01 febrero 2012

CIRCULATION. Percutaneous Coronary Intervention in Patients With Severe Aortic Stenosis. Implications for Transcatheter Aortic Valve Replacement

Sachin S. Goel, MD; Shikhar Agarwal, MD, MPH, CPH; E. Murat Tuzcu, MD; Stephen G. Ellis, MD; Lars G. Svensson, MD, PhD; Tarique Zaman, MD; Navkaranbir Bajaj, MD; Lee Joseph, MD; Neil S. Patel, BS; Olcay Aksoy, MD; William J. Stewart, MD; Brian P. Griffin, MD; Samir R. Kapadia, MD

Background—With the availability of transcatheter aortic valve replacement, management of coronary artery disease in patients with severe aortic stenosis (AS) is posing challenges. Outcomes of percutaneous coronary intervention (PCI) in patients with severe AS and coronary artery disease remain unknown. We sought to compare the short-term outcomes of PCI in patients with and without AS.

01 febrero 2013

JACC. Predictors of Reocclusion After Successful Drug-Eluting Stent–Supported Percutaneous Coronary Intervention of Chronic Total Occlusion

Renato Valenti, MD; Ruben Vergara, MD; Angela Migliorini, MD; Guido Parodi, MD; Nazario Carrabba, MD; Giampaolo Cerisano, MD; Emilio Vincenzo Dovellini, MD; David Antoniucci, MD

Objectives: This study sought to assess the incidence of reocclusion and identification of predictors of angiographic failure after successful chronic total occlusion (CTO) drug-eluting stent–supported percutaneous coronary intervention (PCI).

01 febrero 2013

AMERICAN JOURNAL OF CARDIOLOGY. Pregnancy Outcomes in Women With Aortic Valve Substitutes

Helena J. Heuvelman, MD, MSc , Bardia Arabkhani, MSc , Jerome M.J. Cornette, MD , Petronella G. Pieper, MD, PhD , Ad J.J.C. Bogers, MD, PhD , Johanna J.M. Takkenberg, MD, PhD , Jolien W. Roos-Hesselink, MD, PhD

Young women who require aortic valve replacement need information on the potential cardiac and obstetric complications of pregnancy for the different valve substitutes available. We, therefore, assessed the pregnancy outcomes in women who had received an autograft, homograft, or mechanical valve in the aortic position. Women who were pregnant after surviving aortic valve replacement at our institution from 1987 to 2011 were included. Information on cardiac status and pregnancy outcome was obtained through the hospital medical records and by an extensive patient questionnaire. A total of 40 women experienced 67 pregnancies, of which 55 (82%) were completed pregnancies, 6 (9%) were miscarriages, and 6 (9%) were terminated. Of the 40 women, 18 (45%) had a pulmonary autograft, 13 (32%) a homograft, and 9 (23%) a mechanical valve. The mean age at the first pregnancy was 30.0 ± 5.7 years. No maternal mortality but 1 fetal death (1.8%) and 1 neonatal death (1.8%) occurred. Maternal cardiac complications developed in 13% and obstetric complications in 38% of the completed pregnancies. Heart failure (9%), arrhythmias (7%), hypertension-related disorders (7%), preterm delivery (24%), and small-for-gestational-age infants (15%) were most often encountered. Mechanical valve recipients had the greatest incidence of both cardiac and obstetric complications. In conclusion, pregnancy-associated complications after aortic valve replacement were common, and human tissue valves should be considered in the discussion for the optimal aortic valve substitute in a young woman. However, careful obstetric monitoring is mandatory.

01 febrero 2013

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS. Paclitaxel versus sirolimus eluting stents in diabetic patients: Does stent type and/or stent diameter matter?: Long-term clinical outcome of 2,429-patient multicenter registry

Giuseppe Tarantini MD, PhD, Michela Facchin MD, Davide Capodanno MD, Giuseppe Musumeci MD, Francesco Saia MD, PhD, Alberto Menozzi MD, PhD, Emanuele Meliga MD, Massimo Mancone MD, PhD, Corrado Lettieri MD, Corrado Tamburino MD, PhD

Background: Drug-eluting stents (DES) are more effective in reducing restenosis than bare-metal stents. Less certain is the relative performance of the two widely used DES—sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES)—in diabetic patients undergoing percutaneous coronary intervention (PCI).

