01 septiembre 2012

CIRCULATION. Periprocedural Heparin Bridging in Patients Receiving Vitamin K Antagonists. Systematic Review and Meta-Analysis of Bleeding and Thromboembolic Rates

Deborah Siegal, MD, MSc; Jovana Yudin, MD, BSc; Scott Kaatz, DO, MSc; James D. Douketis, MD, FRCPC; Wendy Lim, MD, MSc, FRCPC; Alex C. Spyropoulos, MD, FCCP, FRCPC

Background—Periprocedural bridging with unfractionated heparin or low-molecular-weight heparin aims to reduce the risk of thromboembolic events in patients receiving long-term vitamin K antagonists. Optimal periprocedural anticoagulation has not been established.

01 agosto 2013

CIRCULATION. The Long-Term Multicenter Observational Study of Dabigatran Treatment in Patients With Atrial Fibrillation (RELY-ABLE) Study

Stuart J. Connolly, MD; Lars Wallentin, MD, PhD; Michael D. Ezekowitz, MB, ChB, DPhil; John Eikelboom, MD; Jonas Oldgren, MD, PhD; Paul A. Reilly, PhD; Martina Brueckmann, MD; Janice Pogue, PhD; Marco Alings, MD, PhD; John V. Amerena, MB, BS; Alvaro Avezum, MD, PhD; Iris Baumgartner, MD; Andrzej J. Budaj, MD, PhD; Jyh-Hong Chen, MD, PhD; Antonio L. Dans, MD, MDc; Harald Darius, MD, PhD; Giuseppe Di Pasquale, MD; Jorge Ferreira, MD; Greg C. Flaker, MD; Marcus D. Flather, MD; Maria Grazia Franzosi, PhD; Sergey P. Golitsyn, MD, PhD; David A. Halon, MB, ChB; Hein Heidbuchel, MD, PhD; Stefan H. Hohnloser, MD; Kurt Huber, MD; Petr Jansky, MD; Gabriel Kamensky, PhD; Matyas Keltai, MD; Sung Soon Kim, MD; Chu-Pak Lau, MD, PhD; Jean-Yves Le Heuzey, PhD; Basil S. Lewis, MD, FRCP; Lisheng Liu, MD, PhD; John Nanas, MD; Razali Omar, MD; Prem Pais, MD, PhD; Knud E. Pedersen, MD; Leopoldo S. Piegas, MD, PhD; Dimitar Raev, MD; Pal J. Smith, MD; Mario Talajic, MD; Ru San Tan, MB, BS; Supachai Tanomsup, MD; Lauri Toivonen, MD, PhD; Dragos Vinereanu, MD, PhD, FESC; Denis Xavier, MD; Jun Zhu, MD; Susan Q. Wang, PhD; Christine O. Duffy, MSHS; Ellison Themeles, BA; Salim Yusuf, MBBS, DPhil

Background—During follow-up of between 1 and 3 years in the Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) trial, 2 doses of dabigatran etexilate were shown to be effective and safe for the prevention of stroke or systemic embolism in patients with atrial fibrillation. There is a need for longer-term follow-up of patients on dabigatran and for further data comparing the 2 dabigatran doses.

01 agosto 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Enhanced Mortality Risk Prediction With a Focus on High-Risk Percutaneous Coronary Intervention. Results From 1,208,137 Procedures in the NCDR (National Cardiovascular Data Registry

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 septiembre 2013

CIRCULATION. Rosiglitazone and Outcomes for Patients With Diabetes Mellitus and Coronary Artery Disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial

Richard G. Bach, MD; Maria Mori Brooks, PhD; Manuel Lombardero, MS; Saul Genuth, MD; Thomas W. Donner, MD; Alan Garber, MD, PhD; Laurence Kennedy, MD; E. Scott Monrad, MD; Rodica Pop-Busui, MD, PhD; Sheryl F. Kelsey, PhD; Robert L. Frye, MD; for the BARI 2D Investigators

Background—Rosiglitazone improves glycemic control for patients with type 2 diabetes mellitus, but there remains controversy regarding an observed association with cardiovascular hazard. The cardiovascular effects of rosiglitazone for patients with coronary artery disease remain unknown.

