01 octubre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS.

Tullio Palmerini, MD, Sorin J. Brener, MD, Roxana Mehran, MD, George Dangas, MD, Philippe Genereux, MD, Diego Della Riva, MD, Andrea Mariani, MD, Ke Xu, PhD and Gregg W. Stone, MD

Background: Although the reduction in mortality with bivalirudin compared with unfractionated heparin plus glycoprotein IIb/IIIa inhibitors in the Harmonizing Outcome with Revascularization and Stent in Acute Myocardial Infarction (HORIZONS-AMI) trial has been attributed to lower rates of major bleeding, alternative mechanisms have not been investigated in depth. We sought to investigate whether there might be an interaction between white blood cell (WBC) count and bivalirudin for the risk of mortality, and whether this interaction is independent of major bleeding.

01 octubre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. ST-Segment–Elevation Myocardial Infarction

Gregg W. Stone, MD, Bernhard Witzenbichler, MD, Jacek Godlewski, MD, Jan-Henk E. Dambrink, MD, Andrzej Ochala, MD, Saqib Chowdhary, MD, Magdi El-Omar, MD, Thomas Neunteufl, MD, David Christopher Metzger, MD, Jose M. Dizon, MD, Steven D. Wolff, MD, Sorin J. Brener, MD, Roxana Mehran, MD, Akiko Maehara, MD and C. Michael Gibson, MD

Background: Whether intralesional abciximab administration and thrombus aspiration confer clinical benefits to patients undergoing primary percutaneous coronary intervention for ST-segment–elevation myocardial infarction is controversial.

24 septiembre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Effect on Platelet Reactivity From a Prasugrel Loading Dose After a Clopidogrel Loading Dose Compared With a Prasugrel Loading Dose Alone

Jean G. Diodati, MD, Jorge F. Saucedo, MD, John K. French, MB, ChB, PhD, Anthony Y. Fung, MBBS, Tracy E. Cardillo, MSN, Carsten Henneges, PhD, Mark B. Effron, MD, Harold N. Fisher, MD and Dominick J. Angiolillo, MD, PhD

Background: Adding a prasugrel loading dose (LD) to a clopidogrel LD could be desirable because clopidogrel may fail to provide adequate levels of platelet inhibition in patients with acute coronary syndrome undergoing percutaneous coronary intervention.

01 diciembre 2013

RADIOLOGY. Coronary Stenosis: Morphologic Index Characterized by Using CT Angiography Correlates with Fractional Flow Reserve and Is Associated with Hemodynamic Status

Minghua Li, MD, Jiayin Zhang, MD, Jingwei Pan, MD, Zhigang Lu, MD

Coronary computed tomographic (CT) angiography has been well recognized as a reliable noninvasive modality for the detection of obstructive coronary artery disease (1–4). However, it has limitations in helping predict hemodynamically significant lesions, which can be accurately assessed by using the coronary fractional flow reserve (FFR) metric (5,6).

01 diciembre 2013

RADIOLOGY. CT in Transcatheter Aortic Valve Replacement

Philipp Blanke, MD, U. Joseph Schoepf, MD, Jonathon A. Leipsic, MD

Aortic stenosis is the most prevalent cardiac valvular disease in the Western world (1,2). Aortic valve replacement is indicated for symptomatic patients with severe aortic stenosis, because the prognosis for untreated patients is poor (3). Surgical valve replacement is the definitive treatment for severe aortic stenosis and is technically possible in patients of any age (3,4). However, as many as 30% of patients with aortic stenosis are not considered surgical candidates because of comorbidities and estimated extreme surgical mortality risk (5). Transcatheter aortic valve replacement (TAVR, also referred to as transcatheter aortic valve implantation, or TAVI) is a recently introduced method to treat selected high-risk patients with aortic stenosis (6–8). As of mid-2013, more than 90 000 procedures have been performed worldwide (9), mostly in patients at high surgical risk. Safety, efficacy, and noninferiority to conventional open surgery have been demonstrated in recent prospective multicenter investigations (10,11).

01 diciembre 2013

RADIOLOGY. Combined Use of Automatic Tube Potential Selection with Tube Current Modulation and Iterative Reconstruction Technique in Coronary CT Angiography

Young Joo Suh, MD, Young Jin Kim, MD, PhD, Sae Rom Hong, MD, Yoo Jin Hong, MD, Hye-Jeong Lee, MD, PhD, Jin Hur, MD, PhD, Byoung Wook Choi, MD, PhD

Coronary computed tomographic (CT) angiography is a reliable noninvasive imaging modality for evaluating coronary heart disease in appropriate clinical settings (1). However, with an increasing number of coronary CT angiograms being obtained, there have also been increasing concerns about the safety of radiation doses (2). Consequently, advances have been introduced in coronary CT angiography protocols to achieve the lowest radiation dose possible while providing high image quality (3).