01 febrero 2013

AMERICAN HEART JOURNAL. Targeted anti-inflammatory systemic therapy for restenosis: The Biorest Liposomal Alendronate with Stenting sTudy (BLAST)—a double blind, randomized clinical trial

Shmuel Banai, MD , Ariel Finkelstein, MD , Yaron Almagor, MD , Abid Assali, MD , Yonathan Hasin, MD , Uri Rosenschein, MD , Patricia Apruzzese, MA , Alexandra J. Lansky, MD , Teruyoshi Kume , Elazer R. Edelman, MD, PhD

Background: Activation of systemic innate immunity is critical in the chain of events leading to restenosis. LABR-312 is a novel compound that transiently modulates circulating monocytes, reducing accumulation of these cells at vascular injury sites and around stent struts. The purpose of the study was to examine the safety and efficacy of a single intravenous bolus of LABR-312 in reducing restenosis in patients treated for coronary narrowing. Patient response was examined in light of differential inflammatory states as evidenced by baseline circulating monocyte levels, diabetes mellitus, and acute coronary syndrome.

01 febrero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Intra-Aortic Coronary Stent Fracture Revealed by Stent Boost Imaging and Confirmed by Multislice Computed Tomography

David Pesenti Rossi, MD; Nicolas Baron, MD; Jean-Louis Georges, MD; Bernard Livarek, MD

A 77-year-old man was admitted with unstable angina. He had a history of 2-vessel coronary artery bypass grafting and percutaneous coronary intervention of each anastomosis. The proximal anastomosis of the marginal branch (circumflex) bypass grafting was directly stented with a TITAN-2 3.5 × 19-mm bare-metal stent (BMS) (Hexacath, Paris, France), 2 months before.

01 febrero 2013

AMERICAN JOURNAL OF CARDIOLOGY. Use of Complementary Therapies in Cardiovascular Disease

Kavita Prasad, MD , Varun Sharma, MD , Kandace Lackore, BS , Sarah M. Jenkins, MS , Abhiram Prasad, MD , Amit Sood, MD

The aim of the present study was to assess the use of complementary and alternative medicine (CAM) treatments in outpatients with cardiovascular disease and their interest in future use. The increasing popularity of CAM therapies highlights the need to explore their use among patients with cardiovascular disease. Data were collected with a prospective, point-of-care, anonymous, 17-question survey about basic medical information and previous use and interest in the future use of dietary supplements and other CAM interventions among patients undergoing outpatient cardiology evaluation at a Midwestern tertiary care center. The survey was completed by 1,055 patients (655 men, 351 women; mean age 63.5 years) of whom 98.1% were white. Of these, 36.8% had cardiac symptoms for >10 years, 48.2% had coronary artery disease, and 82.5% reported use of CAM therapies. Of these patients, 75.4% reported using dietary supplements, 31.5% chiropractic therapy, 23.9% mind-body therapies, and 19.2% massage. Only 14.4% had discussed the use of CAM treatments with their physicians. The top 4 treatments used for cardiac symptoms were relaxation techniques, stress management, meditation, and guided imagery. Also, 48.6% were interested in participating in a future clinical trial of an alternative treatment. The great majority of patients seen in current practice use CAM therapies, and a large proportion expressed an interest in participating in research with CAM therapies. In conclusion, research directed with an integrative approach to cardiovascular care might prove beneficial when designing future studies.

01 febrero 2013

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS. Choice of stent and outcomes after treatment of drug-eluting stent restenosis in highly complex lesions

Xavier Freixa MD, Ali S. Almasood MD, Sohail Q. Khan MD, Karen Mackie RN, Mark Osten MD, Douglas Ing MD, Christopher B. Overgaard MD, Eric M. Horlick MD, Peter H. Seidelin MD, FSCAI, Vladimír Džavík MD, FSCAI

Objectives: Our aim was to compare the outcomes of a same versus different drug-eluting stent (DES) implantation strategy for the treatment of DES instent restenosis (ISR).

