Background: Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic acute coronary syndrome for which optimal management remains undefined.
Background: ST-segment myocardial infarction patients frequently present to non-percutaneous coronary intervention (PCI) hospitals and require interhospital transfer for primary PCI. The effect of distance and mode of transport to the PCI center and the frequency that recommended primary PCI times are met are not clear.
Background: In patients with severe aortic stenosis, transcatheter aortic valve replacement (TAVR) improves survival when compared with nonsurgical therapy but with higher in-hospital and lifetime costs. Complications associated with TAVR may decrease with greater experience and improved devices, thereby reducing the overall cost of the procedure. Therefore, we sought to estimate the effect of periprocedural complications on in-hospital costs and length of stay of TAVR.
Introduction: Paravalvular leaks (PVLs) have been a recognized problem after surgical valve replacement since prosthetic valves were first implanted for aortic and mitral valve disease 5 decades ago.1 Although the reported incidence varies considerably, it is generally estimated that a PVL of some magnitude is present in ≈7% to 17% of mitral and 2% to 10% of aortic valve replacement prostheses.2–5 Most PVLs are small and inconsequential, but anywhere from 1% to 5% of aortic or mitral valve replacement procedures are complicated by a clinically relevant PVL.2–5 Although the use of transcatheter devices to close prosthetic PVLs was described >20 years ago,6 this procedure remained relatively rare until recently, but with the availability of nitinol mesh devices designed for occlusion of various other communications, transcatheter PVL closure has become a regular, although still somewhat uncommon, procedure for many structural interventional cardiologists.4,5,7–12 Moreover, as transcatheter aortic valve replacement has become increasingly widespread, and paravalvar regurgitation has been recognized as one of its most frequent and significant complications,13 an entirely new domain has opened up, namely, management of PVLs after transcatheter aortic valve replacement.
In this issue of Circulation: Cardiovascular Interventions, Im et al1 are assessing the fate and clinical significance of optical coherence tomography (OCT)–detected incomplete stent apposition (ISA) in drug-eluting stents (DESs). This work is addressing an important clinical question because interventional cardiologists are obsessed with achieving optimal stent expansion since the early days of coronary stent implantation, and this is still today considered the best way to prevent acute and long-term sequelae such as stent thrombosis. Indeed, intravascular ultrasound (IVUS) studies unveiled the prominent role of stent underexpansion in the pathogenesis of stent thrombosis in the past.2 Therefore, optimal stent expansion allowing to achieve a high acute lumen gain is of concern ever since. This knowledge triggered the development of improved stent design and high-pressure balloons, as well as the use of invasive imaging technologies, such as IVUS, to diagnose stent underexpansion. Back then, complete apposition of the stent struts against the vessel wall3 was an implicit prerequisite for optimal stent expansion. ISA, defined as the absence of contact of ≥1 stent strut with the vessel wall, became an entity in its own right in the late 1990s with the introduction of intracoronary brachytherapy and the IVUS observation of late-acquired ISA.4 This interest extended later, in the beginning of the millennium, to the first-generation DES.5,6 Late-acquired ISA was interpreted as symptom of vascular toxicity, caused by either radiation or cytotoxic drugs and suspected to be associated with adverse outcomes. Nevertheless, an adverse effect of either acute ISA or late- acquired ISA on clinical outcome was not demonstrated in prospective studies at that time.7
Is it too early to call this the Readmission Decade? Readmissions are on everybody’s mind—identifying readmissions, preventing readmissions, considering the financial repercussions of having too many readmissions, lamenting the injustice of being held accountable for readmissions. Only time will tell whether this is a passing storm or here to stay, but for the moment the issue of readmissions is having its moment in the sun.
Background: The goal of this study was to compare angiographic interpretation of coronary arteriograms by sites in community practice versus those made by a centralized angiographic core laboratory.
Background: Appropriate use criteria for diagnostic catheterization (DC) were recently published. These criteria are yet to be examined for a large population of patients undergoing DC.
Background: Diastolic fractional flow reserve (dFFR) has been shown to be highly sensitive for detection of inducible myocardial ischemia. However, its reliance on measurement of left-ventricular pressure for zero-flow pressure correction, as well as manual extraction of the diastolic interval, has been its major limitation. Given previous reports of minimal zero-flow pressure at end-diastole, we compared instantaneous ECG-gated end-diastolic FFR with conventional full-cardiac cycle FFR and other diastolic indices in the porcine model.
Background: Intravenous adenosine infusion produces coronary and systemic vasodilatation, generally leading to systemic hypotension. However, adenosine-induced hypotension during stable hyperemia is heterogeneous, and its relevance to coronary stenoses assessment with fractional flow reserve (FFR) remains largely unknown.
Background: Although increased coronary microvascular resistance (CMR), resulting in coronary microvascular dysfunction, is speculated to be responsible for myocardial ischemia in patients with cardiac syndrome X (CSX), it has never been directly demonstrated, and the correlation between CMR and severity of myocardial ischemia has not been elucidated in this setting. This study aimed to ascertain the increased CMR directly and to explore the relationship between CMR and severity of ischemia in patients with CSX.
Background: The relative safety of drug-eluting stents (DESs) and bare-metal stents (BMSs) with respect to stent thrombosis (ST) continues to be debated. There are limited data comparing safety and efficacy of second-generation DES to BMS. We compared the clinical outcomes between second-generation DES and BMS for primary percutaneous coronary intervention using network meta-analysis.
Background: Stent longitudinal distortion, while infrequent, can lead to adverse clinical events. Our first bench comparison of susceptibility of different stent designs to distortion applied force to the entire circumference of the proximal stent hoop. The test increased understanding of stent design and led to recommendations for design change in some. Our second-generation test more closely mimics clinical scenarios by applying force to a point on the proximal hoop of a malapposed stent.
Background: We aimed to evaluate a new drug-free fully bioresorbable lactic acid–based scaffold designed to allow early dismantling synchronized with artery wall healing in comparison with a bare metal stent (BMS).
Background: A simple risk score to predict long-term mortality after percutaneous coronary intervention (PCI) using preprocedural risk factors is currently not available. In this study, we created one by simplifying the results of a Cox proportional hazards model.
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