01 noviembre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Bypassing the Emergency Department and Time to Reperfusion in Patients With Prehospital ST-Segment–Elevation

Akshay Bagai, MD, MHS, Hussein R. Al-Khalidi, PhD, Daniel Muñoz, MD, MPA, Lisa Monk, RN, MSN, Mayme L. Roettig, RN, MSN, Claire C. Corbett, MMS, NREMT-P, J. Lee Garvey, MD, B. Hadley Wilson, MD, Christopher B. Granger, MD and James G. Jollis, MD

Background—Among patients identified prehospital with ST-segment–elevation myocardial infarction, emergency medical service transport from the field directly to the catheterization laboratory, thereby bypassing the emergency department (ED), may shorten time to reperfusion.

01 agosto 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Management of Vascular Access in Transcatheter Aortic Valve Replacement. Part 2: Vascular Complications

Stefan Toggweiler, MD∗; Jonathon Leipsic, MD∗; Ronald K. Binder, MD∗; Melanie Freeman, MBBS∗; Marco Barbanti, MD∗; Robin H. Heijmen, MD, PhD‡; David A. Wood, MD∗; John G. Webb, MD∗

The interventional cardiologist must be able to recognize and manage potential vascular complications. Iliofemoral complications are the most frequent vascular complications in transfemoral transcatheter aortic valve implantation. Small vessel dimensions, moderate or severe calcification, and center experience are the major predictors. The traditional treatment for injured arteries has been surgical reconstruction, but endovascular techniques may allow for less invasive but effective management of arterial injuries. Dissection may be treated with prolonged balloon inflation or deployment of a self-expanding or balloon-expandable stent or a surgical graft. Iliofemoral rupture is a serious complication that may lead to retroperitoneal bleeding that can be unrecognized. Rapid insertion of a dilator or sheath or an occlusive balloon is used to achieve hemostasis. Prolonged balloon inflation or implantation of a covered stent or surgical repair should then be considered. Treatment options for failed percutaneous closure include prolonged manual compression, balloon angioplasty, stent implantation, and surgery. Aortic complications are rare, but serious complications are associated with a high mortality rate, even if emergent surgery is performed. There are specific vascular complications associated with alternative access routes such as transapical and transaxillary and direct aortic access.

01 agosto 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Improved Safety and Reduction in Stent Thrombosis Associated With Biodegradable Polymer-Based Biolimus-Eluting Stents Versus Durable Polymer-Based Sirolimus-Eluting Stents in Patients With Coronary Artery Disease

Patrick W. Serruys, MD, PhD∗; Vasim Farooq, MB, ChB∗; Bindu Kalesan, PhD, MPH†; Ton de Vries, MSc‡; Pawel Buszman, MD, PhD§; Axel Linke, MD⋮; Thomas Ischinger, MD¶; Volker Klauss, MD#; Franz Eberli, MD∗∗; William Wijns, MD, PhD††; Marie Claude Morice, MD‡‡; Carlo Di Mario, MD, PhD§§; Roberto Corti, MD⋮⋮; Diethmar Antoni, MD¶¶; Hae Y. Sohn, MD##; Pedro Eerdmans, MD, PhD∗∗∗; Tessa Rademaker-Havinga, MSc‡; Gerrit-Anne van Es, PhD‡; Bernhard Meier, MD, PhD†††; Peter Jüni, MD†; Stephan Windecker, MD†††

Objectives: This study sought to report the final 5 years follow-up of the landmark LEADERS (Limus Eluted From A Durable Versus ERodable Stent Coating) trial.

01 agosto 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Enhanced Mortality Risk Prediction With a Focus on High-Risk Percutaneous Coronary Intervention

J. Matthew Brennan, MD, MPH∗; Jeptha P. Curtis, MD†; David Dai, PhD, MS∗; Susan Fitzgerald, MS, RN‡; Akshay K. Khandelwal, MD§; John A. Spertus, MD⋮; Sunil V. Rao, MD∗; Mandeep Singh, MD¶; Richard E. Shaw, MD#; Kalon K.L. Ho, MD, MSc∗∗; Ronald J. Krone, MD††; William S. Weintraub, MD‡‡; W. Douglas Weaver, MD§; Eric D. Peterson, MD, MPH∗

Objectives: This study sought to update and validate a contemporary model for inpatient mortality following percutaneous coronary intervention (PCI), including variables indicating high clinical risk.

