01 octubre 2012

JACC CARDIOVASCULAR INTERVENTIONS. Will We Ever Know the Optimal Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation?

Adnan Kastrati, MD; Robert A. Byrne, MBBCh; Stefanie Schulz, MD

Drug-eluting stents (DES) have emerged as the most effective means to reduce restenosis after percutaneous coronary intervention (PCI) (1- 2). However, high antirestenotic efficacy in comparison with bare-metal stents (BMS) is achieved at the expense of a delay in healing of the stented arterial segment (3). Although meta-analyses of randomized trials could not confirm initial reports concerning a higher overall risk of stent thrombosis with DES compared with BMS (4- 6), there seems to be a different distribution of events over time with a tendency toward more thrombotic events with BMS early after PCI and an excess of events very late after PCI with DES. J Am Coll Cardiol Intv. 2011;4(10):1129-1132. doi:10.1016/j.jcin.2011.08.003. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

01 octubre 2011

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Bleeding Risk Comparing Targeted Low-Dose Heparin With Bivalirudin in Patients Undergoing Percutaneous Coronary Intervention. Results From EVENT Registry

Sripal Bangalore, MD, MHA, David J. Cohen, MD, MSc, Neal S. Kleiman, MD, Tal Regev-Beinart, MD, Sunil V. Rao, MD, Michael J. Pencina, PhD and Laura Mauri, MD, MSc on behalf of the EVENT Registry Investigators, Boston, MA

Background—Prior randomized trials have shown reduced bleeding with bivalirudin compared with unfractionated heparin (UFH) in patients undergoing percutaneous coronary intervention (PCI). However, it is not known if this benefit is also present when UFH doses are more tightly controlled (as measured by activated clotting time, ACT). Circulation: Cardiovascular Interventions. 2011; 4: 463-473 Published online before print October 4, 2011, doi: 10.1161/​CIRCINTERVENTIONS.111.961912. Copyright © 2012 American Heart Association, Inc.

01 octubre 2011

CIRCULATION. Coronary Artery Bypass Surgery With or Without Mitral Valve Annuloplasty in Moderate Functional Ischemic Mitral Regurgitation. Final Results of the Randomized Ischemic Mitral Evaluation (RIME) Trial

K.M. John Chan, FRCS CTh; Prakash P. Punjabi, FRCS CTh; Marcus Flather, MD, FRCP; Riccardo Wage, DCR (R); Karen Symmonds, DCR (R); Isabelle Roussin, MD; Shelley Rahman-Haley, MD, FRCP; Dudley J. Pennell, MD, FRCP; Philip J. Kilner, MD, PhD; Gilles D. Dreyfus, MD; John R. Pepper, MChir, FRCS for the RIME Investigators

Background—The role of mitral valve repair (MVR) during coronary artery bypass grafting (CABG) in patients with moderate ischemic mitral regurgitation (MR) is uncertain. We conducted a randomized, controlled trial to determine whether repairing the mitral valve during CABG may improve functional capacity and left ventricular reverse remodeling compared with CABG alone. Circulation. 2012; 126: 2502-2510 Published online before print November 7, 2012, doi: 10.1161/​CIRCULATIONAHA.112.143818. Copyright © 2012 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

01 octubre 2011

JACC CARDIOVASCULAR INTERVENTIONS. Dual Antiplatelet Therapy Duration and Clinical Outcomes Following Treatment With Zotarolimus-Eluting Stents

David E. Kandzari, MD; Colin S. Barker, MD; Martin B. Leon, MD; Laura Mauri, MD, MSc; William Wijns, MD, PhD; Jean Fajadet, MD; Roxana Mehran, MD

Objectives: We sought to evaluate differences in late safety outcomes relative to dual antiplatelet therapy (DAPT) duration in patients treated with zotarolimus-eluting stents (ZES). J Am Coll Cardiol Intv. 2011;4(10):1119-1128. doi:10.1016/j.jcin.2011.06.017. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

