01 noviembre 2013

THE AMERICAN JOURNAL OF CARDIOLOGY. One-Year Outcomes of Percutaneous Coronary Intervention With the 38-mm Resolute Zotarolimus-Eluting Stent

Michael Lee, MD, Shirish Hiremath, MD AFFILIATIONS Department of Cardiology, Ruby Hall Clinic, Pune, India , Robaayah Zambahari, MD, Martin Leon, MD, Laura Mauri, MD, MSc, Alan Yeung, MD, RESOLUTE US and RESOLUTE Asia Investigators

This study was designed to prospectively evaluate the safety and efficacy of the 38-mm Resolute zotarolimus-eluting stent (R-ZES). Drug-eluting stents with long lengths are needed to ensure coverage of long lesions in some patients. Patients recruited from the RESOLUTE US and RESOLUTE Asia studies were implanted with at least one 38-mm R-ZES. Up to 2 lesions (in separate vessels) could be implanted with length ≤35 mm and a reference vessel diameter of 3.0 to 4.2 mm. The primary end point was 1-year target lesion failure, defined as cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. The 1-year target lesion failure rate using 1 vessel per patient was compared with a performance goal (19%) derived from historical data. There were 223 patients enrolled (n = 269 lesions). The mean age was 60.9 ± 10.9 years, 79% were men, and 38% had diabetes. Target lesion failure rate using a single-vessel analysis was 4.5%, and the upper limit of the 1-sided 95% confidence interval (7.5%) was less than the performance goal of 19%. A secondary analysis using all lesions resulted in a target lesion failure rate of 5.4% (upper limit of 1-sided 95% confidence interval, 8.6%). Baseline characteristics and clinical outcomes were similar between patients with and without diabetes. The rate of probable or definite stent thrombosis was 0.9%. In conclusion, the 38-mm length of the R-ZES was found to be safe and effective with a low rate of target lesion failure and stent thrombosis and no differences in outcomes between patients with and without diabetes.

01 noviembre 2013

THE AMERICAN JOURNAL OF CARDIOLOGY. Outcomes of Consecutive Patients Referred for Consideration for Transcatheter Aortic Valve Implantation from an Encompassing Health-Care Region

Steven R. Meyer, MD, PhD, Miriam Shanks, MD, Benjamin D. Tyrrell, MD, Roderick G.G. MacArthur, MD, Dylan A. Taylor, MD, Suzanne Welsh, RN, Chai Paterson, Robert C. Welsh, MD

Procedural outcomes for transcatheter aortic valve implantation (TAVI) are well described. However, limited information exists regarding patient screening and selection. Thus, the purpose of the study was to review consecutive patients referred for TAVI from an inclusive-defined population. The Mazankowski Alberta Heart Institute TAVI program has maintained a prospective database on all referred patients. Patients are reviewed in outpatient clinic attended by a nurse, cardiologist, cardiac surgeon, and administrative assistant. After workup is complete, a TAVI Heart Team conference occurs to accept or reject each patient. Since November 2009, 276 patients (145 men and 131 women) have been referred with a steady increase in the number of referrals annually. Mean age was 82.2 years (men 81.6 and women 82.8), with 13% aged <70 years. Mean EuroSCORE was 13.8 and mean STS score was 5.7. Of the referred patients, 34% received TAVI, 17% were rejected, 12% underwent open AVR, 10% refused TAVI, and 27% are currently being assessed or followed. There were no differences in the mean EuroSCORE (13.4 vs 14.3; p = 0.64) or STS scores (5.2 vs 6.4; p = 0.13) of those accepted for TAVI versus those who were not. In conclusion, a team-based approach to assess this complex patient population is essential to ensure efficient and comprehensive evaluation, in turn determining appropriate care allocation. With expansion of clinical experience and the evidence supporting TAVI, the Heart Teams defined to assess this patient population will be burdened with increased clinical commitment and require appropriate support.

15 noviembre 2013

THE AMERICAN JOURNAL OF CARDIOLOGY. Comparison of Cancer Risk Associated With Low-Dose Ionizing Radiation from Cardiac Imaging and Therapeutic Procedures After Acute Myocardial Infarction in Women Versus Men

Patrick R. Lawler, MD, Jonathan Afilalo, MD, MSc, Mark J. Eisenberg, MD, MPH, Louise Pilote, MD, MPH, PhD

Patients with cardiovascular disease are increasingly exposed to low-dose ionizing radiation (LDIR) from diagnostic and therapeutic procedures. Previous studies have suggested that the malignancy risk associated with LDIR may be greatest in women and in young patients. We sought to compare the effect of LDIR on incident cancer across gender and age strata in a population-based cohort of patients with myocardial infarction (MI). All initially cancer-free patients with MI from 1996 to 2006 were identified in a province-wide administrative database. Procedure-specific LDIR dose estimates were used to generate a cumulative cardiac LDIR exposure variable. Time-dependent multivariate Cox regression was used to determine the relation between cardiac LDIR and incident cancer. A time-lag covariate of 3 years was used wherein a de novo cancer could only be attributed to LDIR incurred at least 3 years earlier. The effect of age and gender on LDIR-associated risk of cancer was evaluated with stratified models and the addition of interaction terms. The study cohort consisted of 56,606 men and 26,255 women. For each millisievert of cardiac LDIR, women were more likely to develop a cancer (hazard ratio 1.005, 95% confidence interval 1.002 to 1.008) than men (hazard ratio 1.002, 95% confidence interval 1.001 to 1.004) after adjusting for age, noncardiac LDIR, and covariates (p for interaction = 0.014). Contrarily, over the range studied (predominantly patients aged >50 years), age was not a determinant of LDIR-associated risk of cancer. In conclusion, women exposed to LDIR from cardiac imaging and therapeutic procedures after MI are at a greater risk of incident cancer compared with men after similar exposure. The extrapolated absolute risk from LDIR exposure would nonetheless be expected to be low.

01 enero 2013

JACC. Elevated Plasma Fibrinogen Rather Than Residual Platelet Reactivity After Clopidogrel Pre-Treatment Is Associated With an Increased Ischemic Risk During Elective Percutaneous Coronary Intervention

Lawrence Ang, MD⁎; Khalid Bin Thani, MD, MAS⁎; Manjusha Ilapakurti, MBBS, MPH⁎; Michael S. Lee, MD†; Vachaspathi Palakodeti, MD⁎; Ehtisham Mahmud, MD⁎

Objectives: This study was undertaken to determine the roles of serum fibrinogen and residual platelet reactivity after clopidogrel pre-treatment on ischemic events after elective percutaneous coronary intervention (PCI).

01 enero 2013

JACC. Use of Medications for Secondary Prevention After Coronary Bypass Surgery Compared With Percutaneous Coronary Intervention

Mark A. Hlatky, MD⁎; Matthew D. Solomon, MD, PhD⁎; David Shilane, PhD⁎; Thomas K. Leong, MPH†; Ralph Brindis, MD‡; Alan S. Go, MD†

Objectives: This study sought to compare use of evidence-based secondary preventive medications after coronary bypass surgery (CABG) and percutaneous coronary intervention (PCI).

01 enero 2013

JACC. The Negative Impact of Incomplete Angiographic Revascularization on Clinical Outcomes and Its Association With Total Occlusions. The SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) Trial

Vasim Farooq, MBChB⁎; Patrick W. Serruys, MD, PhD⁎; Hector M. Garcia-Garcia, MD, PhD⁎; Yaojun Zhang, MD⁎; Christos V. Bourantas, MD, PhD⁎; David R. Holmes, MD†; Michael Mack, MD‡; Ted Feldman, MD§; Marie-Claude Morice, MD∥; Elisabeth Ståhle, MD¶; Stefan James, MD¶; Antonio Colombo, MD#; Roberto Diletti, MD⁎; Michail I. Papafaklis, MD, PhD⁎⁎; Ton de Vries, MSc††; Marie-angèle Morel, BSc††; Gerrit Anne van Es, PhD††; Friedrich W. Mohr, MD‡‡; Keith D. Dawkins, MD§§; Arie-Pieter Kappetein, MD, PhD∥∥; Georgios Sianos, MD, PhD¶; Eric Boersma, MSc, PhD⁎

Objectives: The study sought to evaluate the clinical impact of angiographic complete (CR) and incomplete (ICR) revascularization and its association with the presence of total occlusions (TO), after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in the “all-comers” SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) trial.

01 enero 2013

JACC. 5-Year Outcome After Transcatheter Aortic Valve Implantation

Stefan Toggweiler, MD; Karin H. Humphries, DSc; May Lee, MSc; Ronald K. Binder, MD; Robert R. Moss, MD; Melanie Freeman, MBBS; Jian Ye, MD; Anson Cheung, MD; David A. Wood, MD; John G. Webb, MD

Objectives: The purpose of this study was to investigate the 5-year outcome following transcatheter aortic valve implantation (TAVI).

01 enero 2013

JACC. The Prevalence and Outcomes of Transradial Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Analysis From the National Cardiovascular Data Registry (2007 to 2011)

Dmitri V. Baklanov, MD⁎; Lisa A. Kaltenbach, MS†; Steven P. Marso, MD⁎; Sumeet S. Subherwal, MD†; Dmitriy N. Feldman, MD‡; Kirk N. Garratt, MD§; Jeptha P. Curtis, MD∥; John C. Messenger, MD¶; Sunil V. Rao, MD†

Objectives: The purpose of this study was to examine use and describe outcomes of radial access for percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).

12 noviembre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Transcatheter Aortic Valve Replacement. Outcomes of Transcatheter and Surgical Aortic Valve Replacement in High-Risk Patients With Aortic Stenosis and Left Ventricular Dysfunction. Results From the Placement of Aortic Transcatheter Valves (PARTNER) Trial (Cohort A)

Sammy Elmariah, MD, MPH, Igor F. Palacios, MD, Thomas McAndrew, MS, Irene Hueter, PhD, Ignacio Inglessis, MD, Joshua N. Baker, MD, Susheel Kodali, MD, Martin B. Leon, MD, Lars Svensson, MD, Philippe Pibarot, DVM, PhD, Pamela S. Douglas, MD, William F. Fearon, MD, Ajay J. Kirtane, MD, SM, Hersh S. Maniar, MD and Jonathan J. Passeri, MD on behalf of the PARTNER Investigators

Background: The Placement of Aortic Transcatheter Valves (PARTNER) trial demonstrated similar survival after transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively) in high-risk patients with symptomatic, severe aortic stenosis. The aim of this study was to evaluate the effect of left ventricular (LV) dysfunction on clinical outcomes after TAVR and SAVR and the impact of aortic valve replacement technique on LV function.

19 noviembre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Coronary Hemodynamics. Hemodynamic Response to Intravenous Adenosine and Its Effect on Fractional Flow Reserve Assessment. Results of the Adenosine for the Functional Evaluation of Coronary Stenosis Severity (AFFECTS) Study

Jason M. Tarkin, MBBS, Sukhjinder Nijjer, MBChB, Sayan Sen, MBBS, Ricardo Petraco, MD, Mauro Echavarria-Pinto, MD, Kaleab N. Asress, BM BCh, MA, Tim Lockie, MBChB, PhD, Muhammed Z. Khawaja, MBBS, Jamil Mayet, MBChB, MD, Alun D. Hughes, MBBS, PhD, Iqbal S. Malik, MBBS, PhD, Ghada W. Mikhail, MBBS, PhD, Christopher S. Baker, MBBS, PhD, Rodney A. Foale, MD, Simon Redwood, MBBS, MD, Darrel P. Francis, MB BChir, MA, MD, Javier Escaned, MD, PhD and Justin E. Davies, MBBS, PhD

Background: We studied the hemodynamic response to intravenous adenosine on calculation of fractional flow reserve (FFR). Intravenous adenosine is widely used to achieve conditions of stable hyperemia for measurement of FFR. However, intravenous adenosine affects both systemic and coronary vascular beds differentially.

15 enero 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Stent Outcomes. Staged Versus One-time Complete Revascularization With Percutaneous Coronary Intervention for Multivessel Coronary Artery Disease Patients Without ST-Elevation Myocardial Infarction

Edward L. Hannan, PhD, Zaza Samadashvili, MD, Gary Walford, MD, Alice K. Jacobs, MD, Nicholas J. Stamato, MD, Ferdinand J. Venditti, MD, David R. Holmes Jr, MD, Samin Sharma, MD and Spencer B. King III, MD

Background: There are evidence-based guidelines for staging of patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), but we are not aware of any evidence comparing the strategy of complete revascularization (CR) with PCI in the index admission versus the strategy of staging in a subsequent admission for patients with coronary artery disease without STEMI.

12 febrero 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Stent Outcomes. Randomized Comparison of Sirolimus-Eluting and Everolimus-Eluting Coronary Stents in the Treatment of Total Coronary Occlusions. Results From the Chronic Coronary Occlusion Treated by Everolimus-eluting Stent Randomized Trial

Raul Moreno, MD, PhD, Eulogio García, MD, Rui Teles, MD, Jose-Ramon Rumoroso, MD, Henrique Cyrne Carvalho, MD, PhD, Francisco Javier Goicolea, MD, José Moreu, MD, Josefa Mauri, MD, Manel Sabaté, MD, PhD, Vicente Mainar, MD, Lino Patricio, MD, Mariano Valdés, MD, PhD, Felipez Fernández Vázquez, MD, Angel Sánchez-Recalde, MD, Guillermo Galeote, MD, Santiago Jimenez-Valero, MD, Manuel Almeida, MD, Esteban Lopez de Sa, MD, Luis Calvo, MD, PhD, Ignacio Plaza, MD, PhD, Jose-Luis Lopez-Sendón, MD, PhD, Jose-Luis R. Martín, MD, PhD, for the CIBELES Investigators

Background: Patients with coronary total occlusions are at especially high risk for restenosis and new revascularizations. Sirolimus-eluting stents dramatically improved the clinical outcome of this subset of patients in randomized trials, but other drug-eluting stents, mainly the everolimus-eluting stent (currently the most frequently used stent), have not yet been evaluated in patients with coronary total occlusions. The objective was to compare the second-generation everolimus-eluting stent with the first-generation sirolimus-eluting stent in patients with coronary total occlusions.

15 enero 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Cardiac Catheterization. Contrast-Induced Acute Kidney Injury and Risk of Adverse Clinical Outcomes After Coronary Angiography. A Systematic Review and Meta-Analysis

Matthew T. James, MD, PhD, Susan M. Samuel, MD, MSc, Megan A. Manning, BSc, Marcello Tonelli, MD, SM, William A. Ghali, MD, MPH, Peter Faris, PhD, Merril L. Knudtson, MD, Neesh Pannu, MD, MSc and Brenda R. Hemmelgarn, MD, PhD

Background: Contrast-induced acute kidney injury (CI-AKI) has been associated with mortality, although it has been suggested this association may be attributable to confounding. We performed a systematic review and meta-analysis to characterize the associations between CI-AKI and subsequent clinical outcomes.

22 enero 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Myocardial Infarction. Preinfarction Angina Reduces Infarct Size in ST-Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention

Ronald Reiter, MD, Timothy D. Henry, MD and Jay H. Traverse, MD

Background: Preinfarction angina may act as a clinical surrogate of ischemic preconditioning that may reduce infarct size and improve mortality in the setting of thrombolytic therapy for ST-elevation myocardial infarction. However, the benefits of preinfarction angina in the setting of primary percutaneous coronary intervention with stenting is inconclusive because of the greater achievement of infarct artery patency and speed of reperfusion.

22 enero 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Myocardial Infarction. Transcatheter Closure of Post-myocardial Infarction Ventricular Septal Rupture

Gabriele Egidy Assenza, MD, Doff B. McElhinney, MD, Anne Marie Valente, MD, Disty D. Pearson, PA-C, Massimo Volpe, MD, Giuseppe Martucci, MDcM, Michael J. Landzberg, MD* and James E. Lock, MD*

Background: Ventricular septal rupture (VSR) after acute myocardial infarction (AMI) is a potentially lethal mechanical complication of acute coronary syndromes. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases. We report our single-center experience with double-umbrella device percutaneous closure of post-AMI VSR.