29 octubre 2013

CIRCULATION. Coronary Heart Disease. Biomarkers in Relation to the Effects of Ticagrelor in Comparison With Clopidogrel in Non–ST-Elevation Acute Coronary Syndrome Patients Managed With or Without In-Hospital Revascularization. A Substudy From the Prospective Randomized Platelet Inhibition and Patient Outcomes (PLATO) Trial

Lars Wallentin, MD, PhD; Daniel Lindholm, MD; Agneta Siegbahn, MD, PhD; Lisa Wernroth, MSc; Richard C. Becker, MD; Christopher P. Cannon, MD; Jan H. Cornel, MD, PhD; Anders Himmelmann, MD, PhD; Evangelos Giannitsis, MD; Robert A. Harrington, MD; Claes Held, MD, PhD; Steen Husted, MD, DSc; Hugo A. Katus, MD; Kenneth W. Mahaffey, MD; Ph. Gabriel Steg, MD; Robert F. Storey, MD, DM; Stefan K. James, MD, PhD; for the PLATO study group

Background: Risk stratification and the use of specific biomarkers have been proposed for tailoring treatment in patients with non–ST-elevation acute coronary syndrome (NSTE-ACS). We investigated the prognostic importance of high-sensitivity troponin T (hs-TnT), N-terminal pro-brain natriuretic peptide (NT-proBNP), and growth differentiation factor-15 (GDF-15) in relation to randomized treatment (ticagrelor versus clopidogrel) and management strategy (with or without revascularization) in the NSTE-ACS subgroup of the Platelet Inhibition and Patient Outcomes (PLATO) trial.

04 octubre 2013

CIRCULATION. Coronary Heart Disease. Optimal Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation. A Randomized, Controlled Trial

Cheol Whan Lee, MD*; Jung-Min Ahn, MD*; Duk-Woo Park, MD; Soo-Jin Kang, MD; Seung-Whan Lee, MD; Young-Hak Kim, MD; Seong-Wook Park, MD; Seungbong Han, PhD; Sang-Gon Lee, MD; In-Whan Seong, MD; Seung-Woon Rha, MD; Myung-Ho Jeong, MD; Do-Sun Lim, MD; Jung-Han Yoon, MD; Seung-Ho Hur, MD; Yun-Seok Choi, MD; Joo-Young Yang, MD; Nae-Hee Lee, MD; Hyun-Sook Kim, MD; Bong-Ki Lee, MD; Kee-Sik Kim, MD; Seung-Uk Lee, MD; Jei-Keon Chae, MD; Sang-Sig Cheong, MD; Il-woo Suh, MD; Hun-Sik Park, MD; Deuk-Young Nah, MD; Doo-Soo Jeon, MD; Ki-Bae Seung, MD; Keun Lee, MD; Jae-Sik Jang, MD; Seung-Jung Park, MD, PhD

Background: The risks and benefits of long-term dual antiplatelet therapy remain unclear.

19 noviembre 2013

CIRCULATION. Coronary Heart Disease. Outcome Impact of Coronary Revascularization Strategy Reclassification With Fractional Flow Reserve at Time of Diagnostic Angiography

Eric Van Belle, MD, PhD; Gilles Rioufol, MD, PhD; Christophe Pouillot, MD; Thomas Cuisset, MD, PhD; Karim Bougrini, MD; Emmanuel Teiger, MD, PhD; Stéphane Champagne, MD; Loic Belle, MD; Didier Barreau, MD; Michel Hanssen, MD; Cyril Besnard, MD; Raphael Dauphin, MD; Jean Dallongeville, MD, PhD; Yassine El Hahi, MSc; Georgios Sideris, MD; Christophe Bretelle, MD; Nicolas Lhoest, MD; Pierre Barnay, MD; Laurent Leborgne, MD, PhD; Patrick Dupouy, MD; for the Investigators of the Registre Français de la FFR – R3F

Background: There is no large report of the impact of fractional flow reserve (FFR) on the reclassification of the coronary revascularization strategy on individual patients referred for diagnostic angiography.

