Background: Allogenic platelet transfusions (PT) are administered to treat excessive bleeding in patients on P2Y12 receptor inhibitors (RI). We assessed the effect of ex vivo and in vivo PT on platelet activation and aggregation in patients on dual antiplatelet therapy.
Case Presentation: Two patients presented to our cardiology clinic. Mr. H was 70 years old with a history of cardiac transplantation for ischemic cardiomyopathy. He presented with worsening dyspnea. Two years ago, he could run up 2 flights of stairs but had recently started to become short of breath while walking short distances. He also described pedal edema and progressive orthopnea. His medical history was significant for coronary artery disease. On examination, we noted an elderly male (6′0″; 85 kg). The heart rate was 90 bpm with a blood pressure of 156/90 mm Hg. The SaO2 was 98% on room air. The heart sounds were normal, but we auscultated a III/VI continuous machinery murmur over the left upper sternal border. His ECG showed sinus rhythm and left ventricular hypertrophy. The chest radiograph displayed mild cardiomegaly. We performed a transthoracic echocardiogram that was remarkable for concentric left ventricular hypertrophy with normal ejection fractions. Right heart catheterization revealed normal filling pressures and cardiac output. An endomyocardial biopsy showed no evidence of allograft rejection.
Background: There is little evidence regarding the efficacy and safety of bioresorbable scaffolds (BRS) for the percutaneous treatment of chronic total occlusions.
Background: There are only little data available on the comparison of clinical outcomes between a 1-stent strategy (1-SS) and a 2-stent strategy (2-SS) for percutaneous coronary intervention in unprotected distal left main disease.
Background: The usage of rotational atherectomy (RA) is growing in the current percutaneous coronary intervention (PCI) because of the expansion of PCI indication to more complex lesions. However, the complications after RA have been linked to procedure-related morbidity and mortality. The purpose of this study was to investigate the incidence and determinants of complications in RA using a large nationwide registration system in Japan (J-PCI).
Abstract: Accurate assessment of the left main coronary artery (LMCA) is critical in determining treatment strategies and delineating revascularization options to improve prognosis. There has been an evolution in invasive techniques that allow detailed assessment of both function and anatomy. As technologies advance, there is an increasing amount of evidence supporting the use of percutaneous coronary intervention for the LMCA. This state-of-the-art paper provides an in-depth exploration of intravascular ultrasound, fractional flow reserve, and optical coherence tomography. A discussion is provided that explores the basis for application of these technologies, the body of evidence for each modality and its use in LMCA assessment, and the potential role in post-PCI optimization in what is a dynamically changing field.
Objectives: This study sought to develop a scoring model predicting percutaneous coronary intervention (PCI) success in chronic total occlusions.
A 67-year-old man who had experienced a previous heart attack 6 years ago now presents with severe constrictive chest pain for >2 hours with profuse sweating and low blood pressure. An ECG is recorded (Figure 1), and immediately after, the cardiac catheterization laboratory is activated. No prior ECGs are available. What is the diagnosis and what is the precise anatomic lesion?
Background: Advancing age is associated with a greater prevalence of coronary artery disease in heart failure with reduced ejection fraction and with a higher risk of complications after coronary artery bypass grafting (CABG). Whether the efficacy of CABG compared with medical therapy (MED) in patients with heart failure caused by ischemic cardiomyopathy is the same in patients of different ages is unknown.
Background: Continued dual antiplatelet therapy and optimal medical therapy (OMT) improve outcomes in selected patient populations with established coronary heart disease, but whether OMT modifies the treatment effect of dual antiplatelet therapy is unknown.
Background: No randomized study has investigated the value of optical coherence tomography (OCT) in optimizing the results of percutaneous coronary intervention (PCI) for non–ST-segment elevation acute coronary syndromes.
Adoption of invasive imaging for guidance during percutaneous coronary interventions (PCI) varies largely between clinical sites and between geographies, being greatest in Japan, intermediate to low in the United States and Asia, and very low to nonexistent in Europe. Yet nearly every interventional cardiologist will agree that intracoronary images obtained by intravascular ultrasound (IVUS) and optical coherence tomography (OCT) add significant information content to what is provided by angiography alone, thereby improving the understanding of and our capacity to interpret angiographic images. Although Japanese colleagues have the opportunity to use either IVUS or OCT in the majority of cases as part of their regular procedural strategy, use of invasive imaging in the rest of the world is hampered by inadequate or restricted reimbursement.
Background: In the PEGASUS-TIMI 54 trial (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54), ticagrelor reduced the risk of major adverse cardiovascular events when added to low-dose aspirin in stable patients with prior myocardial infarction, resulting in the approval of ticagrelor 60 mg twice daily for long-term secondary prevention. We investigated the incidence of stroke, outcomes after stroke, and the efficacy of ticagrelor focusing on the approved 60 mg twice daily dose for reducing stroke in this population.
A 37-year-old previously healthy man, a manual sugarcane juicer who lives in a rural area, presented with a 1-month history of atypical chest pain in his left shoulder area and a 2-week history of breathlessness on moderate exertion. On admission, the patient was tachycardic and tachypneic and had a blood pressure of 90/60 mm Hg with pulsus paradoxus. Physical examination showed elevated jugular venous pressure and distant heart sounds. ECG revealed ST-segment elevation in the anterior precordial leads (Figure 1A), but his troponin level was normal.
Background: Intramural ventricular septal defects (VSDs) are interventricular communications through right ventricular free wall trabeculations that can occur after repair of conotruncal anomalies. We assessed the prevalence of residual intramural VSDs and their effect on postoperative course.
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