01 octubre 2012

JACC CARDIOVASCULAR INTERVENTIONS. Vascular Inflammation and Repair. Implications for Re-Endothelialization, Restenosis and Stent Thrombosis

Teruo Inoue, MD, PhD; Kevin Croce, MD, PhD; Toshifumi Morooka, MD; Masashi Sakuma, MD; Koichi Node, MD; Daniel I. Simon, MD

The cellular and molecular processes that control vascular injury responses after percutaneous coronary intervention involve a complex interplay among vascular cells and progenitor cells that control arterial remodeling, neointimal proliferation, and re-endothelialization. Drug-eluting stents (DES) improve the efficacy of percutaneous coronary intervention by modulating vascular inflammation and preventing neointimal proliferation and restenosis. Although positive effects of DES reduce inflammation and restenosis, negative effects delay re-endothelialization and impair endothelial function. Delayed re-endothelialization and impaired endothelial function are linked to stent thrombosis and adverse clinical outcomes after DES use. Compared with bare-metal stents, DES also differentially modulate mobilization, homing, and differentiation of vascular progenitor cells involved in re-endothelialization and neointimal proliferation. The effects of DES on vascular inflammation and repair directly impact clinical outcomes with these devices and dictate requirements for extended-duration dual antiplatelet therapy. J Am Coll Cardiol Intv. 2011;4(10):1057-1066. doi:10.1016/j.jcin.2011.05.025. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

01 octubre 2011

CIRCULATION. Calcific Aortic Valve Disease: Not Simply a Degenerative Process

Nalini M. Rajamannan, MD; Frank J. Evans, PhD; Elena Aikawa, MD, PhD; K. Jane Grande-Allen, PhD; Linda L. Demer, MD, PhD; Donald D. Heistad, MD; Craig A. Simmons, PhD; Kristyn S. Masters, PhD; Patrick Mathieu, MD; Kevin D. O Brien, MD; Frederick J. Schoen, MD, PhD; Dwight A. Towler, MD, PhD; Ajit P. Yoganathan, PhD; Catherine M. Otto, MD

Calcific aortic valve disease (CAVD) encompasses the range of disease from initial alterations in the cell biology of the leaflets to end-stage calcification resulting in left ventricular outflow obstruction. The first detectable macroscopic changes in the leaflets, seen as calcification, or focal leaflet thickening with normal valve function, is termed aortic valve sclerosis, but it is likely that the initiating events in the disease process occur much earlier. Disease progression is characterized by a process of thickening of the valve leaflets and the formation of calcium nodules—often including the formation of actual bone—and new blood vessels, which are concentrated near the aortic surface. End-stage disease, eg, calcific aortic stenosis, is characterized pathologically by large nodular calcific masses within the aortic cusps that protrude along the aortic surface into the sinuses of Valsalva, interfering with opening of the cusps. There is no disease along the ventricular surface. For decades, this disease was thought to be a passive process in which the valve degenerates with age in association with calcium accumulation. Moreover, although CAVD is more common with age, it is not an inevitable consequence of aging. Instead, CAVD appears to be an actively regulated disease process that cannot be characterized exclusively as senile or degenerative. Circulation. 2011; 124: 1783-1791 doi: 10.1161/​CIRCULATIONAHA.110.006767 Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

01 octubre 2011

JACC CARDIOVASCULAR INTERVENTIOS. Should Everolimus-Eluting Stents Be Preferred in Patients With Acute and Stable Coronary Syndromes?