27 septiembre 2013

CIRCULATION. Interventional Cardiology. Inaccuracy of Estimated Resting Oxygen Uptake in the Clinical Setting

Nikhil Narang, MD; Jennifer T. Thibodeau, MD, MSc; Benjamin D. Levine, MD; M. Odette Gore, MD; Colby R. Ayers, MS; Richard A. Lange, MD, MBA; Joaquin E. Cigarroa, MD; Aslan T. Turer, MD, MHS; James A. de Lemos, MD; Darren K. McGuire, MD, MHSc

Background: The Fick principle (cardiac output = oxygen uptake (GraphicO2)/systemic arterio-venous oxygen difference) is used to determine cardiac output in numerous clinical situations. However, estimated rather than measured GraphicO2 is commonly used because of complexities of the measurement, though the accuracy of estimation remains uncertain in contemporary clinical practice.

25 octubre 2013

CIRCULATION. Interventional Cardiology. Pathology of Second-Generation Everolimus-Eluting Stents Versus First-Generation Sirolimus- and Paclitaxel-Eluting Stents in Humans

Fumiyuki Otsuka, MD, PhD; Marc Vorpahl, MD; Masataka Nakano, MD; Jason Foerst, MD; John B. Newell, AB; Kenichi Sakakura, MD; Robert Kutys, MS; Elena Ladich, MD; Aloke V. Finn, MD; Frank D. Kolodgie, PhD; Renu Virmani, MD

Background: Clinical trials have demonstrated that the second-generation cobalt-chromium everolimus-eluting stent (CoCr-EES) is superior to the first-generation paclitaxel-eluting stent (PES) and is noninferior or superior to the sirolimus-eluting stent (SES) in terms of safety and efficacy. It remains unclear whether vascular responses to CoCr-EES are different from those to SES and PES because the pathology of CoCr-EES has not been described in humans.

18 octubre 2013

CIRCULATION. Coronary Heart Disease. Disturbed Coronary Hemodynamics in Vessels With Intermediate Stenoses Evaluated With Fractional Flow Reserve. A Combined Analysis of Epicardial and Microcirculatory Involvement in Ischemic Heart Disease

Mauro Echavarria-Pinto, MD; Javier Escaned, MD, PhD; Enrico Macías, MD; Miguel Medina, MD; Nieves Gonzalo, MD, PhD; Ricardo Petraco, MD; Sayan Sen, MBBS; Pilar Jimenez-Quevedo, MD, PhD; Rosana Hernandez, MD, PhD; Rafael Mila, MD; Borja Ibañez, MD, PhD; Ivan J. Nuñez-Gil, MD; Cristina Fernández, MD, PhD; Fernando Alfonso, MD, PhD; Camino Bañuelos, MD; Eulogio García, MD; Justin Davies, MBBS, PhD; Antonio Fernández-Ortiz, MD, PhD; Carlos Macaya, MD, PhD

Background: In chronic ischemic heart disease, focal stenosis, diffuse atherosclerotic narrowings, and microcirculatory dysfunction (MCD) contribute to limit myocardial flow. The prevalence of these ischemic heart disease levels in fractional flow reserve (FFR) interrogated vessels remains largely unknown.

23 octubre 2013

CIRCULATION. Valvular Heart Disease. Impact of Preoperative Moderate/Severe Mitral Regurgitation on 2-Year Outcome After Transcatheter and Surgical Aortic Valve Replacement. Insight From the Placement of Aortic Transcatheter Valve (PARTNER) Trial Cohort A

Marco Barbanti, MD; John G. Webb, MD; Rebecca T. Hahn, MD; Ted Feldman, MD; Robert H. Boone, MD; Craig R. Smith, MD; Susheel Kodali, MD; Alan Zajarias, MD; Christopher R. Thompson, MD; Philip Green, MD; Vasilis Babaliaros, MD; Raj R. Makkar, MD; Wilson Y. Szeto, MD; Pamela S. Douglas, MD; Tom McAndrew, MS; Irene Hueter, PhD; D. Craig Miller, MD; Martin B. Leon, MD

Background: The effect of preoperative mitral regurgitation (MR) on clinical outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) is controversial. This study sought to examine the impact of moderate and severe MR on outcomes after TAVR and surgical aortic valve replacement (SAVR).

