01 febrero 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Inter–Core Lab Variability in Analyzing Quantitative Coronary Angiography for Bifurcation Lesions. A Post-Hoc Analysis of a Randomized Trial

Maik J. Grundeken, MD∗; Yuki Ishibashi, MD, PhD†; Philippe Généreux, MD‡; Laura LaSalle, MPH‡; Javaid Iqbal, MD†; Joanna J. Wykrzykowska, MD, PhD∗; Marie-Angèle Morel, BSc§; Jan G. Tijssen, PhD∗; Robbert J. de Winter, MD, PhD∗; Chrysafios Girasis, MD§; Hector M. Garcia-Garcia, MD, PhD†; Yoshinobu Onuma, MD, PhD†; Martin B. Leon, MD‡; Patrick W. Serruys, MD, PhD¶

Objectives: This study sought to evaluate inter–core lab variability in quantitative coronary angiography (QCA) analysis of bifurcation lesions.

01 febrero 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Health Status After Transcatheter Aortic Valve Replacement in Patients at Extreme Surgical Risk. Results From the CoreValve U.S. Trial

Ruben L. Osnabrugge, MSc∗; Suzanne V. Arnold, MD, MHA†; Matthew R. Reynolds, MD, MSc‡; Elizabeth A. Magnuson, ScD†; Kaijun Wang, PhD†; Vincent A. Gaudiani, MD‖; Robert C. Stoler, MD¶; Thomas A. Burdon, MD#; Neal Kleiman, MD∗∗; Michael J. Reardon, MD∗∗; David H. Adams, MD††; Jeffrey J. Popma, MD‡‡; David J. Cohen, MD, MSc†

Objectives: The purpose of this study was to characterize health status outcomes after transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis among patients at extreme surgical risk and to identify pre-procedural patient characteristics associated with a poor outcome.

01 febrero 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Outcomes of Inoperable Symptomatic Aortic Stenosis Patients Not Undergoing Aortic Valve Replacement. Insight Into the Impact of Balloon Aortic Valvuloplasty From the PARTNER Trial (Placement of AoRtic TraNscathetER Valve Trial)

Samir Kapadia, MD∗; William J. Stewart, MD∗; William N. Anderson, PhD†; Vasilis Babaliaros, MD‡; Ted Feldman, MD§; David J. Cohen, MD, MSc‖; Pamela S. Douglas, MD¶; Raj R. Makkar, MD#; Lars G. Svensson, MD, PhD∗; John G. Webb, MD∗∗; S. Chiu Wong, MD††; David L. Brown, MD‡‡; D. Craig Miller, MD§§; Jeffrey W. Moses, MD‖‖; Craig R. Smith, MD‖‖; Martin B. Leon, MD‖‖; E. Murat Tuzcu, MD∗

Objectives: The aim of this report is to characterize the impact of balloon aortic valvuloplasty (BAV) in patients not undergoing aortic valve replacement in the PARTNER (Placement of AoRtic TraNscathetER Valves) trial.

01 febrero 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Prosthetic Valve Endocarditis After Transcatheter Valve Replacement. A Systematic Review

Ignacio J. Amat-Santos, MD∗; Henrique B. Ribeiro, MD∗; Marina Urena, MD∗; Ricardo Allende, MD∗; Christine Houde, MD‡; Elisabeth Bédard, MD∗; Jean Perron, MD∗; Robert DeLarochellière, MD∗; Jean-Michel Paradis, MD∗; Eric Dumont, MD∗; Daniel Doyle, MD∗; Siamak Mohammadi, MD∗; Mélanie Côté, MSc∗; José Alberto San Roman, MD†; Josep Rodés-Cabau, MD∗

Objectives: The aim of this review is to describe the incidence, features, predisposing factors, and outcomes of prosthetic valve endocarditis (PVE) after transcatheter valve replacement (TVR).

01 febrero 2015

JACC: CARDIOVASCULAR INTERVENTIONS. Efficacy of Polymer Injection for Ischemic Mitral Regurgitation. Persistent Reduction of Mitral Regurgitation and Attenuation of Left Ventricular Remodeling

Xin Zeng, MD, PhD∗; Lin Zou, MD, PhD∗; Robert A. Levine, MD∗; J. Luis Guerrero, BS†; Mark D. Handschumacher, BS∗; Suzanne M. Sullivan, BS†; Gavin J.C. Braithwaite, PhD‡; James R. Stone, MD, PhD§; Jorge Solis, MD∗; Orhun K. Muratoglu, MD‖; Gus J. Vlahakes, MD†; Judy Hung, MD∗

Objectives: The aim of this study was to examine the chronic effects of polyvinyl-alcohol (PVA) injection on mitral regurgitation (MR) reduction, mitral valve geometry, and left ventricular (LV) remodeling in a chronic ischemic MR sheep model.

