01 enero 2012

CIRCULATION. ST-Elevation Acute Coronary Syndromes in the Platelet Inhibition and Patient Outcomes (PLATO) Trial

Paul W. Armstrong, MD; Hany Siha, MD; Yuling Fu, MD; Cynthia M. Westerhout, PhD; Ph. Gabriel Steg, MD; Stefan K. James, MD, PhD; Robert F. Storey, MD, DM; Jay Horrow, MD; Hugo Katus, MD; Peter Clemmensen, MD, PhD; Robert A. Harrington, MD; Lars Wallentin, MD, PhD

Background—Ticagrelor, when compared with clopidogrel, reduced the 12-month risk of vascular death/myocardial infarction and stroke in patients with ST-elevation acute coronary syndromes intended to undergo primary percutaneous coronary intervention in the PLATelet inhibition and patient Outcomes (PLATO) trial. This prespecified ECG substudy explored whether ticagrelor s association with vascular death and myocardial infarction within 1 year would be amplified by (1) the extent of baseline ST shift and (2) subsequently associated with fewer residual ST changes at hospital discharge.

01 febrero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. ST-Segment Elevation Myocardial Infarction, Cardiac Arrest, and Cardiogenic Shock. An Interventional Triumvirate of Opportunity

Karl B. Kern, MD

Cardiogenic shock following myocardial infarction remains a significant clinical challenge. Newly reported 30-day mortality rates remain in the 40% range and are not affected by the use of intra-aortic balloon counterpulsation (1). Few cardiac conditions are more deadly. The major exception is patients who suffer cardiac arrest with their ST-segment elevation myocardial infarction (STEMI) and, once resuscitated, manifest cardiogenic shock. Garot et al. (2) from Paris have shown that such patients have a 6-month mortality of 67%. In this post–cardiac arrest population, multiple stepwise logistic regression analysis showed the absence of shock on admission to be independently associated with improved 6-month survival (odds ratio [OR]: 12.66, 95% confidence interval [CI]: 3.39 to 47.63) (2). In a separate report, Mooney et al. (3) found similar poor outcomes among those resuscitated from cardiac arrest with subsequent cardiogenic shock. In their series of 140 patients resuscitated from out-of-hospital cardiac arrest, 61 (44%) manifested cardiogenic shock. Post–cardiac arrest patients with shock had a significantly higher in-hospital mortality rate than those without (62% vs. 30%; OR: 0.26, 95% CI: 0.13 to 0.53).

01 febrero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. The Safety and Outcomes of Chronic Total Occlusion Interventions

Brigitta C. Brott, MD

The percutaneous treatment of chronic total occlusions (CTO) is often viewed as one of the remaining frontiers of interventional cardiology. It remains a challenging procedure, associated with increased risk of significant complications. Chronic total occlusions are present in approximately 15% of patients referred for cardiac catheterization and in approximately 23% of those with multivessel or left main disease, and attempted percutaneous revascularization rates are low at approximately 13% ((1),2). In addition, many cardiologists favor medical therapy of these lesions with referral for coronary artery bypass grafting (CABG) for refractory symptoms, because these lesions are by definition categorized as stable coronary artery disease. Therefore, they consider CTO patients in the same group as those treated in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial (3). This approach has recently been challenged by a meta-analysis of 7,182 patients with stable coronary artery disease comparing optimal medial therapy and percutaneous coronary intervention (PCI), which found greater angina relief both short- and long-term (4). More importantly, in the COURAGE trial, those with moderate to large regions of ischemia demonstrated a survival benefit with percutaneous treatment (5).

