01 julio 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Futility, Benefit, and Transcatheter Aortic Valve Replacement

Brian R. Lindman, MD, MSCI∗; Karen P. Alexander, MD†; Patrick T. O´Gara, MD‡; Jonathan Afilalo, MD, MSc

Transcatheter aortic valve replacement (TAVR) is a transformative innovation that provides treatment for high or prohibitive surgical risk patients with symptomatic severe aortic stenosis who either were previously not referred for or were denied operative intervention. Trials have demonstrated improvements in survival and symptoms after TAVR versus medical therapy; however, there remains a sizable group of patients who die or lack improvement in quality of life soon after TAVR. This raises important questions about the need to identify and acknowledge the possibility of futility in some patients considered for TAVR. In this very elderly population, a number of factors in addition to traditional risk stratification need to be considered including multimorbidity, disability, frailty, and cognition in order to assess the anticipated benefit of TAVR. Consideration by a multidisciplinary heart valve team with broad areas of expertise is critical for assessing likely benefit from TAVR. Moreover, these complicated decisions should take place with clear communication around desired health outcomes on behalf of the patient and provider. The decision that treatment with TAVR is futile should include alternative plans to optimize the patient´s health state or, in some cases, discussions related to end-of-life care. We review issues to be considered when making and communicating these difficult decisions.

01 julio 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Comparative Outcomes After Unprotected Left Main Stem Percutaneous Coronary Intervention. A National Linked Cohort Study of 5,065 Acute and Elective Cases From the BCIS Registry (British Cardiovascular Intervention Society)

Sami S. Almudarra, MBBS, MSc∗; Chris P. Gale, BSc(Hons), MBBS, PhD, Dip MEd, MSc∗; Paul D. Baxter, BSc, PhD, CStat∗; Sarah J. Fleming, BSc, MSc, PhD∗; Richard A. Brogan, BSc(Hons), MB ChB∗; Peter F. Ludman, MA, MD‡; Mark A. de Belder, MA, MD§; Nick P. Curzen, BM(Hons), PhD‖

Objectives: The goal of this study was to report outcomes from percutaneous coronary intervention (PCI) to an unprotected left main stem (UPLMS) stenosis according to presenting syndrome, including ST-segment elevation myocardial infarction (STEMI), non–ST-segment elevation acute coronary syndrome (NSTEACS), and chronic stable angina (CSA).

01 julio 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Impact of Delay to Reperfusion on Reperfusion Success, Infarct Size, and Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction. The INFUSE-AMI Trial (INFUSE-Anterior Myocardial Infarction)

Alejandra Guerchicoff, PhD∗; Sorin J. Brener, MD∗; Akiko Maehara, MD∗; Bernhard Witzenbichler, MD‡; Martin Fahy, MSc∗; Ke Xu, PhD∗; Bernard J. Gersh, MD§; Roxana Mehran, MD∗; C. Michael Gibson, MD¶; Gregg W. Stone, MD∗

Objectives: Our aim was to study the impact of delay from symptom onset to first coronary device on infarct size and clinical outcomes at 30 days and 1 year in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention.

01 julio 2014

JACC: CARDIOVASCULAR INTERVENTIONS. ABSORB Biodegradable Stents Versus Second-Generation Metal Stents. A Comparison Study of 100 Complex Lesions Treated Under OCT Guidance

Alessio Mattesini, MD∗; Gioel G. Secco, MD∗; Gianni Dall´Ara, MD∗; Matteo Ghione, MD∗; Juan C. Rama-Merchan, MD∗; Alessandro Lupi, MD‡; Nicola Viceconte, MD∗; Alistair C. Lindsay, MD, PhD∗; Ranil De Silva, MD, PhD∗; Nicolas Foin, PhD§; Toru Naganuma, MD‖; Serafina Valente, MD†; Antonio Colombo, MD, PhD‖; Carlo Di Mario, MD, PhD∗

Objectives: The aim of this study was to compare the acute performance of the PLLA ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) with second-generation metal drug-eluting stents (DES) in complex coronary artery lesions.

01 julio 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Direct Drug-Eluting Stenting to Reduce Stent Restenosis. A Randomized Comparison of Direct Stent Implantation to Conventional Stenting With Pre-Dilation or Provisional Stenting in Elective PCI Patients

Wouter S. Remkes, MD; Samer Somi, MD, PhD; Vincent Roolvink, MD; Saman Rasoul, MD, PhD; Jan Paul Ottervanger, MD, PhD; A.T. Marcel Gosselink, MD, PhD; Jan C.A. Hoorntje, MD, PhD; Jan-Henk E. Dambrink, MD, PhD; Menko-Jan de Boer, MD, PhD; Harry Suryapranata, MD, PhD; Arnoud W.J. van ´t Hof, MD, PhD

Objectives: The aim was to investigate whether a strategy of direct drug-eluting stent (DES) implantation without pre-dilation is associated with a reduced incidence of restenosis compared with CS with pre-dilation or provisional stenting (PS).

