial stiffness measured by pulse wave velocity (PWV).

Association between cardiovascular risk factors and the presence and extent of coronary atherosclerotic plaque as detected by multislice computed tomography in Egyptian patients

Fatma Aboul-Enein — 2010-07-01

Framingham risk score uses traditional risk factors to categorize patients according to their risk for cardiovascular events and to establish treatment guidelines. To investigate the prevalence of coronary artery plaques using multislice computed tomography coronary angiography in Egyptian patients with no history of coronary artery disease (CAD) to evaluate whether risk factors are related to prevalence of coronary artery plaques.

Streptococcal serum opacity factor activity enhances reverse cholesterol transport in vitro

2010-07-01

Cardiovascular disease (CVD) is the major cause of human mortality and morbidity in developed countries and so that identification of new therapies is an important public health priority. Dysregulated lipid metabolism leading to elevated low-density lipoprotein (LDL)-cholesterol (C) and to low plasma high-density lipoprotein (HDL)-C is an important CVD risk factor. With wider use of the statins, which lower plasma LDL-C, low HDL-C has emerged as the most important lipoprotein disorder for which current therapies are inadequate. A form of low HDL-C is associated with hypertriglyceridemia (HTG). Cases of this form are expected to rise with the epidemics of obesity-linked metabolic syndrome and diabetes, which are characterized by HTG. HDL-cholesterol and cardioprotection are mechanistically linked by reverse cholesterol transport (RCT), the transfer of cholesterol from macrophages in the subendothelial space of atherosclerotic lesion via the plasma to the liver for disposal. The major RCT steps are free cholesterol (FC) efflux from arterial macrophages, FC conversion to cholesteryl esters (CE) by plasma lecithin:cholesterol acyl transferase (LCAT), and hepatic removal of the CE by the hepatic HDL receptor SR-BI.

Impact of obesity on cardiac stress testing

2010-07-01

Obesity (BMI >30) is a global pandemic associated with cardiovascular disease (CVD), increased morbidity and mortality, decreased life expectancy, and multiple comorbidities. It alters cardiac structure and function, causes circulatory changes, and leads to endothelial dysfunction. In addition, it impairs the assessment of CVD by reducing the sensitivity of the physical exam, causing alterations in the electrocardiogram (EKG), reducing exercise tolerance, and affecting the resolution of imaging studies.

Drug retention in the coronary and femoral arteries is dependent on the route of administration in swine: assessment of intimal and adventitial endovascular and systemic pharmacokinetics and toxicology with nanoparticle albumin-bound paclitaxel

2010-07-01

We have previously reported coronary efficiency data comparing multiple modes of coronary delivery, with results indicating nanoparticle retention of less than 0.5% with luminal and intimal delivery vs. more than 55% with adventitial delivery. This work has been expanded to test the relative efficiency of delivering common antirestenotic compounds to the artery wall and to examine pharmacokinetic and toxicity profiles of paclitaxel following coronary and femoral delivery.

Vascular response to stenting of coronary arteries is similar in mature and juvenile swine

2010-07-01

Coronary arteries of juvenile swine continue to be the model of choice for preclinical evaluation of coronary stents. Limitations due to differences in animal maturity are routinely cited with respect to this model, but to date no studies have been conducted to investigate whether or not this limitation actually exists.

In-hospital and long-term outcome of primary percutaneous coronary intervention for acute myocardial infarction due to left main coronary artery occlusion

2010-07-01

Acute myocardial infarction (AMI) due to left main coronary artery (LMCA) occlusion has a poor prognosis, and data on the clinical outcome of primary percutaneous coronary intervention (PCI) of acute LMCA occlusion are limited. The purpose of this study was to determine the clinical features and outcomes of patients who underwent primary PCI for AMI due to LMCA occlusion.

Validity of GRACE risk score to predict prognosis in elderly patients with acute coronary syndrome

Mohamed Loutfi — 2010-07-01

Elderly patients with acute coronary syndromes (ACS) are a high-risk group with clinical and anatomical complexities that result in a poor prognosis. The Global Registry of Acute Coronary Event (GRACE) risk score was developed in a large multinational registry to predict in-hospital and 6-month mortality across the broad spectrum of ACS.