01 enero 2012

CIRCULATION. Six-Month Versus 12-Month Dual Antiplatelet Therapy After Implantation of Drug-Eluting Stents. The Efficacy of Xience/Promus Versus Cypher to Reduce Late Loss After Stenting (EXCELLENT) Randomized, Multicenter Study

Hyeon-Cheol Gwon, MD*; Joo-Yong Hahn, MD*; Kyung Woo Park, MD; Young Bin Song, MD; In-Ho Chae, MD; Do-Sun Lim, MD; Kyoo-Rok Han, MD; Jin-Ho Choi, MD; Seung-Hyuk Choi, MD; Hyun-Jae Kang, MD; Bon-Kwon Koo, MD; Taehoon Ahn, MD; Jung-Han Yoon, MD; Myung-Ho Jeong, MD; Taek-Jong Hong, MD; Woo-Young Chung, MD; Young-Jin Choi, MD; Seung-Ho Hur, MD; Hyuck-Moon Kwon, MD; Dong-Woon Jeon, MD; Byung-Ok Kim, MD; Si-Hoon Park, MD; Nam-Ho Lee, MD; Hui-Kyung Jeon, MD; Yangsoo Jang, MD; Hyo-Soo Kim, MD

Background—The optimal duration of dual antiplatelet therapy (DAPT) after implantation of drug-eluting coronary stents remains undetermined. We aimed to test whether 6-month DAPT would be noninferior to 12-month DAPT after implantation of drug-eluting stents.

01 febrero 2013

JACC. Prognostic Impact of the Presence and Absence of Angina on Mortality and Cardiovascular Outcomes in Patients With Type 2 Diabetes and Stable Coronary Artery Disease

Gilles R. Dagenais, MD; Jiang Lu, MS; David P. Faxon, MD; Peter Bogaty, MD; Dale Adler, MD; Francisco Fuentes, MD; Jorge Escobedo, MD; Ashok Krishnaswami, MD; James Slater, MD; Robert L. Frye, MD

Objectives: The purpose of this analysis was to assess in patients with type 2 diabetes and stable coronary artery disease (CAD) whether the risk of all-cause mortality and cardiovascular events varied according to the presence or absence of angina and angina equivalent symptoms.

01 febrero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Angiographic Success and Procedural Complications in Patients Undergoing Percutaneous Coronary Chronic Total Occlusion Interventions

Vishal G. Patel, MD; Kimberly M. Brayton, MD, JD; Aracely Tamayo, MSW, MPH; Owen Mogabgab, MD; Tesfaldet T. Michael, MD, MPH; Nathan Lo, MD; Mohammed Alomar, MD; Deborah Shorrock; Daisha Cipher, PhD; Shuaib Abdullah, MD; Subhash Banerjee, MD; Emmanouil S. Brilakis, MD, PhD

Objectives: This study sought to perform a weighted meta-analysis of the complication risk during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

01 febrero 2012

CIRCULATION. Residual Shunt After Ductus Arteriosus Occluder Implantation Complicated by Late Endocarditis

Christophe Saint-André, JD; Xavier Iriart, MD; Hopewell Ntsinjana, MD; Jean-Benoît Thambo, MD

We report the case of a 20-year-old woman who had percutaneous closure of a patent ductus arteriosus (PDA) with a 17-mm Rashkind occluder when she was 4 years of age. A small residual shunt was noted on color-flow Doppler echocardiography immediately after the procedure and at 6-month follow-up. Because of the lack of hemodynamic complications, no additional intervention was performed.

01 febrero 2012

JACC. Intracoronary Enalaprilat to Reduce Microvascular Damage During Percutaneous Coronary Intervention (ProMicro) Study

Fabio Mangiacapra, MD, PhD; Aaron J. Peace, MD, PhD; Luigi Di Serafino, MD, PhD; Stylianos A. Pyxaras, MD; Jozef Bartunek, MD, PhD; Eric Wyffels, MD; Guy R. Heyndrickx, MD, PhD; William Wijns, MD, PhD; Bernard De Bruyne, MD, PhD; Emanuele Barbato, MD, PhD

Objectives: This study investigated the influence of intracoronary enalaprilat on coronary microvascular function and peri-procedural outcome measures in patients with stable angina undergoing percutaneous coronary intervention (PCI).

