01 junio 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Drug-Eluting Balloons. Effective and Durable Treatment for In-Stent Restenosis

Habib Samady, MD; Girum Mekonnen, MD

The introduction of percutaneous transluminal coronary angioplasty (PTCA) by Andreas Gruentzig was a game changer for coronary revascularization 1. However, PTCA is associated with significant rates of acute closure and restenosis resulting from vascular recoil, neointimal hyperplasia, and negative remodeling. Bare-metal stents (BMS) effectively treat acute closure and limit restenosis by preventing vascular recoil and negative remodeling 2. With widespread adoption of BMS emerged in-stent restenosis (ISR), a lesion resulting from aggressive smooth muscle cell proliferation and extracellular matrix production that has been significantly reduced by drug-eluting stents (DES). Nevertheless, both BMS and DES are deployed for patient and lesion specific reasons and hence ISR is not uncommonly encountered in clinical practice. Furthermore, ISR may present as unstable angina (16% to 66%) or myocardial infarction (1% to 20%) and therefore continues to be a significant limitation of contemporary percutaneous coronary intervention

01 junio 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Open-Label, Randomized, Placebo-Controlled Evaluation of Intracoronary Adenosine or Nitroprusside After Thrombus Aspiration During Primary Percutaneous Coronary Intervention for the Prevention of Microvascular Obstruction in Acute Myocardial Infarction. The REOPEN-AMI Study (Intracoronary Nitroprusside Versus Adenosine in Acute Myocardial Infarction)

Objectives: This study sought to assess whether intracoronary adenosine or nitroprusside following thrombus aspiration (TA) is superior to TA alone for the prevention of microvascular obstruction (MVO) in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI).

01 junio 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Transapical Implantation of a Second-Generation Transcatheter Heart Valve in Patients With Noncalcified Aortic Regurgitation

Moritz Seiffert, MD∗; Patrick Diemert, MD†; Dietmar Koschyk, MD†; Johannes Schirmer, MD∗; Lenard Conradi, MD∗; Renate Schnabel, MD, MSc†; Stefan Blankenberg, MD†; Hermann Reichenspurner, MD, PhD∗; Stephan Baldus, MD†; Hendrik Treede, MD∗

Objectives: This study sought to report on the feasibility and early results of transcatheter aortic valve implantation employing a second-generation device in a series of patients with pure aortic regurgitation.

01 junio 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Transvenous, Antegrade Melody Valve-in-Valve Implantation for Bioprosthetic Mitral and Tricuspid Valve Dysfunction. A Case Series in Children and Adults

Michael W. Cullen, MD∗; Allison K. Cabalka, MD†; Oluseun O. Alli, MBBS‡; Sorin V. Pislaru, MD, PhD∗; Paul Sorajja, MD∗; Vuyisile T. Nkomo, MD, MPH∗; Joseph F. Malouf, MD∗; Frank Cetta, MD∗; Donald J. Hagler, MD∗; Charanjit S. Rihal, MD, MBA∗

Objectives: The purpose of this study was to report the results of percutaneous valve-in-valve therapy using the Melody valve (Medtronic, Minneapolis, Minnesota) for patients with degenerated mitral and tricuspid bioprosthetic valves.

01 junio 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Risk Factors for Thrombus Formation on the Amplatzer Cardiac Plug After Left Atrial Appendage Occlusion

Bjoern Plicht, MD∗; Thomas F.M. Konorza, MD∗; Philipp Kahlert, MD∗; Fadi Al-Rashid, MD∗; Hagen Kaelsch, MD∗; Rolf Alexander Jánosi, MD∗; Thomas Buck, MD∗; Hagen S. Bachmann, MD†; Winfried Siffert, MD†; Gerd Heusch, MD‡; Raimund Erbel, MD∗

Objectives This study sought to identify risk factors for thrombus formation on the Amplatzer Cardiac Plug (ACP) (St. Jude Medical, St. Paul, Minnesota) after left atrial appendage occlusion.