01 diciembre 2014

JACC. Procedural Results and Safety of Common Interventional Procedures in Congenital Heart Disease. Initial Report From the National Cardiovascular Data Registry

John W. Moore, MD, MPH∗; Robert N. Vincent, MD†; Robert H. Beekman, MD‡; Lee Benson, MD§; Lisa Bergersen, MD, MPH‖; Ralf Holzer, MD¶; Natalie Jayaram, MD#; Kathy Jenkins, MD, MPH‖; Yan Li, PhD∗∗; Richard Ringel, MD††; Jonathan Rome, MD‡‡; Gerard R. Martin, MD§§

Background: The National Cardiovascular Data Registry (NCDR) launched the IMPACT (Improving Pediatric and Adult Congenital Treatment) Registry in 2010. By 2013, its patient enrollment exceeded that of other current and historical congenital catheterization registries.

01 diciembre 2014

JACC. Current Status of Bioresorbable Scaffolds in the Treatment of Coronary Artery Disease

Jens Wiebe, MD; Holger M. Nef, MD; Christian W. Hamm, MD

State-of-the-art drug-eluting metal stents are the gold standard for interventional treatment of coronary artery disease. Although they overcome some disadvantages and limitations of plain balloon angioplasty and bare-metal stents, some limitations apply, most notably a chronic local inflammatory reaction due to permanent implantation of a foreign body, restriction of vascular vasomotion due to a metal cage, and the risk of late and very late stent thrombosis. The development of biodegradable scaffolds is a new approach that attempts to circumvent these drawbacks. These devices provide short-term scaffolding of the vessel and then dissolve, which should theoretically circumvent the side effects of metal drug-eluting stents. Various types of these bioresorbable scaffolds are currently under clinical evaluation. This review discusses different concepts of bioresorbable scaffolds with respect to material, design, and drug elution and presents the most recent evidence.

01 diciembre 2014

JACC. Effect of Prasugrel Pre-Treatment Strategy in Patients Undergoing Percutaneous Coronary Intervention for NSTEMI. The ACCOAST-PCI Study

Gilles Montalescot, MD, PhD∗; Jean-Philippe Collet, MD, PhD∗; Patrick Ecollan, MD†; Leonardo Bolognese, MD‡; Jurrien ten Berg, MD, PhD§; Dariusz Dudek, MD, PhD‖; Christian Hamm, MD¶; Petr Widimsky, MD, DrSc#; Jean-François Tanguay, MD∗∗; Patrick Goldstein, MD††; Eileen Brown, PhD‡‡; Debra L. Miller, RN, RCIS‡‡; LeRoy LeNarz, MD‡‡; Eric Vicaut, MD, PhD§§

Background: After percutaneous coronary intervention (PCI) for non–ST-segment elevation myocardial infarction (NSTEMI), treatment with a P2Y12 antagonist with aspirin is recommended for 1 year.

01 diciembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Relationship Between Inflammation and Benefits of Early High-Dose Rosuvastatin on Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome. The Pathophysiological Link in the PRATO-ACS Study (Protective Effect of Rosuvastatin and Antiplatelet Therapy on Contrast-Induced Nephropathy and Myocardial Damage in Patients With Acute Coronary Syndrome Undergoing Coronary Intervention)

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

Objectives: This study sought to investigate whether the beneficial impact of high-dose rosuvastatin against contrast-induced acute kidney injury (CI-AKI) in acute coronary syndrome (ACS) patients varied in relation to baseline high-sensitivity C-reactive protein (hs-CRP) levels.

01 diciembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Results of the Combined U.S. Multicenter Pivotal Study and the Continuing Access Study of the Nit-Occlud PDA Device for Percutaneous Closure of Patent Ductus Arteriosus

John W. Moore, MD, MPH∗; Jessica Greene, BS†; Salvadore Palomares†; Alexander Javois, MD‡; Carl Y. Owada, MD§; John P. Cheatham, MD‖; Mark H. Hoyer, MD¶; Thomas K. Jones, MD#; Daniel S. Levi, MD

Objectives: This study aimed to compare the efficacy and safety of the Nit-Occlud PDA device (PFM Medical, Cologne, Germany) to benchmarks designed as objective performance criteria (OPC).

01 diciembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Cardiac Catheterization in the Early Post-Operative Period After Congenital Cardiac Surgery

George T. Nicholson, MD∗; Dennis W. Kim, MD, PhD∗; Robert N. Vincent, MD∗; Brian E. Kogon, MD†; Bruce E. Miller, MD‡; Christopher J. Petit, MD∗

Objectives: This study sought to demonstrate that early cardiac catheterization, whether used solely as a diagnostic modality or for the use of transcatheter interventional techniques, can be used effectively and with an acceptable risk in the post-operative period.