01 febrero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Percutaneous Closure of Paravalvular Leak After Transcatheter Aortic Valve Replacement

Jane Luu, MD, MPH; Omar Ali, MD; Ted E. Feldman, MD; Matthew J. Price, MD

Paravalvular leak (PVL) occurs more frequently after transcatheter aortic valve replacement (TAVR) than after surgical replacement (1). PVL may be due to prosthesis underexpansion, undersizing, impingement of calcium nodules interfering with stent expansion, or incorrect positioning so the valve skirt is not completely apposed to the aortic annulus. Even mild PVL is associated with increased late mortality (1). Clinical experience with percutaneous closure of PVL after TAVR is limited, but this could be a reasonable strategy in these high-risk patients. Prior devices used for percutaneous closure have required delivery guide sheaths from 5- to 8-F (2). Two patients with severe aortic stenosis and New York Heart Association class IV symptoms underwent TAVR with a 26-mm Sapien valve (Edwards Lifesciences, Irvine, California) complicated by moderate-to-severe aortic insufficiency (AI) and acute heart failure. In both cases, the PVL was closed successfully with an Amplatzer Vascular Plug (AVP)-4 (St. Jude, St. Paul, Minnesota) delivered through a 4- or 5-F diagnostic catheter, with subsequent resolution of symptoms (Figs. (Figure 26_gr1) and Figure 26_gr2).

01 febrero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Transcatheter Left Atrial Appendage Closure After Incomplete Surgical Ligation

Takashi Matsumoto, MD; Mamoo Nakamura, MD; Wen-Loong Yeow, MD; Robert J. Siegel, MD; Saibal Kar, MD

An 82-year-old woman with chronic atrial fibrillation on full anticoagulation with warfarin was referred for a repeat attempt to close the left atrial appendage (LAA) with a transcatheter, transseptal approach. In April 2011, she underwent surgical mitral and tricuspid repair, ligation of the LAA, and unsuccessful MAZE procedure. A subsequent transesophageal echocardiogram (TEE) demonstrated residual communication (asterisk and white arrow) between the left atrium and LAA by pulsed and color flow Doppler ((Figure 15_gr1)A,Figure 15_gr1B).

01 febrero 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Protective Effect of Telmisartan Against Endothelial Dysfunction After Coronary Drug-Eluting Stent Implantation in Hypertensive Patients

Mitsuyasu Terashima, MD; Hideaki Kaneda, MD; Kenya Nasu, MD; Hitoshi Matsuo, MD; Maoto Habara, MD; Tsuyoshi Ito, MD; Nobuyoshi Tanaka, MD; Sudhir Rathore, MD; Yoshihisa Kinoshita, MD; Masashi Kimura, MD; Mariko Ehara, MD; Yasuyoshi Suzuki, BS; Takahiko Suzuki, MD

Objectives: The aim of this prospective, randomized study was to evaluate the effects of telmisartan, compared with the calcium-channel blocker amlodipine, on endothelial function after coronary drug-eluting stent (DES) implantation in hypertensive patients.

01 febrero 2013

JACC. Safety and Efficacy of Second-Generation Everolimus-Eluting Xience V Stents Versus Zotarolimus-Eluting Resolute Stents in Real-World Practice

Kyung Woo Park, MD, PhD; Joo Myung Lee, MD; Si-Hyuck Kang, MD; Hyo-Suk Ahn, MD; Han-Mo Yang, MD, PhD; Hae-Young Lee, MD, PhD; Hyun-Jae Kang, MD, PhD; Bon-Kwon Koo, MD, PhD; Janghyun Cho, MD, PhD; Hyeon-Cheol Gwon, MD, PhD; Sung Yoon Lee, MD, PhD; In-Ho Chae, MD, PhD; Tae-Jin Youn, MD, PhD; Jei Keon Chae, MD, PhD; Kyoo-Rok Han, MD, PhD; Cheol Woong Yu, MD, PhD; Hyo-Soo Kim, MD, PhD

Objectives This study sought to compare the safety and efficacy of the Xience V/Promus everolimus-eluting stent (EES) (Abbott Vascular, Temecula, California) with the Endeavor Resolute zotarolimus-eluting stent (ZES-R) (Medtronic Cardiovascular, Santa Rosa, California) in “all-comer” cohorts.