Sanjay Kaul, MD; George A. Diamond, MD

Drug-eluting stents (DES) were first approved in the United States in 2003 on the basis of improvement in angiographic and clinical restenosis. The first 2 DES, now referred to as “first-generation” DES, were the sirolimus-eluting stent (SES) (Cypher, Cordis Corporation, Miami Lakes, Florida; approved in 2003) and paclitaxel-eluting stent (PES) (Taxus, Boston Scientific, Natick, Massachusetts; approved in 2004). Within a few months of approval, early signs began to accumulate suggesting that DES were associated with increased risk of sub-acute stent thrombosis and adverse cardiac outcomes. This was followed by indications that the benefits of DES relative to restenosis and target-lesion revascularization (TLR) might have been overestimated and risks relative to stent thrombosis (ST) might have been underestimated in preapproval randomized controlled trials conducted primarily in relatively low-risk patients and lesions, compared with more complex patients and lesions treated in clinical practice (the so-called “off-label use”) J Am Coll Cardiol Intv. 2011;4(10):1116-1118. doi:10.1016/j.jcin.2011.09.001. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

01 octubre 2011

JACC CARDIOVASCULAR INTERVENTIONS. Assessing the Temporal Course of Neointimal Hyperplasia Formation After Different Generations of Drug-Eluting Stents

Carlos A. Collet, MD; J. Ribamar Costa, MD; Alexandre Abizaid, MD, PhD; Daniel Chamié, MD; Rodolfo Staico, MD; Ricardo Costa, MD; Dimytri Siquera, MD; Javier Obregon, MD; Fausto Feres, MD, PhD; Amanda Sousa, MD, PhD; Jose Eduardo Sousa, MD, PhD

Objectives This study sought to assess the temporal course of neointimal hyperplasia (NIH) formation following implantation of 2 different generations of drug-eluting stents (DES). J Am Coll Cardiol Intv. 2011;4(10):1067-1074. doi:10.1016/j.jcin.2011.07.010. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

01 octubre 2011

CIRCULATION. Causes of Delay and Associated Mortality in Patients Transferred With ST-Segment–Elevation Myocardial Infarction

Michael D. Miedema, MD; Marc C. Newell, MD; Sue Duval, PhD; Ross F. Garberich, MS; Chauncy B. Handran, BS; David M. Larson, MD; Steven Mulder, MD; Yale L. Wang, MD; Daniel L. Lips, MD; Timothy D. Henry, MD

Background—Regional ST-segment–elevation myocardial infarction systems are being developed to improve timely access to primary percutaneous coronary intervention (PCI). System delays may diminish the mortality benefit achieved with primary PCI in ST-segment–elevation myocardial infarction patients, but the specific reasons for and clinical impact of delays in patients transferred for PCI are unknown. 2011; 124: 1636-1644 Published online before print September 19, 2011, doi: 10.1161/​CIRCULATIONAHA.111.033118. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

01 octubre 2012

CIRCULATION. Thrombus Formation on a Left Atrial Appendage Closure Device

Lorette Cardona, MD; Galrinho Ana, MD; Branco Luísa, MD, FESC; Ana Leal; Fiarresga António, MD; Sousa Lídia, MD; Ferreira Rui Cruz, MD

Transcatheter closure of the left atrial appendage (LAA) is becoming more common as an interventional therapy to prevent thromboembolic complications in patients with atrial fibrillation (AF) and contraindications to chronic oral anticoagulation. Most of the studies about this new technique demonstrated its safety as an alternative method to oral anticoagulation in this group of patients.1 One of the feared complications is thrombus formation in relation with the device. To prevent this, patients are medicated with long-term antiplatelet treatment.1 A case is reported in which a thrombus was noted on the left side of an Amplatzer Cardiac Plug by transesophageal echocardiography, and anticoagulation had to be started. Circulation. 2011; 124: 1595-1596 doi: 10.1161/​CIRCULATIONAHA.110.004135. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

26 agosto 2011

RADIOLOGY. Effect of Metabolic Syndrome on Coronary Artery Stenosis and Plaque Characteristics as Assessed with 64–Detector Row Cardiac CT

Soo Lim, MD, PhD, Hayley Shin, MPH, Yenna Lee, MD, Ji Won Yoon, MD, Seon Mee Kang, MD, Sung Hee Choi, MD, PhD, Kyong Soo Park, MD, PhD, Hak Chul Jang, MD, PhD, Sang Il Choi, MD, PhD and Eun Ju Chun, MD, PhD