Increased thrombogenic potential of blood may be a key determinant for acute coronary syndrome onset

2010-07-01

Plaque rupture does not always cause acute coronary syndrome (ACS), and many silent plaque raptures have been detected by various imaging modalities. We hypothesized that dynamic change in the thrombogenic potential of blood may play an important role for the onset of ACS among the patents with ruptured plaques.

Three-year outcomes following sirolimus- versus paclitaxel-eluting stent implantation in an unselected population with coronary artery disease: The REWARDS Registry

2010-07-01

Safety concerns have necessitated the assessment of longer-term outcomes of patients treated with drug-eluting stents (DES). This study aimed to examine whether there is a difference in long-term outcomes between sirolimus-eluting (SES) and paclitaxel-eluting stents (PES).

Stent thrombosis after drug-eluting stent implantation in acute coronary syndrome versus stable patients

2010-07-01

Drug-eluting stent (DES) implantation for acute coronary syndrome (ACS) is controversial because of concern of an increase in stent thrombosis (ST). Our study aim was to compare rates of definite ST after DES implantation in patients presenting with ACS vs. stable patients.

Predictors for choosing trans-femoral approach in a center where trans-radial approach is routinely used for coronary angiography

Madhu Reddy, Ann Narmi, Ruby Satpathy, Jason Go, Michael G. Del Core — 2010-07-01

In centers where trans-radial approach (TRA) is routinely used for coronary angiography (CA), little data is available on the predictors for choosing trans-femoral approach (TFA).

Single- versus multiple-vessel stenting for patients with ST-elevation myocardial infarction: results from a 30,886-patient meta-analysis

2010-07-01

There is uncertainty on the most appropriate management of patients with acute ST-elevation myocardial infarction (STEMI) and concomitant multivessel coronary artery disease. We thus performed a systematic review and meta-analysis comparing a culprit-only vs. multivessel percutaneous coronary intervention (PCI) in this setting.

The impact of chronic obstructive pulmonary disease on hemodynamics and outcome in patients with acute myocardial infarction

2010-07-01

Patients with chronic obstructive pulmonary disease (COPD) often present with pulmonary hypertension and right ventricular dysfunction. The impact of the reduction in cardiac reserve imposed by COPD on outcome in patients with acute MI is unclear. The present study evaluated the impact of COPD on hemodynamics and outcome of acute MI patients.

Optimizing the pharmacoinvasive approach to acute ST-segment elevation myocardial infarction: use of half-dose thrombolytic therapy in combination with glycoprotein IIb/IIIa receptor inhibitors compared with full-dose thrombolytic therapy in the setting of routine urgent post-thrombolytic percutaneous coronary intervention

2010-07-01

Many studies have shown that a pharmacoinvasive strategy of urgent percutaneous coronary intervention following thrombolytic therapy in ST-segment elevation myocardial infarction (STEMI) patients is associated with better outcomes than thrombolytics alone. Some studies used full-dose thrombolytics and some used half-dose thrombolytics with glycoprotein IIb/IIIa inhibitors. The comparative efficacy and safety of these regimens remain unclear.

Do ON versus OFF hours and transfer distance impact in-hospital outcomes for patients presenting with STEMI?

2010-07-01

While there is an agreement on the impact of door-to-balloon time as a prognostic factor, it is unknown whether the in-hospital outcome of patients with ST-segment elevation myocardial infarction (STEMI) differs when presenting during business hours (ON hours) vs. after hours (OFF hours).

Adverse outcomes in patients prescribed a proton pump inhibitor following percutaneous coronary intervention with drug-eluting stents

2010-07-01

Recent evidence shows that clopidogrel and proton pump inhibitors (PPI) are metabolized by the same pathway, and patients taking both drugs have higher levels of platelet reactivity and more adverse outcomes than patients taking only clopidogrel.

