15 abril 2012

JACC. A Randomized Controlled Trial in Second-Generation Zotarolimus-Eluting Resolute Stents Versus Everolimus-Eluting Xience V Stents in Real-World Patients. The TWENTE Trial

Clemens von Birgelen, MD, PhD; Mounir W.Z. Basalus, MD; Kenneth Tandjung, MD; K. Gert van Houwelingen, MD; Martin G. Stoel, MD; J.(Hans) W. Louwerenburg, MD; Gerard C.M. Linssen, MD, PhD; Salah A.M. Saïd, MD, PhD; Miep A.W.J. Kleijne, MD; Hanim Sen, MD; Marije M. Löwik, PhD; Job van der Palen, PhD; Patrick M.J. Verhorst, MD, PhD; Frits H.A.F. de Man, MD, PhD

Objectives The aim of this study was to compare the safety and efficacy of Resolute zotarolimus-eluting stents (ZES) (Medtronic Cardiovascular, Santa Rosa, California) with Xience V everolimus-eluting stents (EES) (Abbott Vascular Devices, Santa Clara, California) at 1-year follow-up.

15 abril 2012

JACC. A Randomized, Multicenter, Single-Blinded Trial Comparing Paclitaxel-Coated Balloon Angioplasty With Plain Balloon Angioplasty in Drug-Eluting Stent Restenosis. The PEPCAD-DES Study

Harald Rittger, MD; Johannes Brachmann, MD; Anil-M. Sinha, MD, DPhil; Matthias Waliszewski, MD; Marc Ohlow, MD; Andreas Brugger, MD; Holger Thiele, MD; Ralf Birkemeyer, MD; Volkhard Kurowski, MD; Ole-A. Breithardt, MD; Martin Schmidt, MD; Stefan Zimmermann, MD; Sandra Lonke; Moritz von Cranach; The-Vinh Nguyen; Werner G. Daniel, MD; Jochen Wöhrle, MD

Objectives: This study sought to define the impact of paclitaxel-coated balloon angioplasty for treatment of drug-eluting stent restenosis compared with uncoated balloon angioplasty alone.

04 enero 2011

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Value of Age, Creatinine, and Ejection Fraction (ACEF Score) in Assessing Risk in Patients Undergoing Percutaneous Coronary Interventions in the All-Comers LEADERS Trial

Joanna J. Wykrzykowska, MD, Scot Garg, MBChB, MRCP, Yoshinobu Onuma, MD, Ton de Vries, MSc, Dick Goedhart, PhD, Marie-Angele Morel, BSc, Gerrit-Anne van Es, PhD, Pawel Buszman, MD, Axel Linke, MD, Thomas Ischinger, MD, Volker Klauss, MD, Roberto Corti, MD, Franz Eberli, MD,, PhD, William Wijns, MD, Marie-Claude Morice, MD, Carlo di Mario, MD, PhD, Robert Jan van Geuns, MD, PhD, Peter Juni, MD, PhD, Stephan Windecker, MD, PhD and Patrick W. Serruys, MD, PhD

Background— The age, creatinine, and ejection fraction (ACEF) score (age/left ventricular ejection fraction+1 if creatinine >2.0 mg/dL) has been established as an effective predictor of clinical outcomes in patients undergoing elective coronary artery bypass surgery; however, its utility in “all-comer” patients undergoing percutaneous coronary intervention is yet unexplored.

01 febrero 2012

CIRCULATION. Coronary Ostial Stenosis in a Young Patient

Horea Feier, MD, PhD; Dan Cioata, MD; Dragos Teodorescu-Branzeu, MD, PhD; Marian Gaspar, MD, PhD

A 37-year-old man presented to our department complaining of severe chest pain triggered by the slightest physical exercise. The symptoms appeared 6 months previously and have gradually worsened. His medical history was unremarkable, and he had no cardiovascular risk factors except smoking. A 6-lead ECG at rest was normal, as was the chest x-ray. The ultrasonography examination revealed severe aortic regurgitation and a moderately enlarged left ventricle with normal systolic function. The treadmill test was positive for myocardial ischemia. He subsequently underwent a catheter examination that diagnosed severe right and left main coronary ostial stenoses along with severe aortic valve incompetence (Figure 1A and 1B). A computed tomographic examination confirmed these findings (Figure 1C and 1D), revealing an ascending aorta with a maximum transverse diameter of 3.5 cm, an irregular intima, and a thickened wall (6 mm) (Figure 1C). He was referred for urgent replacement of the aortic valve and triple total arterial coronary bypass.