01 septiembre 2012

CIRCULATION. Cerebral Embolization During Transcatheter Aortic Valve Implantation. A Transcranial Doppler Study

Philipp Kahlert, MD; Fadi Al-Rashid, MD; Philipp Döttger, MS; Kathrine Mori, MS; Björn Plicht, MD; Daniel Wendt, MD; Lars Bergmann, MD,, DESA; Eva Kottenberg, MD; Marc Schlamann, MD; Petra Mummel, MD; Dagny Holle, MD; Matthias Thielmann, MD; Heinz G. Jakob, MD; Thomas Konorza, MD; Gerd Heusch, MD; Raimund Erbel, MD; Holger Eggebrecht, MD

Background—Transcatheter aortic valve implantation (TAVI) is associated with a higher risk of neurological events for both the transfemoral and transapical approach than surgical valve replacement. Cerebral magnetic resonance imaging has revealed more new, albeit clinically silent lesions from procedural embolization, yet the main source and predominant procedural step of emboli remain unclear.

01 julio 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Association Between Periprocedural Bleeding and Long-Term Outcomes Following Percutaneous Coronary Intervention in Older Patients

Sunil V. Rao, MD; David Dai, PhD, MS; Sumeet Subherwal, MD, MBA; William S. Weintraub, MD; Ralph S. Brindis, MD, MPH; John C. Messenger, MD; Renato D. Lopes, MD, PhD; Eric D. Peterson, MD, MPH

Objectives: The authors sought to describe the association between post-procedural bleeding and long-term recurrent bleeding, major adverse cardiac events (MACE), and mortality among older patients undergoing percutaneous coronary intervention (PCI).

01 agosto 2013

JACC. The Burgeoning Epidemic of Morbid Obesity in Patients Undergoing Percutaneous Coronary Intervention. Insight From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Michael E. Buschur, MD; Dean Smith, PhD, MPH; David Share, MD; William Campbell, MD; Stephen Mattichak, MD; Manoj Sharma, MD; Hitinder S. Gurm, MD

Objectives: This study sought to examine the prevalence and clinical implications of morbid obesity among patients undergoing percutaneous coronary intervention (PCI).

01 julio 2013

AMERICAN HEART JOURNAL. Everolimus-eluting stent versus bare metal stent in proximal left anterior descending ST-elevation myocardial infarction:

Josep Gomez-Lara, MD PhD , Salvatore Brugaletta, MD PhD , Joan-Antoni Gomez-Hospital, MD PhD , Jose Luis Ferreiro, MD , Gerard Roura, MD , Rafael Romaguera, MD , Victoria Martin-Yuste, MD , Monica Masotti, MD, PhD , Andrés Iñiguez, MD, PhD , Antonio Serra, MD, PhD , Rosana Hernandez-Antolin, MD, PhD , Vicente Mainar, MD, PhD , Marco Valgimigli, MD, PhD , Maurizio Tespili, MD, PhD , Pieter den Heijer, MD, PhD , Armando Bethencourt, MD, PhD , Nicolás Vazquez, MD, PhD , Patrick Serruys, MD, PhD , Manel Sabate, MD, PhD , Angel Cequier, MD, PhD

Background: ST-elevation myocardial infarctions (STEMI) caused by proximal left-anterior descending (LAD) lesions have more myocardium at risk and worse outcomes than those located in other segments. The aim is to compare outcomes of patients with STEMI and proximal-LAD lesions treated with bare-metal stents (BMS) versus everolimus-eluting stents (EES).

01 agosto 2013

JACC. In-Hospital Outcomes of Percutaneous Coronary Interventions in Extremely Obese and Normal-Weight Patients. Findings From the NCDR (National Cardiovascular Data Registry)

Saeed Payvar, MD, MS; Sunghee Kim, PhD; Sunil V. Rao, MD; Ronald Krone, MD; Megan Neely, PhD; Nikhil Paladugu; Ramesh Daggubati, MD

Objectives: The purpose of this study was to compare in-hospital outcomes of percutaneous coronary intervention (PCI) in extreme obesity (EO) (body mass index [BMI] ≥40 kg/m2) with those of normal-weight (NW) patients and to examine the influence of access site on outcomes.

01 octubre 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Comparison of Bivalirudin and Radial Access Across a Spectrum of Preprocedural Risk of Bleeding in Percutaneous Coronary Intervention. Analysis From the National Cardiovascular Data Registry

Dmitri V. Baklanov, MD, Sunghee Kim, PhD, Steven P. Marso, MD, Sumeet Subherwal, MD and Sunil V. Rao, MD

Background—Bleeding is a common, noncardiac, preventable complication of percutaneous coronary intervention. We compared the relative safety of radial access and bivalirudin in percutaneous coronary intervention.