06 diciembre 2012

CIRCULATION. Left Ventricular Support Systems for High-Risk Percutaneous Coronary Interventions

John P. Vavalle, MD, MHS; E. Magnus Ohman, MD

High-risk percutaneous coronary interventions (PCI) are becoming more prevalent as the ability to perform complex coronary interventions continues to improve. Patients for whom high-risk interventions are considered generally have severe diffuse coronary artery disease, a single last patent conduit, or significant left main disease with large territories of myocardial ischemia. In addition, these patients also typically have reduced left ventricular function (ejection fraction <25%–35%) with comorbidities that make them high risk for standard coronary artery bypass grafting. Thus, PCI is increasingly used as a viable alternative for coronary revascularization, but it too is associated with a high degree of morbidity and mortality.

06 diciembre 2012

CIRCULATION. Interventional Cardiology. Long-Term Mortality Data From the Balloon Pump–Assisted Coronary Intervention Study (BCIS-1). A Randomized, Controlled Trial of Elective Balloon Counterpulsation During High-Risk Percutaneous Coronary Intervention

Divaka Perera, MD, FRCP; Rod Stables, DM, FRCP; Tim Clayton, MSc; Kalpa De Silva, MRCP; Matthew Lumley, MRCP; Lucy Clack, MSc; Martyn Thomas, MD, FRCP; Simon Redwood, MD, FRCP; on behalf of the BCIS-1 Investigators

Background: There is conflicting evidence on the utility of elective intra-aortic balloon pump (IABP) use during high-risk percutaneous coronary intervention (PCI). Observational series have indicated a reduction in major in-hospital adverse events, although randomized trial evidence does not support this. A recent study has suggested a mortality benefit trend early after PCI, but there are currently no long-term outcome data from randomized trials in this setting.

01 diciembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Left Main Coronary Artery Stenosis. A Meta-Analysis of Drug-Eluting Stents Versus Coronary Artery Bypass Grafting

Ganesh Athappan, MD∗; Eshan Patvardhan, MD†; Murat E. Tuzcu, MD‡; Stephen Ellis, MD‡; Patrick Whitlow, MD‡; Samir R. Kapadia, MD‡

Objectives: The goal of this study was to provide a systematic review comparing the long-term outcomes of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass graft surgery (CABG) for unprotected left main coronary artery (UPLM) stenosis.

01 diciembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. What Is the Standard of Care for Patients With Left Main Stenosis?

John D. Puskas, MD†; Emmanuel Moss, MD, MSC†

Invasive treatment strategies for coronary artery disease (CAD) are highly scrutinized and constantly evolving. Coronary artery bypass graft (CABG) surgery has long been the gold standard for revascularization in patients with complex CAD; however, advances in the safety and efficacy of percutaneous coronary intervention (PCI) have allowed interventional cardiologists to challenge the status quo and possibly expand the indications for coronary stenting. We read with interest the meta-analysis by Athappan et al. 1 reviewing the available published reports comparing unprotected left main stenting (UPLMS) in the drug-eluting stent (DES) era with CABG surgery. The analysis included 3 randomized, controlled trials and 21 observational studies that were published between 2006 and 2012. The authors selected appropriate primary (all-cause mortality, target vessel revascularization, stroke, and myocardial infarction) and secondary (major adverse cardiac and cerebrovascular events) endpoints and performed a thorough and statistically sound analysis. The result is a valuable contribution to the published reports that succinctly summarizes much of the available data comparing CABG surgery with PCI for UPLMS and gives clinicians a snapshot of the data, although the authors’ conclusions are slightly overstated. The report also serves to highlight the limited availability of high-quality short- and long-term efficacy and safety data on UPLMS. Unfortunately, as the authors themselves point out, including a majority of observational studies in this meta-analysis entails accepting a certain degree of heterogeneity and uncontrollable bias within the results.