01 febrero 2013

JACC. Outcomes After Coronary Computed Tomography Angiography in the Emergency Department

Edward Hulten, MD, MPH; Christopher Pickett, MD; Marcio Sommer Bittencourt, MD; Todd C. Villines, MD; Sara Petrillo, MD; Marcelo F. Di Carli, MD; Ron Blankstein, MD

Objectives: The aim of the study was to systematically review and perform a meta-analysis of randomized, controlled trials of coronary computed tomography angiography (CCTA) versus usual care (UC) triage of acute chest pain in the emergency department (ED).

01 febrero 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Acute Stent Thrombosis: Technical Complication or Inadequate Antithrombotic Therapy? An Optical Coherence Tomography Study

Sammy Elmariah, MD, MPH; Ik-Kyung Jang, MD, PhD

A 68-year-old woman was admitted to the hospital with non–ST-segment elevation myocardial infarction. Coronary angiography showed a 95% mid stenosis in the left anterior descending artery (Figure 1A). The lesion was treated with a 2.50 × 18-mm Xience drug-eluting stent (Abbott Vascular, Santa Clara, California) during bivalirudin infusion (Figure 1B). At the end of the procedure, the patient received a 600-mg loading dose of clopidogrel and bivalirudin was discontinued. Seventy minutes later, the patient experienced chest pain with anterior ST-segment elevations. Repeat angiography demonstrated acute stent thrombosis (AST) (Figure 2A). While the patient was on heparin and eptifibatide, low-pressure angioplasty was performed. Optical coherence tomography (OCT) imaging revealed an intravascular mass consistent with platelet-rich thrombus within the stent (Figure 2B).

01 febrero 2013

JACC. Percutaneous Coronary Intervention Versus Coronary Bypass Surgery in United States Veterans With Diabetes

Masoor Kamalesh, MD; Thomas G. Sharp, MD; X. Charlene Tang, MD, PhD; Kendrick Shunk, MD, PhD; Herbert B. Ward, MD, PhD; James Walsh, MD, PhD; Spencer King, MD; Cindy Colling, RPh, MS; Thomas Moritz, MS; Kevin Stroupe, PhD; Domenic Reda, PhD

Objectives: This study sought to determine the optimal coronary revascularization strategy in patients with diabetes with severe coronary disease.

01 enero 2012

JACC: CARDIOVASCULAR INTERVENTIONS. The Retrograde Technique for Recanalization of Chronic Total Occlusions. A Step-by-Step Approach

Dominique Joyal, MD; Craig A. Thompson, MD; J. Aaron Grantham, MD; Christopher E.H. Buller, MD; Stéphane Rinfret, MD, SM

Chronic total occlusion recanalization still represents the final frontier in percutaneous coronary intervention. Retrograde chronic total occlusion recanalization has recently become an essential complement to the classical antegrade approach. In experienced hands, the retrograde technique currently has a high success rate with a low complication profile, despite frequent utilization in the most anatomically and clinically complex patients. Since its initial description, important changes have occurred that make the technique faster and more successful. We propose a step-by-step approach of the technique as practiced at experienced centers in North America. Because the technique can vary substantially, we describe the different alternatives to each step and offer what we perceived to be the most efficient techniques.

01 febrero 2013

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Cost-Effectiveness of Percutaneous Coronary Intervention With Drug Eluting Stents Versus Bypass Surgery for Patients With Diabetes Mellitus and Multivessel Coronary Artery Disease. Results From the FREEDOM Trial

Elizabeth A. Magnuson, ScD; Michael E. Farkouh, MD, MSc; Valentin Fuster, MD, PhD; Kaijun Wang, PhD; Katherine Vilain, MPH; Haiyan Li, MS; Jaime Appelwick, BA; Victoria Muratov, MD, MPH; Lynn A. Sleeper, ScD; Robin Boineau, MD, MA; Mouin Abdallah, MD, MSc; David J. Cohen, MD, MSc; on behalf of the FREEDOM Trial Investigators

Background—Studies from the balloon angioplasty and bare metal stent eras have demonstrated that coronary artery bypass grafting (CABG) is cost-effective compared with percutaneous coronary intervention (PCI) for patients undergoing multivessel coronary revascularization—particularly among patients with complex coronary artery disease or diabetes mellitus. Whether these results apply in the drug-eluting stent (DES) era is unknown.

