01 noviembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Clinical Outcome After Crush Versus Culotte Stenting of Coronary Artery Bifurcation Lesions. The Nordic Stent Technique Study 36-Month Follow-Up Results

Kari Kervinen, MD∗; Matti Niemelä, MD∗; Hannu Romppanen, MD∗; Andrejs Erglis, MD‡; Indulis Kumsars, MD‡; Michael Maeng, MD§; Niels R. Holm, MD§; Jens F. Lassen, MD§; Pål Gunnes, MD‖; Sindre Stavnes, MD‖; Jan S. Jensen, MD¶; Anders Galløe, MD¶; Inga Narbute, MD‡; Dace Sondore, MD‡; Evald H. Christiansen, MD§; Jan Ravkilde, MD§; Terje K. Steigen, MD#; Jan Mannsverk, MD#; Per Thayssen, MD∗∗; Knud Nørregaard Hansen, MD∗∗; Steffen Helqvist, MD‡‡; Saila Vikman, MD§§; Rune Wiseth, MD‖‖; Jens Aarøe, MD¶¶; Jari Jokelainen, MSc##; Leif Thuesen, MD§

Objectives: The aim of the study was to compare long-term follow-up results of crush versus culotte stent techniques in coronary bifurcation lesions.

01 noviembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Routine Assessment of On-Clopidogrel Platelet Reactivity and Gene Polymorphisms in Predicting Clinical Outcome Following Drug-Eluting Stent Implantation in Patients With Stable Coronary Artery Disease

Chiara Viviani Anselmi, PhD∗; Carlo Briguori, MD, PhD†; Roberta Roncarati, PhD∗; Laura Papa, PhD∗; Gabriella Visconti, MD†; Amelia Focaccio, MD†; Francesca De Micco, PhD†; Michael V.G. Latronico§; Paolo Pagnotta, MD§; Gianluigi Condorelli, MD, PhD§

Objectives: This study sought to assess the usefulness of clopidogrel-pathway genotyping and on-treatment platelet reactivity (OTR) testing in predicting major adverse cardiac events (MACE) in stable coronary artery disease (CAD) patients receiving drug-eluting stents (DES) under dual antiplatelet (clopidogrel plus aspirin) therapy.

01 noviembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Long-Term Experience and Outcomes With Transcatheter Closure of Patent Foramen Ovale

Ignacio Inglessis, MD∗; Sammy Elmariah, MD, MPH∗; Pablo A. Rengifo-Moreno, MD∗; Ronan Margey, MD∗; Caitlin O`Callaghan, NP∗; Ignacio Cruz-Gonzalez, MD, PhD∗; Suzanne Baron, MD∗; Praveen Mehrotra, MD∗; Timothy C. Tan, MD, PhD∗; Judy Hung, MD∗; Zareh N. Demirjian, MD‡; Ferdinando S. Buonanno, MD§; MingMing Ning, MD§; Scott B. Silverman, MD§; Roberto J. Cubeddu, MD∗; Eugene Pomerantsev, MD, PhD∗; Robert M. Schainfeld, DO∗; G. William Dec, MD∗; Igor F. Palacios, MD∗

Objectives: This study sought to examine the frequency of indications for and the immediate and long-term clinical outcomes of transcatheter closure of patent foramen ovale (PFO).

01 noviembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Fluoroscopic Guide to an Ideal Implant Position for Sapien XT and CoreValve During a Valve-in-Valve Procedure

Vinnie N. Bapat, MD; Rizwan Q. Attia, MRCS; Fortunata Condemi, MD; Ravi Visagan, MBBS; Maya Guthrie, BSc; Shelina Sunni, BSc; Martyn Thomas, MD

Objectives: This study sought to provide a guide to the fluoroscopic appearances of various valve-in-valve (VIV) combinations by deploying a transcatheter heart valve (THV) within a degenerated surgical heart valve (SHV) in an ideal position.