01 octubre 2012

EUROPEAN HEART JOURNAL. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document

A. Pieter Kappetein, Stuart J. Head, Philippe Généreux, Nicolo Piazza, Nicolas M. van Mieghem, Eugene H. Blackstone, Thomas G. Brott, David J. Cohen, Donald E. Cutlip, Gerrit-Anne van Es, Rebecca T. Hahn, Ajay J. Kirtane, Mitchell W. Krucoff, Susheel Kodali, Michael J. Mack, Roxana Mehran, Josep Rodés-Cabau, Pascal Vranckx, John G. Webb, Stephan Windecker, Patrick W. Serruys and Martin B. Leon

Objectives The aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI)clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand the understanding of patient risk stratification and case selection.

01 septiembre 2012

CIRCULATION. The Transcatheter Valve Revolution Time for a Compensatory Pause

Frederick G.P. Welt, MS, MD; Michael J. Davidson, MD; Andrew C. Eisenhauer, MD

The last 2 years have seen a torrent of information regarding transcatheter aortic valve replacement (TAVR), and it is no exaggeration to say that this compelling technology has revolutionized our approach to treatment of valvular aortic stenosis. High-risk and inoperable patients heretofore relegated to minimally effective medical therapies have been offered a return to activity and, in some cases, a longer life.1,2

01 septiembre 2012

EUROPEAN HEART JOURNAL. Expert review document part 2: methodology, terminology and clinical applications of optical coherence tomography for the assessment of interventional procedures

Introduction: This document is complementary to an Expert Review Document on Optical Coherence Tomography (OCT) for the study of coronary arteries and atherosclerosis.1 The goal of this companion manuscript is to provide a practical guide framework for the appropriate use and reporting of the novel frequency domain (FD) OCT imaging to guide interventional procedures, with a particular interest on the comparison with intravascular ultrasound (IVUS).

01 septiembre 2012

CIRCULATION. Left Bundle-Branch Block Induced by Transcatheter Aortic Valve Implantation Increases Risk of Death

Patrick Houthuizen, MD*; Leen A.F.M. Van Garsse, MD*; Thomas T. Poels; Peter de Jaegere, MD, PhD; Robert M.A. van der Boon; Ben M. Swinkels, MD; Jurriën M. ten Berg, MD, PhD; Frank van der Kley, MD; Martin J. Schalij, MD, PhD; Jan Baan Jr, MD, PhD; Ricardo Cocchieri, MD; Guus R.G. Brueren, MD, PhD; Albert H.M. van Straten, MD, PhD; Peter den Heijer, MD, PhD; Mohamed Bentala, MD; Vincent van Ommen, MD, PhD; Jolanda Kluin, MD, PhD; Pieter R. Stella, MD, PhD; Martin H. Prins, MD, PhD; Jos G. Maessen, MD, PhD; Frits W. Prinzen, PhD

Background—Transcatheter aortic valve implantation (TAVI) is a novel therapy for treatment of severe aortic stenosis. Although 30% to 50% of patients develop new left bundle-branch block (LBBB), its effect on clinical outcome is unclear.

01 agosto 2012

EUROPEAN HEART JOURNAL. The future of simulation technologies for complex cardiovascular procedures

Christopher U. Cates and Anthony G. Gallagher

Changing work practices and the evolution of more complex interventions in cardiovascular medicine are forcing a paradigm shift in the way doctors are trained. Implantable cardioverter defibrillator (ICD), trasncatheter aortic valve implantation (TAVI), carotid artery stenting (CAS), and acute stroke intervention procedures are forcing these changes at a faster pace than in other disciplines. As a consequence, cardiovascular medicine has had to develop a sophisticated understanding of precisely what is meant by ‘training’ and ‘skill’. An evolving conclusion is that procedure training on a virtual reality (VR) simulator presents a viable current solution. These simulations should characterize the important performance characteristics of procedural skill that have metrics derived and defined from, and then benchmarked to experienced operators (i.e. level of proficiency). Simulation training is optimal with metric-based feedback, particularly formative trainee error assessments, proximate to their performance. In prospective, randomized studies, learners who trained to a benchmarked proficiency level on the simulator performed significantly better than learners who were traditionally trained. In addition, cardiovascular medicine now has available the most sophisticated virtual reality simulators in medicine and these have been used for the roll-out of interventions such as CAS in the USA and globally with cardiovascular society and industry partnered training programmes. The Food and Drug Administration has advocated the use of VR simulation as part of the approval of new devices and the American Board of Internal Medicine has adopted simulation as part of its maintenance of certification. Simulation is rapidly becoming a mainstay of cardiovascular education, training, certification, and the safe adoption of new technology. If cardiovascular medicine is to continue to lead in the adoption and integration of simulation, then, it must take a proactive position in the development of metric-based simulation curriculum, adoption of proficiency benchmarking definitions, and then resolve to commit resources so as to continue to lead this revolution in physician training.