Purpose: To investigate the prevalence and severity of subclinical coronary atherosclerosis and plaque characteristics in asymptomatic subjects according to the presence or absence of metabolic syndrome (MS) with multidetector computed tomography (CT). Published online before print August 26, 2011, doi: 10.1148/radiol.11101725 November 2011 Radiology, 261, 437-445. Copyright © RSNA, 2011

01 octubre 2011

JACC CARDIOVASCULAR INTERVENTIONS. Effects of Increasing Doses of Intracoronary Adenosine on the Assessment of Fractional Flow Reserve

Giuseppe De Luca, MD, PhD; Luca Venegoni, MD; Sergio Iorio, MD; Livio Giuliani, MD; Paolo Marino, MD

Objectives The purpose of this study was to investigate the effects of increasing dose of intracoronary adenosine on fractional flow reserve (FFR) measurement. J Am Coll Cardiol Intv. 2011;4(10):1079-1084. doi:10.1016/j.jcin.2011.08.004. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

01 octubre 2011

JACC CARDIOVASCULAR INTERVENTIONS. Late Vascular Response Following Drug-Eluting Stent Implantation

Lorenz Räber, MD; Patrick W. Serruys, MD, PhD

The therapeutic effect of drug-eluting stents (DES) as compared with bare-metal stents (BMS) is most pronounced during the first year as a result of the potent inhibition of neointimal hyperplasia in the presence of the antiproliferative drug. Whereas healing with BMS, and in parallel, neointimal proliferation, has been shown to be complete after 3 to 6 months (1), potentially followed by a late lumen enlargement beyond 1 year, a different pattern emerged with early generation DES, characterized by delayed healing with an ongoing neointimal growth beyond 6 months in both experimental and clinical studies (2- 3). However, the long-term course of neointimal growth has not been well investigated in early generation DES, and it remains unclear whether newer generation DES show a similar response despite improvements in design. J Am Coll Cardiol Intv. 2011;4(10):1075-1078. doi:10.1016/j.jcin.2011.06.016. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

01 octubre 2011

CIRCULATION. Changing Reflections of the Coronary Microcirculation After Percutaneous Aortic Valve Replacement. Novel Observations With Arterial Pulsed Wave Dynamics

Morton J. Kern, MD

In this issue of Circulation, Davies et al1 assess the changes in coronary blood flow and reserve after the relief of aortic stenosis (AS) by percutaneous aortic valve replacement (PAVR) and implicate these findings as additional mechanisms bearing on the critical role of the coronary microcirculation in this population. Circulation. 2011; 124: 1505-1507 doi: 10.1161/​CIRCULATIONAHA.111.058552. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539

01 noviembre 2011

CIRCULATION. Randomized Trial of Cutting Balloon Compared With High-Pressure Angioplasty for the Treatment of Resistant Pulmonary Artery Stenosis

Lisa Bergersen, MD, MPH; Kimberlee Gauvreau, ScD; Henri Justino, MD; Alan Nugent, MD; Jonathon Rome, MD; Jacqueline Kreutzer, MD; John Rhodes, MD; David Nykanen, MD; Evan Zahn, MD; Larry Latson, MD; Phillip Moore, MD; James Lock, MD; Kathy Jenkins, MD, MPH

Background—We sought to determine the safety and efficacy of Cutting Balloon therapy (CB) compared with conventional high-pressure balloon therapy (HPB) for the treatment of pulmonary artery stenosis. Circulation. 2011; 124: 2388-2396 Published online before print October 31, 2011, doi: 10.1161/​CIRCULATIONAHA.111.018200. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539 Circulation. 2011; 124: 2388-2396 Published online before print October 31, 2011, doi: 10.1161/​CIRCULATIONAHA.111.018200. Copyright © 2011 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539