01 noviembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Transcatheter Aortic Valve Implantation Reduces Sympathetic Activity and Normalizes Arterial Spontaneous Baroreflex in Patients With Aortic Stenosis

Nicolas Dumonteil, MD∗; Angelica Vaccaro, MD†; Fabien Despas, PharmaD, PhD†; Marc Labrunee, MD∗; Bertrand Marcheix, MD, PhD∗; Elisabeth Lambert, PhD‖; Murray Esler, MD, PhD‖; Didier Carrie, MD, PhD∗; Jean-Michel Senard, MD, PhD†; Michel Galinier, MD, PhD∗; Atul Pathak, MD, PhD∗

Objectives: This study sought to measure muscle sympathetic nerve activity (MSNA) in patients with aortic stenosis (AS) before and after transcatheter aortic valve implantation (TAVI) and to compare MSNA with that of control patients.

01 noviembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Percutaneous Transluminal Pulmonary Angioplasty for Central-Type Chronic Thromboembolic Pulmonary Hypertension

Haruhisa Ishiguro, MD∗; Masaharu Kataoka, MD∗; Takumi Inami, MD∗; Ryoji Yanagisawa, MD∗; Nobuhiko Shimura, MD∗; Hiroki Taguchi, MD∗; Hideyasu Kohshoh, MD∗; Hideaki Yoshino, MD∗; Toru Satoh, MD∗

A 76-year-old man had severe pulmonary artery stenosis in the main tract of the right pulmonary artery (Figure 1, Online Video 1), suggesting central-type chronic thromboembolic pulmonary hypertension (CTEPH). Percutaneous transluminal pulmonary angioplasty (PTPA) was strategized because he was excluded from surgical pulmonary endarterectomy due to his severe chronic obstructive pulmonary dysfunction and poor physical condition.

01 noviembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Colocalization of Low and Oscillatory Coronary Wall Shear Stress With Subsequent Culprit Lesion Resulting in Myocardial Infarction in an Orthotopic Heart Transplant Patient

Lucas H. Timmins, PhD∗; Benjamin D. Mackie, MD∗; John N. Oshinski, PhD†; Don P. Giddens, PhD†; Habib Samady, MD∗

Low and oscillatory wall shear stress (WSS) have been implicated in the pathogenesis of atherosclerosis (1,). Furthermore, cardiac allograft vasculopathy (CAV) has the highest rate of progression opposite flow dividers, suggesting a role of regional fluid dynamics (3). However, to our knowledge, the association between regional WSS and clinically manifest CAV has not previously been described.

01 octubre 2014

JACC. Prognostic Value of Fractional Flow Reserve. Linking Physiologic Severity to Clinical Outcomes

Nils P. Johnson, MD1; Gábor G. Tóth, MD2; Dejian Lai, PhD3; Hongjian Zhu, PhD3; Göksel Açar, MD4; Pierfrancesco Agostoni, MD, PhD5; Yolande Appelman, MD, PhD6; Fatih Arslan, MD, PhD5; Emanuele Barbato, MD, PhD2; Shao-Liang Chen, MD7; Luigi Di Serafino, MD, PhD8; Antonio J. Domínguez-Franco, MD9; Patrick Dupouy, MD10; Ali M. Esen, MD4; Özlem B. Esen, MD11; Michalis Hamilos, MD, PhD12; Kohichiro Iwasaki, MD13; Lisette O. Jensen, MD, PhD14; Manuel F. Jiménez-Navarro, MD, PhD9; Demosthenes G. Katritsis, MD, PhD15; Sinan A. Kocaman, MD16; Bon-Kwon Koo, MD, PhD17; Ramón López-Palop, MD, PhD18; Jeffrey D. Lorin, MD19; Louis H. Miller, MD20; Olivier Muller, MD, PhD21; Chang-Wook Nam, MD, PhD22; Niels Oud, MD6; Etienne Puymirat, MD, PhD23; Johannes Rieber, MD24; Gilles Rioufol, MD, PhD25; Josep Rodés-Cabau, MD26; Steven P. Sedlis, MD19; Yasuchika Takeishi, MD, PhD27; Pim A.L. Tonino, MD, PhD28; Eric Van Belle, MD, PhD30; Edoardo Verna, MD31; Gerald S. Werner, MD, PhD32; William F. Fearon, MD33; Nico H.J. Pijls, MD, PhD28; Bernard De Bruyne, MD, PhD2; K. Lance Gould, MD1

Background: Fractional flow reserve (FFR) has become an established tool for guiding treatment, but its graded relationship to clinical outcomes as modulated by medical therapy versus revascularization remains unclear.