Relationship between platelet reactivity inhibition and major bleeding in patients undergoing percutaneous coronary intervention

2010-07-01

Optimal platelet inhibition is critical to prevent ischemic events following percutaneous coronary intervention (PCI). However, recent studies have suggested that excessive inhibition may favor bleedings. We aimed to investigate the relationship between platelet reactivity inhibition and bleedings in patients undergoing PCI.

Angiotensin-converting enzyme therapy and the risk of contrast-induced nephropathy after coronary angiography and percutaneous coronary intervention

Kalpesh Patel, Peter Danyi, Antonio Abbate, Ion S. Jovin — 2010-07-01

The effects of angiotensin-converting enzyme inhibitors (ACEI) on the incidence of post-cardiac catheterization contrast-induced nephropathy (CIN) are not well understood. Some studies suggest that ACEI may contribute to CIN, while others report a renoprotective effect of ACEI. We studied the effect of ACEI intake on the incidence of CIN at 72 h, at 3 months, and on the incidence of dialysis in patients undergoing coronary angiography and percutaneous coronary±intervention.

Safety and efficacy of bivalirudin for percutaneous coronary intervention with rotational atherectomy

2010-07-01

While bivalirudin use in patients undergoing percutaneous coronary intervention (PCI) results in less bleeding compared to unfractionated heparin (UFH), its safety in patients undergoing rotational atherectomy (RA) is unknown. This study attempted to examine the safety and efficacy of bivalirudin for this population.

Body mass index and bleeding complications after percutaneous coronary intervention in the “bivalirudin era”

2010-07-01

Little is known about the association between obesity and bleeding complications after percutaneous coronary intervention (PCI). We investigated the impact of body mass index (BMI) on PCI-related bleeding and whether the use of bivalirudin that is known to reduce bleeding compared to heparin modifies this relationship.

Does reloading clopidogrel for patients with unstable angina who are on chronic clopidogrel therapy and undergoing percutaneous coronary intervention impact outcome?

2010-07-01

Previous data suggests that patients presenting with acute coronary syndrome (ACS) who are on chronic clopidogrel have a poor prognosis possibly due to low response to clopidogrel. This study aimed to evaluate whether there is additional benefit for reloading with clopidogrel on patients with unstable angina who are already on chronic clopidogrel therapy.

Deleterious impact of diabetes mellitus on early and mid-term results after stent implantation in left main coronary disease

2010-07-01

Diabetes mellitus (DM) plays a major role in the development and progression of coronary artery disease and negatively impacts clinical outcome in patients undergoing revascularization. Drug-eluting stents (DES) significantly reduce restenosis when compared with bare metal stents. Even so, most of the series published show a less favorable clinical and angiographic outcome in diabetics. However, little is known about the outcome of diabetics undergoing percutaneous coronary intervention (PCI) to treat left main coronary artery (LMCA) disease. Thus, the aim of our study was to assess the influence of diabetes on short- and mid-term outcome of patients undergoing coronary angioplasty and stent implantation for left main disease.

Allograft vasculopathy: a 23-year retrospective analysis from the Large Lifelink Transplant Registry

2010-07-01

Coronary allograft vasculopathy (CAV) is a major cause of mortality in heart transplantation. Immunosuppressants, coronary risk factors, and statins may influence its pathogenesis. There are conflicting reports regarding the benefits of drug-eluting stents (DES) over bare metal stents (BMS) in CAV.

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Carlos Calderas — 2010-07-01