01 julio 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Native Coronary Artery Patency After Coronary Artery Bypass Surgery

David Pereg, MD∗; Paul Fefer, MD∗; Michelle Samuel, BA, MPH∗; Rafael Wolff, MD∗; Andrew Czarnecki, MD∗; Saswata Deb, MD‡; John D. Sparkes, MSc∗; Stephan E. Fremes, MD‡; Bradley H. Strauss, MD, PhD∗

Objectives: The aim of the study was to determine native coronary artery patency 1 year after coronary artery bypass grafting and to identify clinical and angiographic predictors for the development of a chronic total occlusion (CTO).

01 julio 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Fractional Flow Reserve Calculation From 3-Dimensional Quantitative Coronary Angiography and TIMI Frame Count. A Fast Computer Model to Quantify the Functional Significance of Moderately Obstructed Coronary Arteries

Shengxian Tu, PhD∗; Emanuele Barbato, MD, PhD†; Zsolt Köszegi, MD, PhD‡; Junqing Yang, MD§; Zhonghua Sun, MD‖; Niels R. Holm, MD¶; Balázs Tar, MD‡; Yingguang Li, MSc∗; Dan Rusinaru, MD†; William Wijns, MD, PhD†; Johan H.C. Reiber, PhD∗

Objectives: This study sought to present a novel computer model for fast computation of myocardial fractional flow reserve (FFR) and to evaluate it in patients with intermediate coronary stenoses.

01 julio 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Outcomes With Post-Dilation Following Transcatheter Aortic Valve Replacement. The PARTNER I Trial (Placement of Aortic Transcatheter Valve)

Rebecca T. Hahn, MD∗; Philippe Pibarot, DVM, PhD†; John Webb, MD‡; Josep Rodes-Cabau, MD†; Howard C. Herrmann, MD§; Mathew Williams, MD∗; Raj Makkar, MD‖; Wilson Y. Szeto, MD§; Michael L. Main, MD¶; Vinod H. Thourani, MD#; E. Murat Tuzcu, MD∗∗; Samir Kapadia, MD∗∗; Jodi Akin, MS††; Thomas McAndrew, MS‡‡; Ke Xu, PhD‡‡; Martin B. Leon, MD∗; Susheel K. Kodali, MD∗

Objectives: This study sought to characterize the patients receiving post-implantation balloon dilation (PD) following transcatheter aortic valve replacement (TAVR) and evaluate procedural outcomes in the PARTNER (Placement of Aortic Transcatheter Valve) I trial.

01 julio 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Impact of Watchman and Amplatzer Devices on Left Atrial Appendage Adjacent Structures and Healing Response in a Canine Model

Saibal Kar, MD∗; Dongming Hou, MD, PhD†; Russell Jones‡; Dennis Werner, BS†; Lynne Swanson, DVM†; Brian Tischler, BS†; Kenneth Stein, MD†; Barbara Huibregtse, DVM†; Elena Ladich, MD‡; Robert Kutys, MS‡; Renu Virmani, MD‡

Objectives: This study was designed for conducting a comparative evaluation of the healing response after Watchman (WM) (Boston Scientific, Plymouth, Minnesota) and Amplatzer Cardiac Plug (ACP) (St. Jude Medical, Minneapolis, Minnesota) in a canine left atrial appendage (LAA) model.

01 julio 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Operator Radiation Exposure and Physical Discomfort During a Right Versus Left Radial Approach for Coronary Interventions. A Randomized Evaluation

Herman Kado, MD; Ambar M. Patel, MD; Siva Suryadevara, MD; Martin M. Zenni, MD; Lyndon C. Box, MD; Dominick J. Angiolillo, MD, PhD; Theodore A. Bass, MD; Luis A. Guzman, MD

Objectives: This study sought to assess radiation exposure and operator discomfort when using left radial approach (LRA) versus right radial approach (RRA) for coronary diagnostic and percutaneous interventions.

