01 marzo 2014

JACC. Radial Access for Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Time for a Paradigm Shift?

Robert J. Applegate, MD

In the past 2 decades there has been tremendous evolution of both the effectiveness and safety of percutaneous coronary intervention (PCI). As coronary ischemic events have decreased dramatically in frequency during and after PCI, efforts to improve the safety of PCI have shifted to addressing other complications, especially bleeding, occurring in the periprocedural period. A growing body of literature has shown that periprocedural bleeding is an independent predictor of adverse events including death following PCI (1). The term “bleeding avoidance strategies” has emerged reflecting that multiple factors have been associated with an increase in bleeding, and may have additive effects on this outcome 2. Although multiple factors contribute to bleeding after PCI, the access site (i.e., femoral or radial artery) has recently come under intense scrutiny as a source of potential bleeding, and by extension, a potential modifiable factor in an effort to reduce bleeding complications.

01 marzo 2014

JACC. Underexpansion and Ad Hoc Post-Dilation in Selected Patients Undergoing Balloon-Expandable Transcatheter Aortic Valve Replacement

Marco Barbanti, MD∗; Jonathon Leipsic, MD∗; Ronald Binder, MD∗; Danny Dvir, MD∗; John Tan, MD∗; Melanie Freeman, MBBS∗; Bjarne Norgaard, MD†; Nicolaj Hansson, MD†; Anson Cheung, MD∗; Jian Ye, MD∗; Tae-Hyun Yang, MD∗; Kasia Maryniak, MD∗; Rekha Raju, MD∗; Angus Thompson, MBBS, PhD∗; Philipp Blanke, MD∗; Sandra Lauck, PhD, RN∗; David Wood, MD∗; John Webb, MD∗

Objectives: This study sought to assess the clinical outcomes and hemodynamic performance associated with a strategy of underexpanding balloon-expandable transcatheter heart valves (THV) when excessive oversizing is a concern.

01 marzo 2014

JACC. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Diabetes and Severe Aortic Stenosis at High Risk for Surgery. An Analysis of the PARTNER Trial (Placement of Aortic Transcatheter Valve)

Brian R. Lindman, MD, MSCI∗; Philippe Pibarot, DVM, PhD†; Suzanne V. Arnold, MD, MHA‡; Rakesh M. Suri, MD, DPhil§; Thomas C. McAndrew, MS‖; Hersh S. Maniar, MD∗; Alan Zajarias, MD∗; Susheel Kodali, MD‖; Ajay J. Kirtane, MD, SM‖; Vinod H. Thourani, MD#; E. Murat Tuzcu, MD∗∗; Lars G. Svensson, MD, PhD∗∗; Ron Waksman, MD††; Craig R. Smith, MD¶; Martin B. Leon, MD‖

Objectives: The goal of this study was to determine whether a less-invasive approach to aortic valve replacement (AVR) improves clinical outcomes in diabetic patients with aortic stenosis (AS).

01 marzo 2014

JACC. Bleeding Complications After Surgical Aortic Valve Replacement Compared With Transcatheter Aortic Valve Replacement. Insights From the PARTNER I Trial (Placement of Aortic Transcatheter Valve)

Philippe Généreux, MD∗; David J. Cohen, MD, MSc§; Mathew R. Williams, MD∗; Michael Mack, MD‖; Susheel K. Kodali, MD∗; Lars G. Svensson, MD, PhD¶; Ajay J. Kirtane, MD, SM∗; Ke Xu, PhD†; Thomas C. McAndrew, MS†; Raj Makkar, MD#; Craig R. Smith, MD∗; Martin B. Leon, MD∗

Objectives: This study sought to identify the incidence, predictors, and prognostic impact of bleeding complications (BC) after surgical aortic valve replacement (SAVR) compared with transcatheter aortic valve replacement (TAVR).

01 enero 2014

JACC. Discharge Aspirin Dose and Clinical Outcomes in Patients With Acute Coronary Syndromes Treated With Prasugrel Versus Clopidogrel. An Analysis From the TRITON–TIMI 38 Study (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel–Thrombolysis In Myocardial Infarction 38)

Payal Kohli, MD∗; Jacob A. Udell, MD, MPH†; Sabina A. Murphy, MPH†; Christopher P. Cannon, MD†; Elliott M. Antman, MD†; Eugene Braunwald, MD†; Stephen D. Wiviott, MD†

Objectives: The goal of this study was to determine whether there is a relationship between aspirin dose and the potent antiplatelet agent prasugrel in the TRITON–TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel–Thrombolysis In Myocardial Infarction 38) study.

