01 mayo 2013

JACC: CARDIOVASCULAR INTERVENTIONS. A 3-Center Comparison of 1-Year Mortality Outcomes Between Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement on the Basis of Propensity Score Matching Among Intermediate-Risk Surgical Patients

Nicolo Piazza, MD, PhD⁎; Bindu Kalesan, PhD‡; Nicolas van Mieghem, MD§; Stuart Head, MSc∥; Peter Wenaweser, MD¶; Thierry P. Carrel, MD#; Sabine Bleiziffer, MD⁎; Peter P. de Jaegere, MD, PhD§; Brigitta Gahl#; Robert H. Anderson, MD, PhD⁎⁎; Arie-Pieter Kappetein, MD, PhD∥; Ruediger Lange, MD, PhD⁎; Patrick W. Serruys, MD, PhD§; Stephan Windecker, MD¶; Peter Jüni, MD‡

Objectives: This study sought to compare all-cause mortality in patients at intermediate surgical risk undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR).

01 marzo 2014

JACC. Transcatheter Therapies for Mitral Regurgitation. A Professional Society Overview From the American College of Cardiology, the American Association for Thoracic Surgery, Society for Cardiovascular Angiography and Interventions Foundation, and The Society of Thoracic Surgeons

Patrick T. O´Gara, MD, FACC; John H. Calhoon, MD; Marc R. Moon, MD, FACC; Carl L. Tommaso, MD, FACC, FSCAI

Catheter-based therapies for valvular heart disease, including balloon valvuloplasty, have been in clinical use for over 3 decades. More recently, transcatheter valve replacement technologies have dramatically altered the approach to children and adults with congenital or post-surgical pulmonic valve disease and to adults with degenerative aortic stenosis. Using the lessons learned from the release of these transformational technologies, this document seeks to highlight the critical issues surrounding adult transcatheter MR therapies to properly align the interests of all relevant stakeholders, including primary care physicians; patients and their families; proceduralists (interventional cardiologists, cardiac surgeons); heart valve, heart failure, and imaging experts; general and geriatric cardiologists; other heart team members; and regulators, payers, professional societies, and industry. In order to promote the expansion of this technology to allow for best patient outcomes, new guidelines and requirements for training, operator credentialing, and institutional policies will be developed.

01 abril 2013

JACC. Hybrid Intravascular Imaging. Current Applications and Prospective Potential in the Study of Coronary Atherosclerosis

Christos V. Bourantas, MD, PhD⁎; Hector M. Garcia-Garcia, MD, PhD⁎; Katerina K. Naka, MD†; Antonios Sakellarios, BSc‡; Lambros Athanasiou, BSc‡; Dimitrios I. Fotiadis, PhD‡; Lampros K. Michalis, MD†; Patrick W. Serruys, MD, PhD⁎

The miniaturization of medical devices and the progress in image processing have allowed the development of a multitude of intravascular imaging modalities that permit more meticulous examination of coronary pathology. However, these techniques have significant inherent limitations that do not allow a complete and thorough assessment of coronary anatomy. To overcome these drawbacks, fusion of different invasive and noninvasive imaging modalities has been proposed. This integration has provided models that give a more detailed understanding of coronary artery pathology and have proved useful in the study of the atherosclerotic process. In this review, the authors describe the currently available hybrid imaging approaches, discuss the technological innovations and efficient algorithms that have been developed to integrate information provided by different invasive techniques, and stress the advantages of the obtained models and their potential in the study of coronary atherosclerosis.

01 abril 2013

JACC. Oxidative Stress and Pathological Changes After Coronary Artery Interventions

Rio P. Juni, MD, MSc⁎; Henricus J. Duckers, MD, PhD†; Paul M. Vanhoutte, MD, PhD‡; Renu Virmani, MD, PhD§; An L. Moens, MD, PhD⁎

Oxidative stress greatly influences the pathogenesis of various cardiovascular disorders. Coronary interventions, including balloon angioplasty and coronary stent implantation, are associated with increased vascular levels of reactive oxygen species in conjunction with altered endothelial cell and smooth muscle cell function. These alterations potentially lead to restenosis, thrombosis, or endothelial dysfunction in the treated artery. Therefore, the understanding of the pathophysiological role of reactive oxygen species (ROS) generated during or after coronary interventions, or both, is essential to improve the success rate of these procedures. Superoxide O2·− anions, whether derived from uncoupled endothelial nitric oxide synthase, nicotinamide adenine dinucleotide phosphate oxidase, xanthine oxidase, or mitochondria, are among the most harmful ROS. O2·− can scavenge nitric oxide, modify proteins and nucleotides, and induce proinflammatory signaling, which may lead to greater ROS production. Current innovations in stent technologies, including biodegradable stents, nitric oxide donor-coated stents, and a new generation of drug-eluting stents, therefore address persistent oxidative stress and reduced nitric oxide bioavailability after percutaneous coronary interventions. This review discusses the molecular mechanisms of ROS generation after coronary interventions, the related pathological events—including restenosis, endothelial dysfunction, and stent thrombosis—and possible therapeutic ways forward.