01 diciembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Recanalized Thrombus Treated With Bioresorbable Vascular Scaffold. Insights From Optical Coherence Tomography

Omar Gómez-Monterrosas, MD∗; Ander Regueiro, MD∗; Alejandro Santos, MD†; Shuji Otsuki, MD∗; Giancarla Scalone, MD‡; Diego Fernández-Rodríguez, MD∗; Manel Sabaté, MD, PhD∗

A 29-year-old man underwent coronary angiography after non–ST-segment elevation myocardial infarction. He was a current smoker and did not have any other relevant medical history. Coronary angiography revealed a lesion with contrast filling defect and irregular lumen border at the mid-segment of the left anterior descending artery (Figure 1). Coronary distal flow was partially preserved. Optical coherence tomography (OCT) was performed to characterize the lesion. Lesion was crossed with a BMW Coronary guidewire (Abbott Vascular, Abbott Park, Illinois) and placed in the distal left anterior descending artery. An OCT catheter (C7-XR, Dragon Fly, LightLab, St. Jude Medical, St. Paul, Minnesota) was advanced easily into the distal segment of the left anterior descending artery. OCT imaging revealed multiple honeycomb-like channels and a subocclusive stenosis of the true lumen (Figure 1, Online Video 1). After OCT imaging, an everolimus-eluting Absorb bioresorbable vascular scaffold (BVS), 3 × 18 mm (Abbott Vascular, Santa Clara, California) was implanted, obtaining a satisfactory final angiographic result (Figure 2). OCT revealed an adequate expansion and apposition of the BVS with persistent abluminal hematoma sealed by the scaffold at the distal segment (Figure 2, Online Video 2). Three months later, the patient remained asymptomatic.

01 diciembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Left Ventricular Perforation During Ventriculogram Using an Optitorque Tiger Catheter

Jarrod D. Frizzell, MD, MS; Munif Alkouz, MD; Mark W. Sheldon, MD

A 76-year-old woman underwent left heart catheterization and coronary angiography for a non–ST-segment elevation myocardial infarction. A transradial approach with an Optitorque Tiger (Terumo, Somerset, New Jersey) catheter was used. Angiography was significant for only moderate nonobstructive disease in the right coronary artery. The Tiger catheter crossed the aortic valve and was used to obtain left heart pressures. After the pressure waveform and a small test injection appeared to show adequate positioning, a planned injection of 30 ml of contrast delivered over 10 s was begun. The patient developed chest discomfort and contrast appeared to dissect through the anterolateral wall and entered the pericardium (Online Video 1, Figures Figure 1 and Figure 2). The injection was promptly stopped and the catheter withdrawn. Approximately 4 ml of contrast were delivered. Post-injection myocardial staining and the presence of dye in the pericardium were noted (Online Video 2, Figures Figure 3 and Figure 4). She was hemodynamically stable and monitored uneventfully in the catheterization laboratory for 30 min after a transthoracic echocardiogram showed a small effusion and no signs of tamponade. Shortly after transfer to the cardiac floor, she decompensated and underwent emergent pericardiocentesis. Nearly 250 ml of frank blood were drained. The patient subsequently had an uneventful recovery.

01 diciembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. Direct Oral Anticoagulants. New Drugs and New Concepts

Jerrold H. Levy, MD∗; Alex C. Spyropoulos, MD†; Charles M. Samama, MD, PhD‡; James Douketis, MD§

Direct oral anticoagulants (DOACs) are approved for multiple thromboembolic disorders and provide advantages over existing agents. As with all anticoagulants, management protocols for the eventuality of bleeding are important. Randomized phase III studies generally show that DOACs have a similar risk of clinically relevant bleeding compared with standard anticoagulants, with reductions in major bleeding in some cases. This may be particularly important in patients with atrial fibrillation, for whom the rate of intracranial hemorrhage was approximately halved with DOACs compared with warfarin. Conversely, the risk of gastrointestinal bleeding may be increased. Specific patient characteristics, such as renal impairment, comedications, and particular aspects of each drug, including the proportion eliminated by the kidneys, must be taken into account when assessing the risk of bleeding. Although routine coagulation monitoring of DOACs is not required, it may be useful under some circumstances. Of the traditional clotting assays, a sensitive and calibrated prothrombin time may be useful for detecting the presence or absence of clinically relevant factor Xa inhibitor concentrations (rivaroxaban or apixaban), but specific anti–factor Xa assays can measure drug levels quantitatively. For dabigatran, the results of an activated partial thromboplastin time test may exclude a clinically relevant pharmacodynamic effect, but a calibrated dilute thrombin time assay can be used for quantification of drug levels. In the event of mild or moderate bleeding, normal hemostatic support measures are recommended. For life-threatening bleeding, use of nonspecific prohemostatic agents may be considered, although clinical evidence is scarce. Specific antidotes are in development.

01 diciembre 2014

JACC: CARDIOVASCULAR INTERVENTIONS. A Randomized Comparison of Novel Biodegradable Polymer- and Durable Polymer–Coated Cobalt-Chromium Sirolimus-Eluting Stents

Yaling Han, MD, PhD∗; Bo Xu, MBBS†; Quanmin Jing, MD∗; Shuzheng Lu, MD‡; Lixia Yang, MD§; Kai Xu, MD∗; Yi Li, MD∗; Jing Li, MD∗; Changdong Guan, MSc†; Ajay J. Kirtane, MD, SM‖; Yuejin Yang, MD†

Objectives: The aim of this study was to investigate the hypothesis that a novel biodegradable polymer–coated, cobalt-chromium (CoCr), sirolimus-eluting stent (BP-SES) is noninferior in safety and efficacy outcomes compared with a durable polymer (DP)-SES.