01 enero 2016

CATHETERIZATION & CARDIOVASCULAR INTERVENTIONS. Predictors of blood pressure response: Obesity is associated with a less pronounced treatment response after renal denervation

Dani Id MD1, Stefan C. Bertog MD1,2, Ann-Kathrin Ziegler MD1, Marius Hornung MD1, Ilona Hofmann MD1, Laura Vaskelyte MD1, Predrag Matic MD1, Sameer Gafoor MD1 andHorst Sievert MD1,*

Objectives: The purpose of this study was to identify predictors of BP response.

01 enero 2016

CATHETERIZATION & CARDIOVASCULAR INTERVENTIONS. Brain natriuretic peptide levels variation after left atrial appendage occlusion

Ignacio Cruz-Gonzalez MD, PhD1,*, Jorge Palazuelos Molinero MD2, Maria Valenzuela MD1, Ignacio Rada MD2, Jose Angel Perez-Rivera MD, PhD1, Antonio Arribas Jimenez MD, PhD1, Tania Gabella MD1, Ana Beatriz Prieto MD3, Jorge Martín Polo MD4 andPedro L. Sánchez MD, PhD1

Objective: To explore the variations of brain natriuretic peptide (BNP) secretion after left atrial appendage occlusion.

01 diciembre 2015

CATHETERIZATION & CARDIOVASCULAR INTERVENTIONS. Utilization of catheter-directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter-directed thrombolysis

Nish Patel MD1,†, Nileshkumar J. Patel MD2,†, Kanishk Agnihotri MD3,†, Sidakpal S. Panaich MD4, Badal Thakkar MD5, Achint Patel MD6, Chirag Savani MD7, Nilay Patel MD3, Shilpkumar Arora MD8, Abhishek Deshmukh MD9, Parth Bhatt MD5, Carlos Alfonso MD1, Mauricio Cohen MD1, Alfonso Tafur MD10, Mahir Elder MD4, Tamam Mohamed MD4, Ramak Attaran MD11, Theodore Schreiber MD4, Cindy Grines MD4 andApurva O. Badheka MD, FACP, CCDS11,†,*

Objective: The aim of the study was to assess the utilization of catheter-directed thrombolysis (CDT) and its comparative effectiveness against systemic thrombolysis in acute pulmonary embolism (PE).

01 enero 2016

THE AMERICAN JOURNAL OF CARDIOLOGY. Comparison of Ticagrelor Versus Thienopyridine Loading Effect on Fractional Flow Reserve in Patients With Coronary Artery Disease

Dimitrios Alexopoulos, MD, Periklis Davlouros, MD, Grigorios Tsigkas, MD, Nikolaos Koutsogiannis, MD, Athena Hassapi, MD, Christos Scortsanitis, RN, Ioanna Pentara, MD, Chrysoula Vogiatzi, MD, Ioanna Xanthopoulou, MD

Ticagrelor loading dose (LD) increases adenosine plasma levels, which might interfere with fractional flow reserve (FFR) assessment because the latter is based on adenosine-induced hyperemia. In a prospective study, consecutive patients who underwent coronary angiography with at least 1 de novo stenosis >50% and <90% in severity amenable to intervention underwent FFR assessment using intravenous adenosine 140 μg/kg/min for 3 minutes. Patients were subsequently randomized to either ticagrelor 180 mg (n = 38) or control thienopyridine (n = 38) (prasugrel 60 mg [n = 28] or clopidogrel 600 mg [n = 10]), followed by a second FFR assessment of the target lesion 2 hours after drug. Pre-drug, steady hyperemia FFR (sFFR, median, first to third quartiles) was 0.82 (0.75 to 0.88) and 0.81 (0.75 to 0.88), p = 0.9, whereas post-drug, 0.82 (0.72 to 0.87) and 0.79 (0.73 to 0.86), p = 0.5, in thienopyridine and ticagrelor-treated patients, respectively. The primary end point of percent relative change in sFFR between pre- and post-drug periods was greater in ticagrelor- than thienopyridine-treated patients, −1.24 (−5.54 to 0.0) versus −0.51 (−3.68 to 3.21), p = 0.03, respectively. Absolute change in sFFR between pre- and post-drug periods was marginally higher in ticagrelor- than thienopyridine-treated patients −0.01 (−0.04 to 0.0) versus −0.005 (−0.03 to 0.02), p = 0.048, respectively. Reclassification of treatment decision at the sFFR ≤0.80 cutoff post-drug occurred in 6 (15.8%) versus 5 (13.2%) of ticagrelor- and thienopyridine-treated patients, respectively. In conclusion, after ticagrelor LD, an absolute and relative reduction in sFFR compared with thienopyridine LD is observed. Administration of ticagrelor should be considered as a potential source, albeit minor, of FFR variability.