01 abril 2014

AMERICAN HEART JOURNAL. Evaluating the learning curve in the prospective Randomized Clinical Trial of hemodynamic support with Impella 2.5 versus Intra-Aortic Balloon Pump in patients undergoing high-risk percutaneous coronary intervention: a prespecified subanalysis of the PROTECT II study

José P.S. Henriques, MD, PhD, Dagmar M. Ouweneel, MSc, Srihari S. Naidu, MD, Igor F. Palacios, MD, Jeffrey Popma, MD, E. Magnus Ohman, MD, William W. O´Neill, MD

Background: The introduction of new medical devices may be accompanied by a learning curve.

01 abril 2014

AMERICAN HEART JOURNAL. Temporal trends in clinical characteristics of patients without known cardiovascular disease with a first episode of myocardial infarction

Binita Shah, MD, MS, Sripal Bangalore, MD, MHA, Eugenia Gianos, MD, Li Liang, PhD, W. Frank Peacock, MD, Gregg C. Fonarow, MD, Warren K. Laskey, MD, MPH, Adrian F. Hernandez, MD, Deepak L. Bhatt, MD, MPH

Background: Recent initiatives have focused on primary prevention to delay time to first myocardial infarction (MI). The aim of this study was to evaluate the change in risk factor profile over time in patients without known cardiovascular disease presenting with first MI.

01 abril 2014

AMERICAN HEART JOURNAL. Lack of progress in valvular heart disease in the pre–transcatheter aortic valve replacement era: Increasing deaths and minimal change in mortality rate over the past three decades

Sean Coffey, MB, BS, Brian Cox, PhD, Michael J.A. Williams, MD

Background: Valvular heart disease (VHD) is an increasingly common problem in clinical practice. With the development of new but expensive therapeutic options, health care systems require timely epidemiological information on VHD. We sought to determine the mortality burden of VHD and how it has changed over time.

01 abril 2014

AMERICAN HEART JOURNAL. Predicting target vessel revascularization in older patients undergoing percutaneous coronary intervention in the drug-eluting stent era

Connie N. Hess, MD, MHS, Sunil V. Rao, MD, David Dai, PhD, Megan L. Neely, PhD, Robert N. Piana, MD, John C. Messenger, MD, Eric D. Peterson, MD, MPH

Background: The contemporary need for repeat revascularization in older patients after percutaneous coronary intervention (PCI) has not been well studied. Understanding repeat revascularization risk in this population may inform treatment decisions.

01 abril 2014

AMERICAN HEART JOURNAL. Physician practices regarding contraindications to oral anticoagulation in atrial fibrillation: Findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry

Background: Oral anticoagulation (OAC) therapy reduces the risk of thromboembolic events associated with atrial fibrillation (AF), yet a substantial proportion of patients with AF are not prescribed OAC. The aim of this study is to describe the frequencies of and factors associated with OAC contraindications in contemporary clinical practice.

01 abril 2014

AMERICAN HEART JOURNAL. New-onset atrial fibrillation predicts long-term newly developed atrial fibrillation after coronary artery bypass graft

Seung-Hyun Lee, MD, Dae Ryong Kang, PhD, Jae-Sun Uhm, MD, Jaemin Shim, MD, Jung-Hoon Sung, MD, Jong-Youn Kim, MD, Hui-Nam Pak, MD, PhD, Moon-Hyoung Lee, MD, PhD, Boyoung Joung, MD, PhD

Background: New-onset postoperative atrial fibrillation (POAF) is associated with poor short- and long-term outcomes after isolated coronary artery bypass graft (CABG). This study evaluated whether new-onset POAF is independently associated with long-term (>1 year) atrial fibrillation (AF) and mortality.

01 mayo 2014

AMERICAN HEART JOURNAL. Drivers of hospitalization for patients with atrial fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF)

Benjamin A. Steinberg, MD, Sunghee Kim, PhD, Gregg C. Fonarow, MD, Laine Thomas, PhD, Jack Ansell, MD, Peter R. Kowey, MD, Kenneth W. Mahaffey, MD Bernard J. Gersh, MB, ChB, DPhil, Elaine Hylek, MD, MPH, Gerald Naccarelli, MD, Alan S. Go, MD, James Reiffel, MD, Paul Chang, MD, Eric D. Peterson, MD, MPH, Jonathan P. Piccini, MD, MHS

Background: Atrial fibrillation (AF) is the most common cardiac dysrhythmia and contributes significantly to health care expenditures. We sought to assess the frequency and predictors of hospitalization in patients with AF.