01 agosto 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Incidence, Predictors, Morphological Characteristics, and Clinical Outcomes of Stent Edge Dissections Detected by Optical Coherence Tomography

Daniel Chamié, MD; Hiram G. Bezerra, MD, PhD; Guilherme F. Attizzani, MD; Hirosada Yamamoto, MD; Tomoaki Kanaya, MD; Gregory T. Stefano, MD; Yusuke Fujino, MD; Emile Mehanna, MD; Wei Wang, PhD; Ahmad Abdul-Aziz, BS; Matthew Dias, BS; Daniel I. Simon, MD; Marco A. Costa, MD, PhD

Objectives: This study sought to investigate the frequency, predictors, and detailed qualitative and quantitative assessment of optical coherence tomography (OCT)-detected stent edge dissections. Its impact on subsequent management and clinical outcomes were also investigated.

01 agosto 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Radial Versus Femoral Access for Primary Percutaneous Interventions in ST-Segment Elevation Myocardial Infarction Patients

Wassef Karrowni, MD∗; Ankur Vyas, MD∗; Bria Giacomino, DO∗; Marin Schweizer, PhD†; Amy Blevins, MALS∗; Saket Girotra, MD, SM∗; Phillip A. Horwitz, MD∗

Objectives: This study sought to determine the safety and efficacy of radial access compared with femoral access for primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).

01 agosto 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Costs of Transradial Percutaneous Coronary Intervention

Amit P. Amin, MD, MSc∗; John A. House, MS†; David M. Safley, MD†; Adnan K. Chhatriwalla, MD†; Helmut Giersiefen, PhD‡; Andreas Bremer, PhD‡; Martial Hamon, MD§; Dmitri V. Baklanov, MD†; Akinyele Aluko, MD⋮; David Wohns, MD¶; David W. Mathias, MD#; Robert A. Applegate, MD∗∗; David J. Cohen, MD, MSc†; Steven P. Marso, MD†

Objectives: This study sought to evaluate the costs of transradial percutaneous coronary intervention (TRI) and transfemoral percutaneous coronary intervention (TFI) from a contemporary hospital perspective.

01 agosto 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Impact of Attenuated Plaque as Detected by Intravascular Ultrasound on the Occurrence of Microvascular Obstruction After Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction

Yasutsugu Shiono, MD; Takashi Kubo, MD, PhD; Atsushi Tanaka, MD, PhD; Takashi Tanimoto, MD, PhD; Shingo Ota, MD; Yasushi Ino, MD, PhD; Hiroshi Aoki, MD; Yuichi Ozaki, MD; Makoto Orii, MD; Kunihiro Shimamura, MD; Kohei Ishibashi, MD; Takashi Yamano, MD; Tomoyuki Yamaguchi, MD; Kumiko Hirata, MD, PhD; Toshio Imanishi, MD, PhD; Takashi Akasaka, MD, PhD

Objectives: The aim of the study was to investigate whether intravascular ultrasound (IVUS) can predict microvascular obstruction (MVO) as detected by magnetic resonance imaging (MRI) after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).

01 agosto 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Clinical Implications of Very Low On-Treatment Platelet Reactivity in Patients Treated With Thienopyridine. The POBA Study (Predictor of Bleedings With Antiplatelet Drugs)

Thomas Cuisset, MD, PhD∗; Charlotte Grosdidier, PhD†; Anderson Diendonné Loundou, PhD⋮; Jacques Quilici, MD∗; Marie Loosveld, MD†; Laurence Camoin, PhD‡; Mathieu Pankert, MD∗; Shirley Beguin, PhD¶; Marc Lambert, MD∗; Pierre Emmanuel Morange, MD, PhD†; Jean-Louis Bonnet, MD∗; Marie-Christine Alessi, MD, PhD†

Objectives: This study was designed to define the hyperresponse to thienopyridine (very low on-treatment platelet reactivity [VLTPR]) as the most predictive threshold value of platelet reactivity index vasodilator-stimulated phosphoprotein (PRI VASP) for the prediction of non-access site–related bleeding events. We also aimed to identify predictors of bleeding and VLTPR in patients treated with thienopyridines.