01 enero 2016

THE AMERICAN JOURNAL OF CARDIOLOGY. Comparison of Fractional Flow Reserve Based on Computational Fluid Dynamics Modeling Using Coronary Angiographic Vessel Morphology Versus Invasively Measured Fractional Flow Reserve

Monique Tröbs, MD, Stephan Achenbach, MD, Jens Röther, MD, Thomas Redel, PhD, Michael Scheuering, PhD, David Winneberger, RT, Klaus Klingenbeck, PhD, Lucian Itu, PhD, Tiziano Passerini, PhD, Ali Kamen, PhD, Puneet Sharma, PhD, Dorin Comaniciu, PhD, Christian Schlundt, MD

Invasive fractional flow reserve (FFRinvasive), although gold standard to identify hemodynamically relevant coronary stenoses, is time consuming and potentially associated with complications. We developed and evaluated a new approach to determine lesion-specific FFR on the basis of coronary anatomy as visualized by invasive coronary angiography (FFRangio): 100 coronary lesions (50% to 90% diameter stenosis) in 73 patients (48 men, 25 women; mean age 67 ± 9 years) were studied.

01 enero 2016

THE AMERICAN JOURNAL OF CARDIOLOGY. Comparison of Efficacy and Safety of Left Atrial Appendage Occlusion in Patients Aged <75 to ≥75 Years

Xavier Freixa, MD, Sameer Gafoor, MD, Ander Regueiro, MD, Ignacio Cruz-Gonzalez, MD, PhD, Samera Shakir, MD, Heyder Omran, MD, Sergio Berti, MD, Gennaro Santoro, MD, Joelle Kefer, MD, PhD, Ulf Landmesser, MD, PhD, Jens Erik Nielsen-Kudsk, MD, DMSc, Horst Sievert, MD, Prapa Kanagaratnam, MD, PhD, Fabian Nietlispach, MD, PhD, Steffen Gloekler, MD, Adel Aminian, MD, Paolo Danna, MD, PhD, Marco Rezzaghi, Friederike Stock, MD, Miroslava Stolcova, MD, Marco Costa, MD, PhD, Reda Ibrahim, MD, Wolfgang Schillinger, MD, Jai-Wun Park, MD, PhD, Bernhard Meier, MD, Apostolos Tzikas, MD, PhD

Left atrial appendage occlusion (LAAO) is emerging as a promising alternative to oral anticoagulation. Because aged patients present a greater risk of not only cardioembolic events but also major bleeding, LAAO might represent a valid alternative as this would allow oral anticoagulation cessation while keeping cardioembolic protection.

01 enero 2016

THE AMERICAN JOURNAL OF CARDIOLOGY. Cost comparison of Transcatheter and Operative Pulmonary Valve Replacement (from the Pediatric Health Information Systems Database)

Michael L. O´Byrne, MD, MSCE, Matthew J. Gillespie, MD, Russell T. Shinohara, PhD, Yoav Dori, MD, PhD, Jonathan J. Rome, MD, Andrew C. Glatz, MD, MSCE

Outcomes for transcatheter pulmonary valve replacement (TC-PVR) and operative pulmonary valve replacement (S-PVR) are excellent. Thus, their respective cost is a relevant clinical outcome. We performed a retrospective cohort study of children and adults who underwent PVR at age ≥8 years from January 1, 2011, to December 31, 2013, at 35 centers contributing data to the Pediatric Health Information Systems database to address this question.