01 junio 2013

JACC: CARDIOVASCULAR INTERVENTIONS. The New York State Risk Score for Predicting In-Hospital/30-Day Mortality Following Percutaneous Coronary Intervention

Edward L. Hannan, PhD∗; Louise Szypulski Farrell, MS∗; Gary Walford, MD†; Alice K. Jacobs, MD‡; Peter B. Berger, MD§; David R. Holmes, MD⋮; Nicholas J. Stamato, MD¶; Samin Sharma, MD#; Spencer B. King, MD∗∗

Objectives: This study sought to develop a percutaneous coronary intervention (PCI) risk score for in-hospital/30-day mortality.

01 junio 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Impact of Public Reporting and Outlier Status Identification on Percutaneous Coronary Intervention Case Selection in Massachusetts

James M. McCabe, MD∗; Karen E. Joynt, MD, MPH∗; Frederick G.P. Welt, MD, MSc∗; Frederic S. Resnic, MD, MSc‡

Objectives: This study sought to evaluate the impact of public reporting of hospitals as negative outliers on percutaneous coronary intervention (PCI) case-mix selection.

01 junio 2013

JACC. Computational Fluid Dynamics Applied to Cardiac Computed Tomography for Noninvasive Quantification of Fractional Flow Reserve

Charles A. Taylor, PhD*; Timothy A. Fonte, BS*; James K. Min, MD‡

Coronary computed tomography angiography (CTA) has emerged as a noninvasive method for direct visualization of coronary artery disease, with previous studies demonstrating high diagnostic performance of CTA compared with invasive coronary angiography. However, CTA assessment of coronary stenoses tends toward overestimation, and even among CTA-identified severe stenosis confirmed at the time of invasive coronary angiography, only a minority are found to be ischemia causing. Recent advances in computational fluid dynamics and image-based modeling now permit determination of rest and hyperemic coronary flow and pressure from CTA scans, without the need for additional imaging, modification of acquisition protocols, or administration of medications. These techniques have been used to noninvasively compute fractional flow reserve (FFR), which is the ratio of maximal coronary blood flow through a stenotic artery to the blood flow in the hypothetical case that the artery was normal, using CTA images. In the recently reported prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study and the DeFACTO (Determination of Fractional Flow Reserve by Anatomic Computed Tomographic Angiography) trial, FFR derived from CTA was demonstrated as superior to measures of CTA stenosis severity for determination of lesion-specific ischemia. Given the significant interest in this novel method for determining the physiological significance of coronary artery disease, we herein present a review on the scientific principles that underlie this technology.

01 mayo 2013

CIRCULATION. Quantitative Assessment of the Coronary Microvasculature

Bernard De Bruyne, MD, PhD; Emanuele Barbato, MD, PhD

Epicardial coronary arteries are called conductance arteries (or macrocirculation) because their normal intrinsic resistance is close to zero and their main function is to transport blood. They are visible at invasive coronary angiography with an unsurpassed spatial and temporal resolution. Coronary arteries <500 µm are usually referred to as resistance arteries (or microvasculature) because, by continuously modifying their resistance, they match blood flow to the requirements of the myocytes.

01 mayo 2013

CIRCULATION. Health Services and Outcomes Research. Economic Evaluation of Percutaneous Left Atrial Appendage Occlusion, Dabigatran, and Warfarin for Stroke Prevention in Patients With Nonvalvular Atrial Fibrillation

Sheldon M. Singh, MD; Andrew Micieli, MMI; Harindra C. Wijeysundera, MD, PhD

Background: Percutaneous left atrial appendage (LAA) occlusion and novel pharmacological therapies are now available to manage stroke risk in patients with nonvalvular atrial fibrillation; however, the cost-effectiveness of LAA occlusion compared with dabigatran and warfarin in patients with nonvalvular atrial fibrillation is unknown.