01 diciembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. The Anatomic- and Clinical-Based NERS (New Risk Stratification) Score II to Predict Clinical Outcomes After Stenting Unprotected Left Main Coronary Artery Disease. Results From a Multicenter, Prospective, Registry Study

Shao-Liang Chen, MD∗; Ya-Ling Han, MD†; Yao-Jun Zhang, PhD‡; Fei Ye, MD∗; Hai-Wei Liu, MD†; Jun-Jie Zhang, PhD∗; Bo Xu, MBBS§; Tie-Min Jiang, MD‖; Yu-Jie Zhou, MD¶; Shu-Zheng Lv, MD¶

Objectives: The present study aimed to establish a risk score using a simple calculation with an enhanced predictive value for major adverse cardiac events (MACE) in patients with unprotected left main coronary artery (UPLMCA) disease after the implantation of a drug-eluting stent (DES).

01 diciembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Long-Term Clinical Outcomes After Percutaneous Coronary Intervention for Ostial/Mid-Shaft Lesions Versus Distal Bifurcation Lesions in Unprotected Left Main Coronary Artery. The DELTA Registry (Drug-Eluting Stent for Left Main Coronary Artery Disease): A Multicenter Registry Evaluating Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Left Main Treatment

Toru Naganuma, MD∗; Alaide Chieffo, MD∗; Emanuele Meliga, MD†; Davide Capodanno, MD, PhD‡; Seung-Jung Park, MD§; Yoshinobu Onuma, MD‖; Marco Valgimigli, MD¶; Sanda Jegere, MD#; Raj R. Makkar, MD††; Igor F. Palacios, MD‡‡; Charis Costopoulos, MD∗; Young-Hak Kim, MD§; Piotr P. Buszman, MD, PhD§§; Tarun Chakravarty, MD††; Imad Sheiban, MD‖‖; Roxana Mehran, MD¶¶; Christoph Naber, MD∗∗∗; Ronan Margey, MD‡‡; Arvind Agnihotri, MD‡‡; Sebastiano Marra, MD‖‖; Piera Capranzano, MD‡; Martin B. Leon, MD##; Jeffrey W. Moses, MD##; Jean Fajadet, MD∗∗∗; Thierry Lefevre, MD†††; Marie-Claude Morice, MD†††; Andrejs Erglis, MD#; Corrado Tamburino, MD, PhD‡; Ottavio Alfieri, MD∗; Patrick W. Serruys, MD, PhD‖; Antonio Colombo, MD∗

Objectives: The aim of this study was to compare, in a large all-comer registry, the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for ostial/mid-shaft lesions versus distal bifurcation lesions in unprotected left main coronary artery (ULMCA) stenosis.

01 diciembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Impact of 3-Dimensional Bifurcation Angle on 5-Year Outcome of Patients After Percutaneous Coronary Intervention for Left Main Coronary Artery Disease. A Substudy of the SYNTAX Trial (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery)

Chrysafios Girasis, MD∗; Vasim Farooq, MBChB∗; Roberto Diletti, MD∗; Takashi Muramatsu, MD∗; Christos V. Bourantas, MD, PhD∗; Yoshinobu Onuma, MD∗; David R. Holmes, MD†; Ted E. Feldman, MD‡; Marie-Angele Morel, BSc§; Gerrit-Anne van Es, PhD§; Keith D. Dawkins, MD‖; Marie-Claude Morice, MD¶; Patrick W. Serruys, MD, PhD∗

Objectives: This study sought to investigate the impact of left main coronary artery (LMCA) 3-dimensional (3D) bifurcation angle (BA) parameters on 5-year clinical outcomes of patients randomized to LMCA percutaneous coronary intervention (PCI) in the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial.

01 diciembre 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Left Main Percutaneous Coronary Intervention. Growing in Maturity

Fausto Feres, MD, PhD; Ricardo A. Costa, MD, PhD

In the past, the presence of >50% stenosis in an unprotected left main (ULM) trunk had been classically considered a “surgical” indication for revascularization, and only nonsurgical candidates would be considered for percutaneous coronary intervention (PCI).