01 diciembre 2014

JACC. Training in Structural Heart Interventions

Pradeep K. Yadav, MD∗; Sharif A. Halim, MD, MHS†; John P. Vavalle, MD, MHS∗

Over the last decade, there have been tremendous advances in our ability to treat valvular heart disease and anatomic cardiac defects utilizing catheter-based approaches. At the same time, the number of patients with acquired valvular heart disease or adult congenital heart disease who may benefit from these procedures has grown at a rapid pace—and will continue to grow with the aging population. These rapidly progressing structural heart interventions include transcatheter aortic valve replacement, percutaneous mitral valve repair, septal defect closures, shunt interventions, paravalvular leak closures, balloon aortic valvuloplasty, and left atrial appendage closure. As a result, there is an immediate and growing need for operators trained in these highly complex procedures. Although the curriculum for Accreditation Council for Graduate Medical Education (ACGME) programs, providing training in coronary and peripheral interventions, is well defined with set expectations, there are no ACGME-accredited training programs for structural heart disease in the country. Therefore, there are unique challenges and opportunities facing both the trainees seeking structural heart disease training as well as the programs establishing dedicated structural interventional fellowships.

01 diciembre 2013

JACC. Zotarolimus- Versus Everolimus-Eluting Stents for Unprotected Left Main Coronary Artery Disease

Julinda Mehilli, MD∗; Gert Richardt, MD†; Marco Valgimigli, MD‡; Stefanie Schulz, MD§; Ambika Singh§; Mohamed Abdel-Wahab, MD†; Klaus Tiroch, MD‖; Jürgen Pache, MD¶; Jörg Hausleiter, MD∗; Robert A. Byrne, MB§; Ilka Ott, MD§; Tareq Ibrahim, MD#; Massimiliano Fusaro, MD§; Melchior Seyfarth, MD‖; Karl-Ludwig Laugwitz, MD#; Steffen Massberg, MD∗; Adnan Kastrati, MD§

Objectives: This study sought to compare the safety and efficacy of the zotarolimus-eluting stent (ZES) and the everolimus-eluting stent (EES) for treatment of unprotected left main coronary artery (uLMCA) disease.

01 diciembre 2013

JACC. The Clinical Outcomes of Percutaneous Coronary Intervention Performed Without Pre-Procedural Aspirin

Mohamad Kenaan, MD∗; Milan Seth, MS∗; Herbert D. Aronow, MD, MPH†; David Wohns, MD‡; David Share, MD§; Hitinder S. Gurm, MD∗

Objectives: The purpose of this study was to examine the incidence and outcomes of percutaneous coronary intervention (PCI) performed in patients who had not received pre-procedural aspirin.

01 noviembre 2013

JACC. Stent Thrombosis With Drug-Eluting Stents. Is the Paradigm Shifting?

Tullio Palmerini, MD∗; Giuseppe Biondi-Zoccai, MD†; Diego Della Riva, MD∗; Andrea Mariani, MD∗; Philippe Genereux, MD‡; Angelo Branzi, MD∗; Gregg W. Stone, MD‡

First-generation drug-eluting stents (DES), which impart the controlled release of sirolimus or paclitaxel from durable polymers to the vessel wall, have been consistently shown to reduce the risk of restenosis and target vessel revascularization compared with bare metal stents (BMS). However, stent thrombosis (ST) emerged as a major safety concern with first-generation DES early after their adoption in clinical practice, requiring prolonged dual antiplatelet therapy. Pathological studies have shown that first-generation DES are associated with delayed arterial healing and polymer hypersensitivity reactions resulting in chronic inflammation, predisposing to late and very late ST. Second-generation DES have been developed to overcome these issues with improved stent designs and construction and the use of biocompatible and bioabsorbable polymers. Meta-analyses have shown that the thin-strut, fluoropolymer-coated cobalt-chromium everolimus-eluting stent (CoCr-EES) may be associated with lower rates of definite ST than other DES and, unexpectedly, even lower than BMS. The thin-strut structure of the stent platform, the thromboresistant properties of the fluoropolymer, and the reduced polymer and drug load may contribute to the low rate of ST with CoCr-EES. The notion of DES being safer than BMS represents a paradigm shift in the evolution of percutaneous coronary intervention. The relative safety and efficacy of fluoropolymer-coated CoCr-EES, DES with bioabsorbable polymers, and fully bioresorbable scaffolds are the subject of numerous ongoing large-scale trials.