01 febrero 2013

AMERICAN HEART JOURNAL. Safety and efficacy of everolimus- versus sirolimus-eluting stents: A systematic review and meta-analysis of 11 randomized trials

Kyung Woo Park, MD, PhD , Si-Hyuck Kang, MD , Matthijs A. Velders, MD , Dong-Ho Shin, MD , Seokyung Hahn, PhD , Woo-Hyun Lim, MD , Han-Mo Yang, MD, PhD , Hae-Young Lee, MD, PhD , Adrianus J. Van Boven, MD, PhD , Sjoerd H. Hofma, MD, PhD , Hyun-Jae Kang, MD, PhD , Bon-Kwon Koo, MD, PhD , Byung-Hee Oh, MD, PhD , Young-Bae Park, MD, PhD , David E. Kandzari, MD , Hyo-Soo Kim, MD, PhD

Background: While EES have proven superior to paclitaxel-eluting stents, it remains uncertain whether EES improve clinical outcomes compared to SES, which are the most efficacious among the first-generation drug-eluting stents. We performed a meta-analysis of randomized trials comparing the efficacy and safety of everolimus-eluting stents (EES) versus sirolimus-eluting stents (SES) in patients undergoing percutaneous coronary intervention.

01 febrero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Frequency-Domain Optical Coherence Tomography Assessment of Stent Constriction 9 Months After Sirolimus-Eluting Stent Implantation in a Highly Calcified Plaque

Yusuke Fujino, MD; Guilherme F. Attizzani, MD; Sunao Nakamura, MD; Marco A. Costa, MD, PhD; Hiram G. Bezerra, MD, PhD

A 60-year-old man with a history of chronic renal failure in hemodialysis was admitted due to angina symptoms. Coronary angiography showed an eccentric lesion of distal unprotected left main coronary artery involving the ostium of left anterior descending artery (Figure 22_gr1A). Frequency-domain optical coherence tomography (FD-OCT) revealed a calcified plaque protruding to the lumen (Figure 22_gr1-a). Rotational atherectomy with a 2.0-mm burr (Figure 22_gr1-b) was conducted before the implantation of a 3.5 × 18 mm sirolimus-eluting stent at 12 atm., which was followed by intra-stent post-dilation with a noncompliant 4.0 × 12 mm balloon at 18 atm. (Figure 22_gr1C, c).

01 febrero 2012

JACC: CARDIOVASCULAR INTERVENTIONS. Myocardial Circulation Distal to Chronic Total Occlusions. A Brighter Light at the End of the Tunne

Javier Escaned, MD, PhD; Justin E. Davies, MBBS, PhD

The role of collateral circulation is at the core of the discussion over the net benefit of chronic total occlusion (CTO) recanalization in patients with stable coronary artery disease. Myocardial viability beyond a CTO would have been unthinkable without the pioneer work of Gregg et al. (1) in instrumented dogs, demonstrating the importance of a steady build-up in distal coronary pressure in response to progressively tighter coronary stenosis and its protective effect in complete vessel occlusion. Coronary angiography, introduced 25 years after their research, revealed the extraordinary prevalence of collateral development as an adaptive response of the human heart to occlusive coronary disease. Blood supply in the myocardium subtended by a chronically occluded vessel has been customarily estimated by combining angiography with ischemia-detection techniques. However, many physicians feel that, in most CTO cases with a well-developed collateral circulation, there is little room for clinical worsening and, therefore, revascularization can be safely avoided.