01 mayo 2014

AMERICAN HEART JOURNAL. Circulating fibrosis biomarkers and risk of atrial fibrillation: The Cardiovascular Health Study (CHS)

Michael A. Rosenberg, MD, Marlena Maziarz, MSc, Alex Y. Tan, MD, Nicole L. Glazer, PhD, Susan J. Zieman, MD, PhD, Jorge R. Kizer, MD, MSc, Joachim H. Ix, MD, MAS, Luc Djousse, MD, ScD, David S. Siscovick, MD, MPH, Susan R. Heckbert, MD, PhD, Kenneth J. Mukamal, MD, MPH

Background: Cardiac fibrosis is thought to play a central role in the pathogenesis of atrial fibrillation (AF). Retrospective studies have suggested that circulating fibrosis biomarkers are associated with AF, but prospective studies are limited.

01 mayo 2014

AMERICAN HEART JOURNAL. Cost effectiveness of a gene expression score and myocardial perfusion imaging for diagnosis of coronary artery disease

Charles E. Phelps, PhD, Amy K. O’Sullivan, PhD, Joseph A. Ladapo, MD, PhD, Milton C. Weinstein, PhD, Kevin Leahy, BA, Pamela S. Douglas, MD

Background: Over 3 million patients annually present with symptoms suggestive of obstructive coronary artery disease (oCAD) in the United States (US), but a cardiac etiology is found in as few as 10% of cases. Usual care may include advanced cardiac testing with myocardial perfusion imaging (MPI), with attendant radiation risks and increased costs of care. We estimated the cost effectiveness of CAD diagnostic strategies including “no test,” a gene expression score (GES) test, MPI, and sequential strategies combining GES and MPI.

15 mayo 2014

THE AMERICAN JOURNAL OF CARDIOLOGY. Impact of Dual Antiplatelet Therapy on Outcomes Among Aspirin-Resistant Patients Following Coronary Artery Bypass Grafting

Hrvoje Gasparovic, MD, PhD, Mate Petricevic, MD, Tomislav Kopjar, MD, Zeljko Djuric, MD, Lucija Svetina, MD, Bojan Biocina, MD, PhD

Coronary artery bypass grafting is pivotal in the contemporary management of complex coronary artery disease. Interpatient variability to antiplatelet agents, however, harbors the potential to compromise the revascularization benefit by increasing the incidence of adverse events. This study was designed to define the impact of dual antiplatelet therapy (dAPT) on clinical outcomes among aspirin-resistant patients who underwent coronary artery surgery. We randomly assigned 219 aspirin-resistant patients according to multiple electrode aggregometry to receive clopidogrel (75 mg) plus aspirin (300 mg) or aspirin-monotherapy (300 mg). The primary end point was a composite outcome of all-cause death, nonfatal myocardial infarction, stroke, or cardiovascular hospitalization assessed at 6 months postoperatively. The primary end point occurred in 6% of patients assigned to dAPT and 10% of patients randomized to aspirin-monotherapy (relative risk 0.61, 95% confidence interval 0.25 to 1.51, p = 0.33). No significant treatment effect was noted in the occurrence of the safety end point. The total incidence of bleeding events was 25% and 19% in the dAPT and aspirin-monotherapy groups, respectively (relative risk 1.34, 95% confidence interval 0.80 to 2.23, p = 0.33). In the subgroup analysis, dAPT led to lower rates of adverse events in patients with a body mass index >30 kg/m2 (0% vs 18%, p <0.01) and those <65 years (0% vs 10%, p = 0.02). In conclusion, the addition of clopidogrel in patients found to be aspirin resistant after coronary artery bypass grafting did not reduce the incidence of adverse events, nor did it increase the number of recorded bleeding events. dAPT did, however, lower the incidence of the primary end point in obese patients and those <65 years.

11 octubre 2013

EUROPEAN HEART JOURNAL. Duration of dual antiplatelet treatment with clopidogrel and aspirin in patients with acute coronary syndrome

Christoph Varenhorst1,*, Karin Jensevik2, Tomas Jernberg3, Anders Sundström4, Pål Hasvold5,6, Claes Held1, Bo Lagerqvist1 and Stefan James1

Aims: Dual antiplatelet treatment (DAPT) is a cornerstone in the treatment of acute coronary syndrome (ACS) but the optimal treatment duration is unclear. We aimed to evaluate the effect of DAPT duration with clopidogrel and aspirin on the recurrence of ischaemic events and bleeding in a large, unselected ACS population.