To compare results of two low doses of paclitaxel (<10 μg) on the polymer-free, bioabsorbable silica-coated Cobra-P coronary stent. Sixty arteries in 54 subjects were enrolled into the PLUS-ONE Study. COBRA-P stents with bioabsorbable coating containing either 4 μg/18 mm (n=30) or 8 μg/18 mm (n=30) of paclitaxel were implanted in de novo coronary lesions in native coronary arteries. Visual reference vessel diameter was ≥3.0 and ≤3.75 and lesions up to 20 mm. The primary end point was major adverse cardiac events (MACE) at 4 months defined as cardiac death, myocardial infarction (MI) (Q wave and non-Q wave), and ischemia-driven target lesion revascularization (TLR). Secondary end points included MACE at 30 days and 4 months in-stent and in-segment angiographic late loss (millimeters) by quantitative coronary angiography (QCA). Reference vessel diameter (RVD) was similar in both groups: 2.58 and 2.57 mm. Late lumen loss was similar in both groups: 0.36 (±0.30) mm and 0.34 (±0.27) mm. Volume obstruction by IVUS at 4 months' follow-up was 13.5% (±9.5) and 10.9% (±7.8). In-stent binary restenosis by QCA at 4 months was 7.1% vs. 0%; in-segment binary restenosis was 10.7% vs. 0%. One MACE (TLR: 3.3%; 1/30) occurred in the low-dose arm for ischemia-driven TLR and one TLR occurred for non-ischemia-driven operator-perceived binary restenosis (TLR: 3.3%; 1/30) in the high-dose arm resulting in a total of two TLRs (3.3%; 2/60 lesions) in the study. MACE rate remained unchanged at the 1-year follow-up.

Effectiveness of a new microbial sealant in reducing bacteremia, puncture site, and sheath contamination after percutaneous interventions: a single-center randomized study

2010-07-01

To evaluate the effectiveness of the new film-forming cyanoacrylate liquid microbial sealant InteguSEAL⁎ (Kimberly-Clark) to reduce local skin bacteria contamination and bacteremia after percutaneous interventions (PI).

Transradial percutaneous coronary interventions: single-center 15-year experience

Mohamed Loutfi, Antoine Sauget, Jean Fajadet — 2010-07-01

Percutaneous coronary intervention (PCI) via transradial approach (TRA) has emerged as an alternative and competitive method compared with transfemoral approach (TFA) for PCI in simple to complex coronary disease. TRA is safe and is associated with a reduced rate of access site or bleeding complications.

Predictors of in-hospital gastrointestinal bleeding following percutaneous coronary intervention

2010-07-01

The risk of gastrointestinal bleeding (GIB) is higher in patients taking dual antiplatelet therapy, but other risk factors for GIB are less well defined. We compared 141 patients with in-hospital GIB to 19,181 patients without in-hospital GIB after percutaneous intervention (PCI). We defined GIB as clinical (coffee grounds emesis, melena, or hematochezia) or endoscopic evidence of an actively bleeding upper or lower site. We then performed multivariable logistic regression to establish predictors of in-hospital GIB.

Safety and efficacy of the Xience V everolimus-eluting stent in patients with bifurcation lesions: a subgroup analysis from the Spirit V Prospective Registry

Vladimir Dzavik, Eberhart Grube — 2010-07-01

Earlier SPIRIT percutaneous coronary intervention (PCI) trials with the XIENCE V everolimus-eluting stent (EES), including SPIRIT FIRST, II, III, and IV, met their prespecified primary and major secondary endpoints; however, they were restricted to patients with highly selected inclusion/exclusion criteria. The SPIRIT V Study provided an evaluation of EES performance in ‘real-world’ complex patient and lesion subsets in a global patient population. The aim of this analysis was to analyze outcomes of patients undergoing EES treatment of bifurcation lesions, a subset in which treatment is particularly challenging.

Decreasing trend in in-hospital mortality of patients undergoing percutaneous coronary intervention regardless of race or gender with persistent higher mortality rates in women and minorities in the United States

Mohammad Reza Movahed, Mehrtash Hashemzadeh, M. Mazen Jamal — 2010-07-01

Significant advances have been made in the last few decades. We have recently shown that PCI-related mortality has been declining in recent years. The goal of this study was to evaluate age-adjusted in-hospital mortality rate in patients undergoing percutaneous coronary intervention (PCI) based on race and gender.

Decline in the nationwide in-hospital mortality of patients undergoing coronary bypass surgery in the United States

Mohammad Reza Movahed, M Mazen Jamal — 2010-07-01

Significant advances in surgical techniques and postsurgical care have been made in the last 10 years. The goal of this study was to evaluate any decline in the age-adjusted in-hospital mortality rate of patients undergoing coronary artery bypass grafting (CABG) using a very large database from 1989 to 2004 in the United States.