01 febrero 2013

JACC. Transcatheter Aortic Valve Implantation With the Edwards SAPIEN Versus the Medtronic CoreValve Revalving System Devices

Alaide Chieffo, MD; Gill Louise Buchanan, MBChB; Nicolas M. Van Mieghem, MD; Didier Tchetche, MD; Nicolas Dumonteil, MD; Azeem Latib, MD; Robert M.A. van der Boon, MSc; Olivier Vahdat, MD; Bertrand Marcheix, MD, PhD; Bruno Farah, MD; Patrick W. Serruys, MD, PhD; Jean Fajadet, MD; Didier Carrié, MD, PhD; Peter P.T. de Jaegere, MD, PhD; Antonio Colombo, MD

Objectives: The aim of this study was to compare outcomes after transfemoral transcatheter aortic valve implantation with the Medtronic CoreValve (MCV) versus the Edwards SAPIEN/SAPIEN XT transcatheter heart valve (ESV) for severe aortic stenosis.

01 febrero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Primary Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction, Resuscitated Cardiac Arrest, and Cardiogenic Shock

Darren Mylotte, MD; Marie-Claude Morice, MD; Hélène Eltchaninoff, MD, PhD; Jérôme Garot, MD, PhD; Yves Louvard, MD; Thierry Lefèvre, MD; Philippe Garot, MD

Objectives This study sought to assess the impact of multivessel (MV) primary percutaneous coronary intervention (PCI) on clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) presenting with cardiogenic shock (CS) and resuscitated cardiac arrest (CA).

01 febrero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. The Impact of Coronary Bifurcation Stenting Strategy on Health-Related Functional Status. A Quality-of-Life Analysis From the BBC One (British Bifurcation Coronary; Old, New, and Evolving Strategies) Study

Alex Sirker, MB BChir, PhD; Manav Sohal, MBBS; Keith Oldroyd, MD (Hons); Nick Curzen, BM (Hons), PhD; Rod Stables, DM (Oxon), BM BCh (Oxon); Adam de Belder, MD; David Hildick-Smith, MD

Objectives: This study sought to assess the impact of coronary bifurcation stenting on health-related functional status, using the Seattle Angina Questionnaire (SAQ), for participants in the BBC ONE (British Bifurcation Coronary; Old, New, and Evolving Strategies) trial and to compare simple versus complex bifurcation stenting strategies in this regard.

01 febrero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Virtual Fractional Flow Reserve From Coronary Angiography: Modeling the Significance of Coronary Lesions. Results From the VIRTU-1 (VIRTUal Fractional Flow Reserve From Coronary Angiography) Study

Paul D. Morris, MBChB; Desmond Ryan, PhD; Allison C. Morton, PhD; Richard Lycett, PhD; Patricia V. Lawford, PhD; D. Rodney Hose, PhD; Julian P. Gunn, MD

Objectives: The aim of this study was to develop a computer model that accurately predicts myocardial fractional flow reserve (FFR) from angiographic images alone, in patients with coronary artery disease.

01 enero 2012

CIRCULATION. A Case of a Double Valve

Armita Atashband, MD; Kumudha Ramasubbu, MD

A 36-year-old man was admitted to the hospital for heart failure symptoms. He had initially presented to the emergency room 3 months prior to admission for shortness of breath and a low-grade fever. At that time, he was diagnosed with possible pneumonia and started on antibiotics. Despite this, his symptoms progressed over the next few months. At presentation, he experienced dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and lower extremity edema.

01 febrero 2013

JACC. Coronary Artery Disease and Outcomes of Aortic Valve Replacement for Severe Aortic Stenosis

Jocelyn M. Beach, MD; Tomislav Mihaljevic, MD; Lars G. Svensson, MD, PhD; Jeevanantham Rajeswaran, MSc; Thomas Marwick, MD, PhD; Brian Griffin, MD; Douglas R. Johnston, MD; Joseph F. Sabik, MD; Eugene H. Blackstone, MD

Objectives: The study sought to contrast risk profiles and compare outcomes of patients with severe aortic stenosis (AS) and coronary artery disease (CAD) who underwent aortic valve replacement (AVR) and coronary artery bypass grafting (AS+CABG) with those of patients with isolated AS who underwent AVR alone.