01 enero 2016

THE AMERICAN JOURNAL OF CARDIOLOGY. Percutaneous Closure of Perimembranous Ventricular Septal Defects Using the Second-Generation Amplatzer Vascular Occluders

Makram R. Ebeid, MD, Sarosh P. Batlivala, MD, Jorge D. Salazar, MD, Ahmad Charaf Eddine, MD, Avichal Aggarwal, MD, Ali Dodge-Khatami, MD, Douglas Maposa, MD, Mary B. Taylor, MD

Earlier attempts at percutaneous closure of perimembranous ventricular septal defects (Pm VSDs) were abandoned because of incidence of heart block likely as a result of device rigidity and/or oversizing. This is retrospective review and data reporting of patients who underwent percutaneous closure using the softer second-generation Amplatzer vascular occluders; namely the Amplatzer vascular plug, second generation, (AVP II) and the Amplatzer duct occluder, second generation (ADO II) in our institution. A total of 20 patients were identified; AVP II was used in 9 patients and ADO II in 11 patients.

01 enero 2016

THE AMERICAN JOURNAL OF CARDIOLOGY. Trends in Coronary Angiography, Revascularization, and Outcomes of Cardiogenic Shock Complicating Non–ST-Elevation Myocardial Infarction

Dhaval Kolte, MD, PhD, Sahil Khera, MD, Kaustubh C. Dabhadkar, MD, MPH, Shikhar Agarwal, MD, MPH, Wilbert S. Aronow, MD, Robert Timmermans, MD, Diwakar Jain, MD, Howard A. Cooper, MD, William H. Frishman, MD, Venu Menon, MD, Deepak L. Bhatt, MD, MPH, J. Dawn Abbott, MD, Gregg C. Fonarow, MD, Julio A. Panza, MD

Early revascularization is the mainstay of treatment for cardiogenic shock (CS) complicating acute myocardial infarction. However, data on the contemporary trends in management and outcomes of CS complicating non–ST-elevation myocardial infarction (NSTEMI) are limited. We used the 2006 to 2012 Nationwide Inpatient Sample databases to identify patients aged ≥18 years with NSTEMI with or without CS. Temporal trends and differences in coronary angiography, revascularization, and outcomes were analyzed. Of 2,191,772 patients with NSTEMI, 53,800 (2.5%) had a diagnosis of CS. From 2006 to 2012, coronary angiography rates increased from 53.6% to 60.4% in patients with NSTEMI with CS (ptrend <0.001). Among patients who underwent coronary angiography, revascularization rates were significantly higher in patients with CS versus without CS (72.5% vs 62.6%, p <0.001). Patients with NSTEMI with CS had significantly higher risk-adjusted in-hospital mortality (odds ratio 10.09, 95% confidence interval 9.88 to 10.32) as compared to those without CS. In patients with CS, an invasive strategy was associated with lower risk-adjusted in-hospital mortality (odds ratio 0.43, 95% confidence interval 0.42 to 0.45). Risk-adjusted in-hospital mortality, length of stay, and total hospital costs decreased over the study period in patients with and without CS (ptrend <0.001). In conclusion, we observed an increasing trend in coronary angiography and decreasing trend in in-hospital mortality, length of stay, and total hospital costs in patients with NSTEMI with and without CS. Despite these positive trends, overall coronary angiography and revascularization rates remain less than optimal and in-hospital mortality unacceptably high in patients with NSTEMI and CS.

01 enero 2016

THE AMERICAN JOURNAL OF CARDIOLOGY. Use of Mechanical Circulatory Support in Percutaneous Coronary Intervention in the United States

Rohan Khera, MD, Peter Cram, MD, MBA, Mary Vaughan-Sarrazin, PhD, Phillip A. Horwitz, MD, Saket Girotra, MD, SM

ercutaneous ventricular assist devices (PVADs) and intraaortic balloon pump (IABP) are used to provide mechanical circulatory support (MCS) for high-risk percutaneous coronary intervention (PCI). Contemporary trends in their utilization and impact on in-hospital mortality are not known. Using the National Inpatient Sample (2004 to 2012), we identified 5,031 patients who received a PVAD and 122,333 who received an IABP on the same day as PCI using International Classification of Diseases, Ninth Edition codes.