01 mayo 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Angina Pectoris and Myocardial Ischemia in the Absence of Obstructive Coronary Artery Disease: Practical Considerations for Diagnostic Tests

Francesco Radico, MD; Vincenzo Cicchitti, MD; Marco Zimarino, MD, PhD; Raffaele De Caterina, MD, PhD

Angina and myocardial ischemia without obstructive coronary artery disease are common clinical findings, often neglected for the assumption of a good prognosis. Most often, such patients are neither further investigated nor offered specific treatment beyond reassurance. However, the absence of significant coronary stenoses on angiography does not necessarily imply a “healthy” coronary tree. In such cases, myocardial ischemia may result from different types of functional disease involving the epicardial coronary arteries, the coronary microcirculation, or both; an accurate assessment of these components should be systematically performed after exclusion of organic epicardial disease because a correct diagnosis has relevant prognostic and therapeutic implications. Here we discuss the basic principles of diagnostic tests in this setting and propose a diagnostic sequence of reasonable practical implementation that may help identify patients at risk of future cardiac events.

01 mayo 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Predicting 3-Year Mortality After Percutaneous Coronary Intervention. Updated Logistic Clinical SYNTAX Score Based on Patient-Level Data From 7 Contemporary Stent Trials

Javaid Iqbal, PhD∗; Yvonne Vergouwe, PhD‡; Christos V. Bourantas, MD, PhD∗; David V. Klaveren, MSc‡; Yao-Jun Zhang, MD, PhD∗; Carlos M. Campos, MD∗; Hector M. García-García, MD, PhD§; Marie-Angele Morel, BSc§; Marco Valgimigli, MD, PhD∗; Stephan Windecker, MD, PhD‖; Ewout W. Steyerberg, MD, PhD†; Patrick W. Serruys, MD, PhD∗

Objectives: This study aimed to update the Logistic Clinical SYNTAX score to predict 3-year survival after percutaneous coronary intervention (PCI) and compare the performance with the SYNTAX score alone.

01 mayo 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Everolimus-Eluting Xience V/Promus Versus Zotarolimus-Eluting Resolute Stents in Patients With Diabetes Mellitus

Kyung Woo Park, MD, PhD∗; Joo Myung Lee, MD, MPH∗; Si-Hyuck Kang, MD∗; Hyo-Suk Ahn, MD∗; Hyun-Jae Kang, MD, PhD∗; Bon-Kwon Koo, MD, PhD∗; Jay Young Rhew, MD, PhD†; Sun Ho Hwang, MD, PhD‡; Sung Yoon Lee, MD, PhD§; Tae Soo Kang, MD, PhD‖; Choong Hwan Kwak, MD, PhD¶; Bum-Kee Hong, MD, PhD#; Cheol Woong Yu, MD, PhD∗∗; In-Whan Seong, MD, PhD††; Taehoon Ahn, MD, PhD‡‡; Han Cheol Lee, MD, PhD§§; Sang Wook Lim, MD, PhD‖‖; Hyo-Soo Kim, MD, PhD∗

Objectives: This study sought to compare everolimus-eluting stents (EES) versus Resolute zotarolimus-eluting stents (ZES) in terms of patient- or stent-related clinical outcomes in an “all-comer” group of patients with diabetes mellitus (DM) who underwent percutaneous coronary intervention.

01 mayo 2014

JACC: CARDIOVASCULAR INTERVENTIONS. 1-Year Clinical Outcomes of Diabetic Patients Treated With Everolimus-Eluting Bioresorbable Vascular Scaffolds. A Pooled Analysis of the ABSORB and the SPIRIT Trials

Takashi Muramatsu, MD, PhD∗; Yoshinobu Onuma, MD∗; Robert-Jan van Geuns, MD, PhD∗; Bernard Chevalier, MD‡; Tejas M. Patel, MD§; Ashok Seth, MD||; Roberto Diletti, MD∗; Hector M. García-García, MD, PhD∗; Cécile C. Dorange, MSc¶; Susan Veldhof, RN¶; Wai-Fung Cheong, PhD#; Yukio Ozaki, MD, PhD†; Robert Whitbourn, MD∗∗; Antonio Bartorelli, MD††; Gregg W. Stone, MD‡‡; Alexandre Abizaid, MD, PhD§§; Patrick W. Serruys, MD, PhD∗

Objectives: The aim of this study was to evaluate 1-year clinical outcomes of diabetic patients treated with the Absorb bioresorbable vascular scaffold (BVS).

01 mayo 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Coronary Artery Bypass Graft Surgery Versus Percutaneous Coronary Intervention With First-Generation Drug-Eluting Stents. A Meta-Analysis of Randomized Controlled Trials

Juwairia Al Ali, MD∗; Caroline Franck, MSc†; Kristian B. Filion, PhD†; Mark J. Eisenberg, MD, MPH†

Objectives: This study sought to compare the efficacy of coronary artery bypass graft surgery (CABG) to that of percutaneous coronary intervention (PCI) with first-generation drug-eluting stents among patients with multivessel disease (MVD), unprotected left main (LM) disease, and single-vessel proximal left anterior descending (LAD) disease.