01 mayo 2013

CIRCULATION. Interventional Cardiology. Prognostic Value of the Index of Microcirculatory Resistance Measured After Primary Percutaneous Coronary Intervention

William F. Fearon, MD; Adrian F. Low, MBBS; Andy S. Yong, MBBS, PhD; Ross McGeoch, MBChB; Colin Berry, MBChB, MD; Maulik G. Shah, MD; Michael Y. Ho, MD; Hyun-Sook Kim, MD; Joshua P. Loh, MBBS; Keith G. Oldroyd, MBChB, MD

Background: Most methods for assessing microvascular function are not readily available in the cardiac catheterization laboratory. The aim of this study is to determine whether the Index of Microcirculatory Resistance (IMR), measured at the time of primary percutaneous coronary intervention, is predictive of death and rehospitalization for heart failure.

01 mayo 2013

CIRCULATION. Vascular Medicine. Stent Placement Versus Balloon Angioplasty for the Treatment of Obstructive Lesions of the Popliteal Artery

Aljoscha Rastan, MD; Hans Krankenberg, MD; Iris Baumgartner, MD; Erwin Blessing, MD; Stefan Müller-Hülsbeck, MD; Ernst Pilger, MD; Dierk Scheinert, MD; Johannes Lammer, MD; Martin Gißler, MD; Elias Noory, MD; Franz-Josef Neumann, MD; Thomas Zeller, MD

Background: Stenting has been shown to improve patency after femoral artery revascularization compared with balloon angioplasty. Limited data are available evaluating endovascular treatment for obstructive lesions of the popliteal artery.

01 mayo 2013

CIRCULATION. Coronary Heart Disease. Bayesian Methods Affirm the Use of Percutaneous Coronary Intervention to Improve Survival in Patients With Unprotected Left Main Coronary Artery Disease

John A. Bittl, MD; Yulei He, PhD; Alice K. Jacobs, MD; Clyde W. Yancy, MD; Sharon-Lise T. Normand, PhD; on behalf of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

Background: Several randomized clinical trials support the use of coronary artery bypass grafting (CABG) for patients with unprotected left main coronary artery disease. Studies suggesting the equivalence of percutaneous coronary intervention (PCI) with CABG for this indication indirectly support the 2011 American College of Cardiology Foundation/American Heart Association Class IIa recommendation for PCI to improve survival in patients with unprotected left main coronary artery disease. We tested whether bayesian approaches uphold the new recommendation.

01 mayo 2013

CIRCULATION. Interventional Cardiology. Histopathology of Embolic Debris Captured During Transcatheter Aortic Valve Replacement

Nicolas M. Van Mieghem, MD; Marguerite E.I. Schipper, MD; Elena Ladich, MD; Elham Faqiri, MSc; Robert van der Boon, MSc; Abas Randjgari, MD; Carl Schultz, MD, PhD; Adriaan Moelker, MD, PhD; Robert-Jan van Geuns, MD, PhD; Fumiyuki Otsuka, MD; Patrick W. Serruys, MD, PhD; Renu Virmani, MD; Peter P. de Jaegere, MD, PhD

Background: Recent transcatheter aortic valve replacement studies have raised concerns about adverse cerebrovascular events. The etiopathology of the embolized material is currently unknown.

01 mayo 2013

CIRCULATION. Valvular Heart Disease. Predictors of Mortality and Outcomes of Therapy in Low-Flow Severe Aortic Stenosis

Howard C. Herrmann, MD; Philippe Pibarot, PhD; Irene Hueter, PhD; Zachary M. Gertz, MD; William J. Stewart, MD; Samir Kapadia, MD; E. Murat Tuzcu, MD; Vasilis Babaliaros, MD; Vinod Thourani, MD; Wilson Y. Szeto, MD; Joseph E. Bavaria, MD; Susheel Kodali, MD; Rebecca T. Hahn, MD; Mathew Williams, MD; D. Craig Miller, MD; Pamela S. Douglas, MD; Martin B. Leon, MD

Background: The prognosis and treatment of patients with low-flow (LF) severe aortic stenosis are controversial.