Long-term follow-up registry of percutaneous balloon mitral valvuloplasty in severe mitral stenosis comparing Inoue versus multitrack balloons

Yasser A. Sadek, Reda Ahmed Abuelatta, Abdelrahman Hassan Elbokary — 2010-07-01

We sought to detect outcomes of patients with severe mitral stenosis on the long-term follow-up submitted to percutaneous balloon dilation using Inoue vs. multitrack balloons.

Association of body mass index with new-onset atrial fibrillation after coronary artery bypass graft surgery

2010-07-01

Postoperative atrial fibrillation (POAF) frequently complicates coronary artery bypass grafting (CABG) surgery. As the frequency of obesity has increased in the United States, the number of obese patients undergoing CABG has kept pace. Studies of the relationship between obesity and POAF have yielded contradictory results in large part because most have had insufficient power to adjust for confounding factors.

Percutaneous balloon mitral valvuloplasty in severe mitral stenosis during pregnancy comparing Inoue versus multitrack balloons: comparative study between Inoue and multitrack balloon mitral valvuloplasty in pregnant females with severe mitral stenosis

Yasser A. Sadek, Reda Ahmed Abualatta — 2010-07-01

We sought to compare the maternal and fetal outcomes of patients with severe mitral stenosis submitted to percutaneous balloon dilation using Inoue vs. multitrack balloons during pregnancy.

A novel risk score for long-term mortality assessment after percutaneous coronary intervention: weighting the importance of complications after procedures

2010-07-01

Clinical and angiographic risk factors associated with adverse outcomes after PCI have been included in previous validated risk scores. Complications after PCI are known to increase mortality and morbidity but have not been included in any model.

Influence of contractility and heart rate on pressure drop coefficient and fractional flow reserve for epicardial stenosis

2010-07-01

Fluctuations in heart rate (HR), area stenosis (AS), and contractility (CY) are likely to occur during coronary catheterization procedures. For improved functional diagnostics, evaluation of coronary circulation should rely on methods independent of these hemodynamic changes. This study evaluates the influence of CY and HR on both fractional flow reserve (FFR) and an alternative diagnostic index, pressure drop coefficient (CDPe).

Comparison of same-sitting robotic hybrid coronary revascularization with standard, off-pump coronary artery bypass grafting in patients with multivessel coronary artery disease

2010-07-01

Comparative study of same-sitting, robotic hybrid coronary revascularization (HCR) vs. standard sternotomy, off-pump coronary artery bypass grafting (OPCAB) in patients with multivessel coronary artery disease (MVCAD). HCR is a relatively novel procedure introduced as an alternative to traditional CABG incorporating surgical and percutaneous coronary intervention (PCI) in patients with MVCAD. Although there is some data on staged HCR, the data on same-sitting robotic HCR is meager.

Outcomes of patients with human immunodeficiency virus undergoing cardiac surgery

Shalin P. Desai, Sharon Hunt, Niv Ad — 2010-07-01

Highly active antiretroviral therapy (HAART) has significantly reduced mortality due to HIV infection; however, there is concern that this therapy can cause dyslipidemia and increase the risk for coronary disease. Additionally, given their immunocompromised condition, these patients may be at increased risk for postoperative infections and complications. We evaluated HIV (+) patients undergoing cardiac surgery at a single center to determine the rate of complications, infections, and need for revascularization.

Cardiac surgery-associated acute kidney injury: a comparison of the AKIN and RIFLE criteria

2010-07-01

The high incidence of cardiac surgery-associated acute kidney injury (AKI) has significant consequences of increased mortality, need for dialysis, prolonged hospital stay, and increased hospital costs. The Acute Dialysis Quality Initiative Workgroup published the consensus Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria, and the Acute Kidney Injury Network (AKIN) further developed the definition and stage classification of AKI. However, the ability of the RIFLE and AKIN classifications to predict postoperative mortality in patients undergoing cardiac surgery has not been well evaluated. We hypothesized that both the AKIN and RIFLE classifications could be used to predict in-hospital mortality.