01 enero 2014

JACC. Outcomes of Patients With Chronic Lung Disease and Severe Aortic Stenosis Treated With Transcatheter Versus Surgical Aortic Valve Replacement or Standard Therapy. Insights From the PARTNER Trial (Placement of AoRTic TraNscathetER Valve)

Danny Dvir, MD∗; Ron Waksman, MD∗; Israel M. Barbash, MD∗; Susheel K. Kodali, MD†; Lars G. Svensson, MD, PhD‡; E. Murat Tuzcu, MD‡; Ke Xu, PhD†; Sa´ar Minha, MD∗; Maria C. Alu†; Wilson Y. Szeto, MD§; Vinod H. Thourani, MD‖; Raj Makkar, MD¶; Samir Kapadia, MD‡; Lowell F. Satler, MD∗; John G. Webb, MD#; Martin B. Leon, MD†; Augusto D. Pichard, MD

Objectives: The study aimed to evaluate the impact of chronic lung disease (CLD) on outcomes of severe aortic stenosis patients across all treatment modalities.

01 febrero 2014

JACC. Left Atrial Appendage Occlusion. Opportunities and Challenges

David R. Holmes, MD∗; Dhanunjaya R. Lakkireddy, MD†; Richard P. Whitlock, MD, PhD‡; Ron Waksman, MD§; Michael J. Mack, MD‖

Stroke prevention in patients with atrial fibrillation is a growing clinical dilemma as the incidence of the arrhythmia increases and risk profiles worsen. Strategies in patients with nonvalvular atrial fibrillation have included anticoagulation with a variety of drugs. Knowledge that stroke in this setting typically results from thrombus in the left atrial appendage has led to the development of mechanical approaches, both catheter-based and surgical, to occlude that structure. Such a device, if it were safe and effective, might avoid the need for anticoagulation and prevent stroke in the large number of patients who are currently not treated with anticoagulants. Regulatory approval has been difficult due to trial design challenges, balance of the risk-benefit ratio, specific patient populations studied, selection of treatment in the control group, and specific endpoints and statistical analyses selected. Accumulating data from randomized trials and registries with longer-term follow-up continues to support a role for left atrial appendage exclusion from the central circulation as an alternative to anticoagulation in carefully-selected patient populations.

01 febrero 2014

JACC. Clinical Outcomes With Bioabsorbable Polymer- Versus Durable Polymer-Based Drug-Eluting and Bare-Metal Stents. Evidence From a Comprehensive Network Meta-Analysis

Tullio Palmerini, MD∗; Giuseppe Biondi-Zoccai, MD†; Diego Della Riva, MD∗; Andrea Mariani, MD∗; Manel Sabaté, MD‡; Pieter C. Smits, MD§; Christoph Kaiser, MD‖; Fabrizio D´Ascenzo, MD¶; Giacomo Frati, MD†; Massimo Mancone, MD†; Philippe Genereux, MD∗∗; Gregg W. Stone, MD∗∗

Objectives: This study sought to investigate the relative safety and efficacy of bioabsorbable polymer (BP)-based biolimus-eluting stents (BES) versus durable-polymer (DP)-drug-eluting stents (DES) and bare-metal stents (BMS) by means of a network meta-analysis.

01 febrero 2014

JACC. Short- Versus Long-Term Duration of Dual Antiplatelet Therapy in Patients Treated for In-Stent Restenosis. A PRODIGY Trial Substudy (Prolonging Dual Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia)

Gianluca Campo, MD∗; Matteo Tebaldi, MD∗; Pascal Vranckx, MD, PhD‡; Simone Biscaglia, MD∗; Carlo Tumscitz, MD∗; Roberto Ferrari, MD, PhD∗; Marco Valgimigli, MD, PhD∗

Objectives: This study sought to investigate the clinical outcome of patients treated with percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) randomized to short (6 months) versus long (24 months) dual antiplatelet therapy (DAPT) regimen.

01 enero 2014

JACC. Prevalence and Outcomes of Unoperated Patients With Severe Symptomatic Mitral Regurgitation and Heart Failure. Comprehensive Analysis to Determine the Potential Role of MitraClip for This Unmet Need

Sachin S. Goel, MD†; Navkaranbir Bajaj, MD‡; Bhuvnesh Aggarwal, MD‡; Supriya Gupta, MD†; Kanhaiya Lal Poddar, MD†; Mobolaji Ige, MD‡; Hazem Bdair, MD†; Abed Anabtawi, MD†; Shiraz Rahim, BS§; Patrick L. Whitlow, MD†; E. Murat Tuzcu, MD†; Brian P. Griffin, MD†; William J. Stewart, MD†; Marc Gillinov, MD‖; Eugene H. Blackstone, MD‖; Nicholas G. Smedira, MD‖; Guilherme H. Oliveira, MD†; Benico Barzilai, MD†; Venu Menon, MD†; Samir R. Kapadia, MD†