01 noviembre 2013

JACC. Renal Denervation in Moderate Treatment-Resistant Hypertension

Christian Ott, MD∗; Felix Mahfoud, MD†; Axel Schmid, MD‡; Tilmann Ditting, MD∗; Paul A. Sobotka, MD§; Roland Veelken, MD∗; Aline Spies, MD†; Christian Ukena, MD†; Ulrich Laufs, MD†; Michael Uder, MD‡; Michael Böhm, MD†; Roland E. Schmieder, MD∗

Objectives: This study sought to investigate the effect of renal denervation (RDN) in patients with treatment-resistant hypertension according to the established definition (Joint National Committee VII and European Society of Hypertension/European Society of Cardiology guidelines), that is, office blood pressure (BP) ≥140/90 mm Hg (with at least three antihypertensive drugs, including a diuretic, in adequate doses) and confirmed by 24-h ambulatory BP monitoring (ABPM).

01 octubre 2013

JACC. Anatomic Versus Physiologic Assessment of Coronary Artery Disease. Role of Coronary Flow Reserve, Fractional Flow Reserve, and Positron Emission Tomography Imaging in Revascularization Decision-Making

K. Lance Gould, MD1; Nils P. Johnson, MD, MS1; Timothy M. Bateman, MD2; Rob S. Beanlands, MD3; Frank M. Bengel, MD4; Robert Bober, MD5; Paolo G. Camici, MD6; Manuel D. Cerqueira, MD7; Benjamin J.W. Chow, MD3; Marcelo F. Di Carli, MD8; Sharmila Dorbala, MD, MPH8; Henry Gewirtz, MD9; Robert J. Gropler, MD10; Philipp A. Kaufmann, MD11; Paul Knaapen, MD, PhD12; Juhani Knuuti, MD, PhD13; Michael E. Merhige, MD14; K. Peter Rentrop, MD15; Terrence D. Ruddy, MD3; Heinrich R. Schelbert, MD, PhD16; Thomas H. Schindler, MD17; Markus Schwaiger, MD18; Stefano Sdringola, MD1; John Vitarello, MD19; Kim A. Williams, MD20; Donald Gordon, MD21; Vasken Dilsizian, MD22; Jagat Narula, MD, PhD23

Abstract: Angiographic severity of coronary artery stenosis has historically been the primary guide to revascularization or medical management of coronary artery disease. However, physiologic severity defined by coronary pressure and/or flow has resurged into clinical prominence as a potential, fundamental change from anatomically to physiologically guided management. This review addresses clinical coronary physiology—pressure and flow—as clinical tools for treating patients. We clarify the basic concepts that hold true for whatever technology measures coronary physiology directly and reliably, here focusing on positron emission tomography and its interplay with intracoronary measurements.

01 octubre 2013

JACC. Predictors and Outcomes of Side Branch Occlusion After Main Vessel Stenting in Coronary Bifurcation Lesions. Results From the COBIS II Registry (COronary BIfurcation Stenting)

Joo-Yong Hahn, MD, PhD∗; Woo Jung Chun, MD, PhD†; Ji-Hwan Kim, MD∗; Young Bin Song, MD, PhD∗; Ju Hyeon Oh, MD, PhD†; Bon-Kwon Koo, MD, PhD‡; Seung Woon Rha, MD, PhD§; Cheol Woong Yu, MD, PhD‖; Jong-Sun Park, MD, PhD¶; Jin-Ok Jeong, MD, PhD#; Seung-Hyuk Choi, MD, PhD∗; Jin-Ho Choi, MD, PhD∗; Myung-Ho Jeong, MD, PhD∗∗; Jung Han Yoon, MD, PhD††; Yangsoo Jang, MD, PhD‡‡; Seung-Jea Tahk, MD, PhD§§; Hyo-Soo Kim, MD, PhD‡; Hyeon-Cheol Gwon, MD, PhD∗

Objectives: This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions.