01 noviembre 2012

THE AMERICAN JOURNAL OF CARDIOLOGY. Safety, Effectiveness, and Outcomes of Cardiac Catheterization in Nonagenarians

Bryan LeBude, MD , David Fischman, MD , Michael Savage, MD , Babu Jasti, MD , David Ogilby, MD , Melissa McCarey, BA , Suzanne Adams, RN, MPH , Thiruvallur Vallabhan, MD , Paul Walinsky, MD

With an aging population, nonagenarians (≥90 years of age) are increasingly being considered for cardiac catheterization. Because of the paucity of outcomes data in this population, we sought to evaluate the acute and intermediate outcomes of nonagenarians undergoing cardiac catheterization. A retrospective cohort of 44 nonagenarians undergoing 53 cardiac catheterizations from 2002 to 2010 was identified. Mean age was 91 years (range 90 to 96) with 57% of patients being women. Thirteen percent presented with ST-segment elevation myocardial infarction, 32% with non–ST-segment elevation myocardial infarction, 14% with unstable angina, 25% with chronic angina, and 16% with aortic stenosis. Eighteen percent had left main coronary artery disease and 73% had multivessel coronary disease. Complications occurred in 6 of 44 patients (3 with acute kidney injury, 2 with atrial fibrillation, 1 with femoral artery pseudoaneurysm). Twenty patients were treated with medical management, 1 patient underwent coronary artery bypass surgery, and 2 patients underwent aortic valve replacement. Twenty-one patients underwent percutaneous coronary intervention in 27 different vessels. There was procedural success in 93% of these patients. There were no major adverse cardiac events. Five complications occurred after the intervention (4 atrial fibrillations, 1 femoral artery pseudoaneurysm). Cumulative mortalities at 1 month and 6 and 12 months were 0%, 9%, and 20% respectively. In patients who underwent percutaneous coronary intervention or surgery, mortalities were 0%, 0%, and 13% at 1 month and 6 and 12 months, respectively.

01 noviembre 2012

RADIOLOGY. Coronary In-Stent Restenosis: Assessment with CT Coronary Angiography

Daniele Andreini, MD, , Gianluca Pontone, MD, , Saima Mushtaq, MD, , Antonio L. Bartorelli, MD, , Erika Bertella, MD, , Daniela Trabattoni, MD, , Piero Montorsi, MD, , Stefano Galli, MD, , Claudia Foti, RT, , Andrea Annoni, MD, , Francesca Bovis, MD, , Giovanni Ballerini, MD, , Piergiuseppe Agostoni, MD, PhD, , Cesare Fiorentini, MD, and , Mauro Pepi, MD

Introduction: Multidetector computed tomography (CT) coronary angiography has emerged as a reliable tool for diagnosing coronary artery disease (1). However, the quantification of lumen narrowing of coronary stents by neointimal hyperplasia with multidetector CT is limited due to beam-hardening artifacts caused by metallic stent struts and related to limitations in spatial resolution. However, despite these limitations, single-center studies using 64-section multidetector CT have shown reasonable diagnostic performance for in-stent restenosis (ISR) detection. Recent pooled analyses reported an overall sensitivity of ISR detection of 84% with unassessable stents in up to 13% of cases (2–6). Furthermore, the radiation burden of the first generations of 64-section multidetector CT is still relatively high (2–6). Different strategies have been proposed to reduce the radiation dose, including optimization of scan parameters (7), high-pitch dual-source multidetector CT (8) and prospective electrocardiographic (ECG) triggering instead of retrospective ECG triggering (9). Due to these issues, coronary artery stent evaluation by means of multidetector CT is still regarded of questionable value for routine clinical use by current appropriateness criteria (10). Recently, a new scanner, with a nominal spatial resolution of 230 μm and an adaptive statistical iterative reconstruction (ASIR) algorithm has been introduced. Improved visualization and assessment of in-stent luminal diameter has been demonstrated with coronary stent phantoms by using this technique (10,11). The aim of the present study was to compare accuracy and radiation exposure of the new scanner with improved spatial resolution (scanner A) versus a scanner with standard spatial resolution (scanner B) for evaluation of coronary ISR by using invasive coronary angiography (ICA) and intravascular ultrasonography (US) as the reference methods.

01 noviembre 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Randomized Comparison of Conservative Versus Aggressive Strategy for Provisional Side Branch Intervention in Coronary Bifurcation Lesions. Results From the SMART-STRATEGY (SMart Angioplasty Research Team–Optimal STRATEGY for Side Branch Intervention in Coronary Bifurcation Lesions) Randomized Trial

Young Bin Song, MD, PhD; Joo-Yong Hahn, MD, PhD; Pil-Sang Song, MD; Jeong Hoon Yang, MD; Jin-Ho Choi, MD, PhD; Seung-Hyuk Choi, MD, PhD; Sang Hoon Lee, MD, PhD; Hyeon-Cheol Gwon, MD, PhD

Objectives: The authors sought to compare conservative and aggressive strategies for provisional side branch (SB) intervention in coronary bifurcation lesions.

01 septiembre 2012

EUROPEAN HEART JOURNAL. Endothelial cell repopulation after stenting determines in-stent neointima formation: effects of bare-metal vs. drug-eluting stents and genetic endothelial cell modification

Gillian Douglas1,2, Erik Van Kampen1,2, Ashley B. Hale1,2, Eileen McNeill1,2, Jyoti Patel1,2, Mark J. Crabtree1,2, Ziad Ali1,2, Robert A. Hoerr3, Nicholas J. Alp1,2 and Keith M. Channon1,2,*

Aims Understanding endothelial cell repopulation post-stenting and how this modulates in-stent restenosis is critical to improving arterial healing post-stenting. We used a novel murine stent model to investigate endothelial cell repopulation post-stenting, comparing the response of drug-eluting stents with a primary genetic modification to improve endothelial cell function.

01 noviembre 2012

THE AMERICAN JOURNAL OF CARDIOLOGY. Cardiovascular Risk Factors in a Patient with Diabetes Mellitus and Coronary Artery Disease: Therapeutic Approaches to Improve Outcomes: Perspectives of a Preventive Cardiologist

Michael H. Davidson, MD

In patients with diabetes mellitus (DM), a cardiovascular event is of critical concern because of the impact on long-term survival. Cardiovascular disease (CVD) is the leading cause of death for patients with DM, which makes the modification of risk factors in the patient with DM and CVD a primary focus of the preventive cardiologist. Management of this patient population should include pharmacologic interventions, such as antidyslipidemics (mainly statins) and oral anti-DM (or insulin) agents, as well as diet control, physical exercise, and smoking cessation. It is hoped that focus on the ABCs of treatment—hemoglobin A1c, blood pressure, and cholesterol-lipid profile—along with ongoing and future studies on the effects of these interventions will help to reduce the significant morbidity and mortality from microvascular and macrovascular complications in these high-risk patients with DM.

01 noviembre 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Assessment of Clinical, Electrocardiographic, and Physiological Relevance of Diagonal Branch in Left Anterior Descending Coronary Artery Bifurcation Lesions

Bon-Kwon Koo, MD, PhD?; Seung-Pyo Lee, MD?; Ju-Hee Lee, MD?; Kyung-Woo Park, MD, PhD?; Jung-Won Suh, MD, PhD†; Young-Seok Cho, MD, PhD†; Woo-Young Chung, MD, PhD‡; Joon-Hyung Doh, MD, PhD§; Chang-Wook Nam, MD, PhD?; Cheol Woong Yu, MD, PhD¶; Bong-Ki Lee, MD, PhD#; Dobrin Vassilev, MD??; Robert Gil, MD††; Hong-Seok Lim, MD, PhD‡‡; Seung-Jea Tahk, MD, PhD‡‡; Hyo-Soo Kim, MD, PhD?

Objectives This study sought to investigate the clinical, electrocardiographic, and physiological relevance of main and side branches in coronary bifurcation lesions.

01 noviembre 2012

JACC. Coronary Computed Tomographic Angiography as a Gatekeeper to Invasive Diagnostic and Surgical Procedures. Results From the Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) Registry

Leslee J. Shaw, PhD?; Jörg Hausleiter, MD†; Stephan Achenbach, MD‡; Mouaz Al-Mallah, MD§; Daniel S. Berman, MD?; Matthew J. Budoff, MD¶; Fillippo Cademartiri, MD#; Tracy Q. Callister, MD††; Hyuk-Jae Chang, MD, PhD‡‡; Yong-Jin Kim, MD‡‡; Victor Y. Cheng, MD?; Benjamin J.W. Chow, MD§§; Ricardo C. Cury, MD??; Augustin J. Delago, MD¶¶; Allison L. Dunning, MS##; Gudrun M. Feuchtner, MD, PD???; Martin Hadamitzky, MD†; Ronald P. Karlsberg, MD?; Philipp A. Kaufmann, MD†††; Jonathon Leipsic, MD‡‡‡; Fay Y. Lin, MD, MPH##; Kavitha M. Chinnaiyan, MD§§§; Erica Maffei, MD#; Gilbert L. Raff, MD§§§; Todd C. Villines, MD???; Troy LaBounty, MD?; Millie J. Gomez, MD?; James K. Min, MD?

Objectives: This study sought to examine patterns of follow-up invasive coronary angiography (ICA) and revascularization (REV) after coronary computed tomography angiography (CCTA).

01 septiembre 2012

EUROPEAN HEART JOURNAL. Long-term results of a randomized trial comparing three different devices for percutaneous closure of a patent foramen ovale

Marius Hornung, Stefan C. Bertog, Jennifer Franke, Dani Id, Margaret Taaffe, Nina Wunderlich, Laura Vaskelyte, Ilona Hofmann and Horst Sievert*

Aims Percutaneous patent foramen ovale (PFO) closure for secondary stroke prevention is discussed controversially. Long-term data comparing different closure devices are limited. The objective is the prospective comparison of procedural complications and long-term results after PFO closure in patients with cryptogenic stroke randomized to three different closure devices.

01 noviembre 2012

THE AMERICAN JOURNAL OF CARDIOLOGY. Acute Coronary Syndrome in Patients with Diabetes Mellitus: Perspectives of an Interventional Cardiologist

Saurabh Sanon, MD , Rikesh Patel, MD , Carrie Eshelbrenner, MD , Vani P. Sanon, MD , Mohsin Alhaddad, MD , Rene Oliveros, MD , Son V. Pham, MD , Robert Chilton, DO

Diabetes mellitus (DM) is well known to be a coronary artery disease risk equivalent but the cellular mechanism is not completely understood. Recently, virtual histology intravascular ultrasound has demonstrated that patients with DM tend to have a higher occurrence of vulnerable plaques as compared with patients without DM. Insulin-sensitizing agents, such as metformin, have been shown to have limited cardioprotective effects, whereas thiazolidinediones, such as rosiglitazone, have been reported to have possible deleterious effects on cardiovascular mortality in a meta-analysis; however, limited data exist. In contrast, pioglitazone has been reported to have a significant benefit in patients with type 2 DM with acute coronary syndrome (ACS). Animal and human studies have demonstrated the myocardial protective effects of incretins and hold promise in reducing the incidence of major adverse cardiac events in patients with DM. Moreover, in addition to aspirin, the early use of potent antiplatelet agents, such as prasugrel and intravenous glycoprotein IIb-IIIa inhibitors, in patients with DM presenting with ACS is crucial for reducing cardiovascular events in most patients. Thus, patients with DM deserve special attention in global risk factor reduction and development of newer therapeutic agents to improve glycemic control while minimizing or reducing cardiovascular events. This article focuses on ACS in patients with DM, the pathophysiology of “vulnerable blood” in patients with DM, and newer treatment strategies to improve outcomes in this high-risk patient population.

01 noviembre 2012

RADIOLOGY. Differentiation of Early from Advanced Coronary Atherosclerotic Lesions: Systematic Comparison of CT, Intravascular US, and Optical Frequency Domain Imaging with Histopathologic Examination in ex Vivo Human Hearts

Pál Maurovich-Horvat, MD, PhD, , Christopher L. Schlett, MD, MPH, , Hatem Alkadhi, MD, MPH, , Masataka Nakano, MD, , Paul Stolzmann, MD, , Marc Vorpahl, MD, , Hans Scheffel, MD, , Atsushi Tanaka, MD, , William C. Warger, II, PhD, , Akiko Maehara, MD, , Shixin Ma, MD, , Matthias F. Kriegel, BA, , Ryan K. Kaple, MD, , Harald Seifarth, MD, , Fabian Bamberg, MD, MPH, , Gary S. Mintz, MD, , Guillermo J. Tearney, MD, PhD, , Renu Virmani, MD, and , Udo Hoffmann, MD, MPH

Introduction: Both noninvasive and invasive imaging tools are available to image coronary artery disease. Rapid evolution of coronary computed tomographic (CT) angiography now permits noninvasive imaging of coronary arteries with high spatial resolution (0.3 mm) (1). While coronary CT angiography can reliably help differentiate between calcified and noncalcified plaques, its ability to help discriminate among the components of noncalcified plaques is limited (2–4). Among invasive methods, intravascular ultrasonography (US), which offers an axial resolution of ≈150 μm, is considered to be the clinical reference method for assessing coronary atherosclerotic plaque dimensions, while optical coherence tomography (OCT) and its second-generation form, optical frequency domain imaging (OFDI) provide high spatial resolution (10–15 μm) that may help identify the presence and size of lipid cores and thin fibrous caps, although the delineation of peripheral plaque components is limited (5–7).

01 noviembre 2012

AMERICAN JOURNAL OF ROENTGENOLOGY. Dual-Energy CT of the Heart

Rozemarijn Vliegenthart, Gert Jan Pelgrim, Ullrich Ebersberger, Garrett W. Rowe, Matthijs Oudkerk and U. Joseph Schoepf

OBJECTIVE. Interest in dual-energy CT (DECT) for evaluating the myocardial blood supply, as an addition to coronary artery assessment, is increasing. Although it is still in the early clinical phase, assessment of myocardial ischemia and infarction by DECT constitutes a promising step toward comprehensive evaluation of coronary artery disease with a single noninvasive modality.

01 noviembre 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Development and Validation of a Stent Thrombosis Risk Score in Patients With Acute Coronary Syndromes

George D. Dangas, MD, PhD?; Bimmer E. Claessen, MD, PhD†; Roxana Mehran, MD?; Ke Xu, PhD†; Martin Fahy, MSc†; Helen Parise, PhD†; José P.S. Henriques, MD, PhD‡; E. Magnus Ohman, MD§; Harvey D. White, MD?; Gregg W. Stone, MD†

Objectives This study sought to develop a practical risk score to predict the risk of stent thrombosis (ST) after percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS).

01 noviembre 2012

JACC. The Risk of Adverse Cardiac and Bleeding Events Following Noncardiac Surgery Relative to Antiplatelet Therapy in Patients With Prior Percutaneous Coronary Intervention

Sandeep Singla, MD; Rajesh Sachdeva, MD; Barry F. Uretsky, MD

Noncardiac surgery (NCS) may be required within the first year after percutaneous coronary intervention (PCI) in approximately 4% of patients and is the second most common reason for premature discontinuation of antiplatelet therapy (APT),which may, in turn, increase the risk of perioperative ischemic events, particularly stent thrombosis. Its continuation may increase the risk of perioperative bleeding. We review current information on the incidence of these events, particularly related to APT, describe potentially useful strategies to minimize the risks of adverse outcomes, and provide recommendations on APT use.

01 septiembre 2013

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS. Women treated with second-generation zotarolimus-eluting resolute stents and everolimus-eluting xience V stents: insights from the gender-stratified, randomized, controlled TWENTE trial

Kenneth Tandjung MD1, Mounir W.Z. Basalus MD1, Hanim Sen MD1, Martin G. Stoel MD1, K. Gert van Houwelingen MD1, J. (Hans) W. Louwerenburg MD1, Frits H.A.F. de Man MD, PhD1, Gerard C.M. Linssen MD, PhD2, Salah A.M. Saïd MD, PhD3, Miep A.W.J. Kleijne MD4, Job van der Palen PhD5,6, Clemens von Birgelen MD, PhD1,7,*

Background: Women are underrepresented in clinical research, and few data are available from randomized head-to-head comparisons of second-generation drug-eluting stents (DES) in female patients. Aim of this study was to assess safety and efficacy of two second-generation DES in women. In TWENTE—a prospective, randomized, comparative DES trial—“real-world” patients were stratified for gender before randomization for Resolute or Xience V stents.

10 octubre 2013

ORIGINAL. Indirect meta-analysis of Tryton side branch® stent versus a complex two-stent technique for patients with a bifurcation coronary lesion

Luciano Consuegra Sánchez

Background: Several trials and meta-analysis have addressed whether bifurcations lesions require stenting of both the main vessel and side branch. The Tryton side brach stent is a bifurcation system that secures the side branch and provides ostial protection. Uncertainty remains on the benefits of such Tryton Stent versus double stenting with regards to the occurrence of periprocedural myocardial infarction (periMI).

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