Mitral valve (MV) surgery is recommended in patients with severe symptomatic mitral regurgitation (MR) 1. The role of MV surgery is unclear in patients with severe MR secondary to left ventricular (LV) dysfunction 1. Many patients with severe MR are at high surgical risk due to advanced age, LV dysfunction, or comorbidities. The MitraClip device (Abbott Vascular, Abbott Park, Illinois) provides a novel percutaneous option for patients with severe MR with significant improvement (2,). However, the characteristics and outcomes of this patient population remain unclear. We sought to assess the characteristics and outcomes of patients with severe symptomatic MR who do not undergo MV surgery and their potential eligibility for MitraClip.

01 enero 2014

JACC. Reduction in Cardiac Mortality With Bivalirudin in Patients With and Without Major Bleeding. The HORIZONS-AMI Trial (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction)

Gregg W. Stone, MD∗; Tim Clayton, MSc‡; Efthymios N. Deliargyris, MD§; Jayne Prats, PhD§; Roxana Mehran, MD†; Stuart J. Pocock, PhD‡

Objectives: The purpose of this study was to determine whether, in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), the reduction in cardiac mortality in those taking bivalirudin compared with unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (UFH+GPI) can be fully attributed to reduced bleeding.

01 enero 2014

JACC. Early High-Dose Rosuvastatin for Contrast-Induced Nephropathy Prevention in Acute Coronary Syndrome. Results From the PRATO-ACS Study (Protective Effect of Rosuvastatin and Antiplatelet Therapy On Contrast-Induced Acute Kidney Injury and Myocardial Damage in Patients With Acute Coronary Syndrome)

Mario Leoncini, MD∗; Anna Toso, MD∗; Mauro Maioli, MD∗; Francesco Tropeano, MD∗; Simona Villani, PhD†; Francesco Bellandi, MD∗

Objectives: This study sought to determine if in addition to standard preventive measures on-admission, high-dose rosuvastatin exerts a protective effect against contrast-induced acute kidney injury (CI-AKI).

01 enero 2015

JACC: CARDIOVASCULAR INTERVENTIONS. The EXAMINATION Trial (Everolimus-Eluting Stents Versus Bare-Metal Stents in ST-Segment Elevation Myocardial Infarction). 2-Year Results From a Multicenter Randomized Controlled Trial

Manel Sabaté, MD, PhD∗; Salvatore Brugaletta, MD, PhD∗; Angel Cequier, MD, PhD†; Andrés Iñiguez, MD, PhD‡; Antonio Serra, MD, PhD§; Rosana Hernádez-Antolín, MD, PhD‖; Vicente Mainar, MD, PhD¶; Marco Valgimigli, MD, PhD#; Maurizio Tespili, MD, PhD∗∗; Pieter den Heijer, MD, PhD††; Armando Bethencourt, MD, PhD‡‡; Nicolás Vázquez, MD, PhD§§; Bianca Backx, RN‖‖; Patrick W. Serruys, MD, PhD¶¶

Objectives: This study sought to assess the 2-year outcomes of the population included in the EXAMINATION (Everolimus-Eluting Stents Versus Bare-Metal Stents in ST-Segment Elevation Myocardial Infarction) trial beyond the 1-year prescription period of dual antiplatelet therapy.

01 enero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. A Novel Noninvasive Technology for Treatment Planning Using Virtual Coronary Stenting and Computed Tomography-Derived Computed Fractional Flow Reserve

Kyung-Hee Kim, MD∗; Joon-Hyung Doh, MD†; Bon-Kwon Koo, MD∗; James K. Min, MD‡; Andrejs Erglis, MD§; Han-Mo Yang, MD∗; Kyung-Woo Park, MD∗; Hae-Young Lee, MD∗; Hyun-Jae Kang, MD∗; Yong-Jin Kim, MD∗; Sung Yun Lee, MD†; Hyo-Soo Kim, MD∗

Objectives This study sought to determine whether computational modeling can be used to predict the functional outcome of coronary stenting by virtual stenting of ischemia-causing stenoses identified on the pre-treatment model.

01 enero 2014

JACC: CARDIOVASCULAR INTERVENTIONS. The Absorb Bioresorbable Vascular Scaffold in Coronary Bifurcations. Insights From Bench Testing

Vladimír Džavík, MD∗; Antonio Colombo, MD†

Objectives: This study sought to evaluate the feasibility of performing contemporary bifurcation techniques with the Absorb everolimus-eluting bioresorbable vascular scaffold (Abbott Vascular, Santa Clara, California) (BVS).