01 enero 2013

AMERICAN HEART JOURNAL. Comparative efficacy of 2 zotarolimus-eluting stent generations: Resolute versus endeavor stents in patients with coronary artery disease

Tomohisa Tada, MD , Robert A. Byrne, MB, BCh, PhD , Salvatore Cassese, MD , Lamin King, MS , Stefanie Schulz, MD , Julinda Mehilli, MD , Albert Schömig, MD , Adnan Kastrati, MD

Background: The Resolute zotarolimus-eluting stent (R-ZES) utilizes the same metallic platform and anti-restenotic drug as the Endeavor zotarolimus-eluting stent (E-ZES) but is coated with a more biocompatible polymer with enhanced drug-release kinetics. The aim of this study was to compare the long-term clinical outcomes of 2 zotarolimus-eluting stent generations.

01 enero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Comparison of Bare-Metal Stenting With Minimally Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary Artery. 10-Year Follow-Up of a Randomized Trial

Stephan Blazek, MD; David Holzhey, MD; Camelia Jungert, BSc; Michael A. Borger, MD, PhD; Georg Fuernau, MD; Steffen Desch, MD; Ingo Eitel, MD; Suzanne de Waha, MD; Philipp Lurz, MD; Gerhard Schuler, MD; Friedrich-Wilhelm Mohr, MD; Holger Thiele, MD

Objectives: The aim of this prospective, randomized trial was to assess the 10-year long-term safety and effectiveness of percutaneous coronary intervention (PCI) and minimally invasive direct coronary artery bypass surgery (MIDCAB) for the treatment of proximal left anterior descending (LAD) lesions.

01 enero 2013

AMERICAN JOURNAL OF CARDIOLOGY. Effect of Macroscopic-Positive Thrombus Retrieval During Primary Percutaneous Coronary Intervention With Thrombus Aspiration on Myocardial Infarct Size and Microvascular Obstruction

Romain Chopard, MD , Philoktimon Plastaras, MD , Jerome Jehl, MD , Sebastien Janin, MD , Vincent Descotes Genon, MD , Marie-France Seronde, MD , Siamak Davani, MD, PhD , Bruno Kastler, MD , Francois Schiele, MD, PhD , Nicolas Meneveau, MD, PhD

Adjunctive thrombus aspiration (TA) during primary percutaneous coronary intervention improves myocardial perfusion and survival; however, the effect of effective thrombus retrieval remains unclear. We evaluated whether macroscopic-positive TA in patients with ST-segment elevation myocardial infarction would reduce the infarct size (IS) and microvascular obstruction (MVO), as assessed by contrast-enhanced magnetic resonance imaging. A total of 88 patients with ST-segment elevation myocardial infarction were prospectively recruited and assigned to the TA-positive group (n = 38) or TA-negative group (n = 50) according to whether macroscopic aspirate thrombus was visible to the naked eye. The primary end points were the extent of early and late MVO as assessed by contrast-enhanced magnetic resonance imaging performed during in-hospital stay and IS evaluated in the acute phase and at 6 months of follow-up. The incidence of early and late MVO and IS in the acute phase was lower in the TA-positive group than in the TA-negative group (early MVO 3.8 ± 1.1% vs 7.6 ± 2.1%, respectively, p = 0.003; late MVO 2.1 ± 0.9% vs 5.4 ± 2.9%, p = 0.006; and IS 14.9 ± 8.7% vs 28.2 ± 15.8%, p = 0.004). At the 6-month contrast-enhanced magnetic resonance imaging study, the final IS was significantly lower in the TA-positive group (12.0 ± 8.3% vs 22.3 ± 14.3%, respectively) than in the TA-negative group (p = 0.002). After multivariate adjustment, macroscopic-positive TA represented an independent predictor of final IS (odds ratio 0.34, 95% confidence interval 0.03 to 0.71, p = 0.01). In conclusion, effective macroscopic thrombus retrieval before stenting during percutaneous coronary intervention for ST-segment elevation myocardial infarction is associated with an improvement in myocardial reperfusion, as documented by a clear reduction in the MVO extent and IS.

01 febrero 2013

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS. First experience with andraStent XL implantation in children and adolescents with congenital heart diseases†

Zuzana Venczelova MD, Peter Tittel MD, Jozef Masura MD, PHD, FSCAI

Objectives: To present our experience with a new type of extra-large (dilatable up to 25 mm), balloon-expandable, nonpremounted, cobalt-chromium peripheral stent with semiopen designed cells: AndraStent.

01 enero 2013

AMERICAN HEART JOURNAL. Pharmacodynamic effect of prasugrel 5 mg vs clopidogrel 150 mg in elderly patients with high on-clopidogrel platelet reactivity

Dimitrios Alexopoulos, MD, FACC , Ioanna Xanthopoulou, MD , Theodora-Eleni Plakomyti, MD , Konstantinos C. Theodoropoulos, MD , Eleni Mavronasiou, MD , Anastasia Damelou, MD , George Hahalis, MD , Periklis Davlouros, MD

Background: Elderly patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) frequently exhibit high platelet reactivity (HPR) while on clopidogrel. In the elderly cohort, either prasugrel is not recommended or, if used, halving of the dose has been suggested. We aimed to test the hypothesis that in elderly patients exhibiting HPR after standard treatment with clopidogrel, prasugrel-reduced dose (5 mg) could be more effective than high-dose (150 mg) clopidogrel.

01 enero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. High-Speed Rotational Atherectomy Before Paclitaxel-Eluting Stent Implantation in Complex Calcified Coronary LesionsThe Randomized ROTAXUS

Mohamed Abdel-Wahab, MD; Gert Richardt, MD; Heinz Joachim Büttner, MD; Ralph Toelg, MD; Volker Geist, MD; Thomas Meinertz, MD; Joachim Schofer, MD; Lamin King, MD; Franz-Josef Neumann, MD; Ahmed A. Khattab, MD

Objectives: This study sought to determine the effect of rotational atherectomy (RA) on drug-eluting stent (DES) effectiveness.

01 enero 2013

AMERICAN JOURNAL OF CARDIOLOGY. Prognostic Value of Total Bilirubin in Patients With ST-Segment Elevation Acute Myocardial Infarction Undergoing Primary Coronary Intervention

Mehmet Gul, MD , Huseyin Uyarel, MD , Mehmet Ergelen, MD , Ozgur Akgul, MD , Gurkan Karaca, MD , Selahattin Turen, MD , Murat Ugur, MD , Mehmet Ertürk, MD , Seref Kul, MD , Ozgur Surgit, MD , Mehmet Bozbay, MD , Nevzat Uslu, MD

Previous studies have shown that the serum total bilirubin (TB) concentration was inversely related with stable coronary artery disease, diabetes mellitus, hypertension, and metabolic syndromes. The relation between TB levels and in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI) is not known. Data from 1,624 consecutive patients with STEMI who underwent primary PCI were evaluated. TB was measured after primary PCI, and the study population was divided into tertiles. The high TB group (n = 450) was defined as a value in the upper third tertile (>0.9 mg/dl) and the low TB group (n = 1,174) as any value in the lower 2 tertiles (≤0.9 mg/dl). The in-hospital mortality rate was significantly greater in the high TB group than in the low TB group (4% vs 1.5%, p = 0.003). In the multivariate analyses, a significant association was noted between high TB levels and the adjusted risk of in-hospital cardiovascular mortality (odds ratio 3.24, 95% confidence interval 1.27 to 8.27, p = 0.014). In the receiver operating characteristic curve analysis, TB >0.90 mg/dl was identified as an effective cutpoint in patients with STEMI for in-hospital cardiovascular mortality (area under the curve 0.66, 95% confidence interval 0.55 to 0.76, p = 0.001). The mean follow-up period was 26.2 months. No differences were seen in the long-term mortality rates between the 2 groups. In conclusion, high TB is independently associated with in-hospital adverse outcomes in patients with STEMI who undergo primary PCI. However, no association was found with long-term mortality.