01 enero 2016

THE AMERICAN JOURNAL OF CARDIOLOGY. Factors Associated With Infarct-Related Artery Patency Before Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction (from the FAST-MI 2010 Registry)

Clotilde Bailleul, MD, Etienne Puymirat, MD, PhD, Nadia Aissaoui, MD, PhD, François Schiele, MD, PhD, Gregory Ducrocq, MD, PhD, Pierre Coste, MD, PhD, Didier Blanchard, MD, Camille Brasselet, MD, PhD, Meyer Elbaz, MD, PhD, Philippe Gabriel Steg, MD, Hervé Le Breton, MD, PhD, Eric Bonnefoy-Cudraz, MD, PhD, Gilles Montalescot, MD, PhD, Yves Cottin, MD, PhD, Patrick Goldstein, MD, Jean Ferrières, MD, PhD, Tabassome Simon, MD, PhD, Nicolas Danchin, MD for the FAST-MI investigators

Early infarct-related artery (IRA) patency is associated with better clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). Using the French Registry of ST-elevation and non–ST-elevation Myocardial Infarction (FAST-MI) 2010 registry, we investigated factors related to IRA patency (thrombolysis in myocardial infarction [TIMI] 2/3 flow) at the start of procedure in patients admitted for primary percutaneous coronary intervention.

01 enero 2016

THE AMERICAN JOURNAL OF CARDIOLOGY. The SPYRAL HTN Global Clinical Trial Program: Rationale and design for studies of renal denervation in the absence (SPYRAL HTN OFF-MED) and presence (SPYRAL HTN ON-MED) of antihypertensive medications

David E. Kandzari, MD, Kazuomi Kario, MD, Felix Mahfoud, MD, Sidney A. Cohen, MD, PhD, Garrett Pilcher, MS, Stuart Pocock, PhD, Raymond Townsend, MD, Michael A. Weber, MD, Michael Böhm, MD

Renal sympathetic activation plays a key role in the pathogenesis of hypertension, as demonstrated by high renal norepinephrine spillover into plasma of patients with essential hypertension. Renal denervation has demonstrated a significant reduction in blood pressure in unblinded studies of hypertensive patients. The SYMPLICITY HTN-3 trial, the first prospective, masked, randomized study of renal denervation versus sham control, failed its primary efficacy end point and raised important questions around potentially confounding factors, such as drug changes and adherence, study population, and procedural methods.

01 enero 2016

THE AMERICAN JOURNAL OF CARDIOLOGY. An updated comprehensive meta-analysis of bivalirudin vs heparin use in primary percutaneous coronary intervention

Rahman Shah, MD, FACC, Kelly C. Rogers, PharmD, Khalid Matin, MD, Raza Askari, MD, Sunil V. Rao, MD, FACC, FSCAI

Background: Despite several randomized controlled trials and meta-analyses, the ideal anticoagulant for patients undergoing primary percutaneous coronary intervention (PCI) remains controversial. We performed an updated meta-analysis including recently reported randomized clinical trials that compare bivalirudin and heparin with or without provisional administration of a glycoprotein IIb/IIIa inhibitor (GPI) for primary PCI.

01 enero 2016

THE AMERICAN JOURNAL OF CARDIOLOGY. Incidence and impact of acute kidney injury in patients with acute coronary syndromes treated with coronary artery bypass grafting: Insights from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) and Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trials

Josephine Warren, MD, Roxana Mehran, MD, Usman Baber, MD, MS, Ke Xu, PhD, Daniele Giacoppo, MD, Bernard J. Gersh, MB, ChB, DPhil, Giulio Guagliumi, MD, Bernhard Witzenbichler, MD, E. Magnus Ohman, MD, Stuart J. Pocock, PhD, Gregg W. Stone, MD

Background: Acute kidney injury (AKI) is a well-recognized predictor of morbidity and mortality after percutaneous coronary intervention. However, the impact of AKI on the outcome of patients with acute coronary syndromes (ACS) in relation to coronary artery bypass grafting (CABG) has not been established.

05 noviembre 2015

CIRCULATION: CARDIOVASCULAR INTERVENTIONS. Cardiac Catheterization. Factors Affecting Bleeding and Stent Thrombosis in Clinical Trials Comparing Bivalirudin With Heparin During Percutaneous Coronary Intervention

John A. Bittl, MD, Yulei He, PhD, Christopher D. Lang, MD and George D. Dangas, MD, PhD

Background: Patients treated with bivalirudin in randomized clinical trials of percutaneous coronary intervention generally have less bleeding but more acute stent thrombosis (ST) than do patients treated with heparin, but differences have varied among trials.