01 febrero 2013

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS. Assessment of clinical outcomes related to early discharge after elective percutaneous coronary intervention†

Purushothaman Muthusamy MD, Denise K. Busman MSN, RN2,, Alan T. Davis PHD, David H. Wohns MD, FACC, FSCAI

Objective: To assess clinical outcomes of same-day discharge (SDD) patients after elective percutaneous coronary intervention (PCI).

01 enero 2013

AMERICAN HEART JOURNAL. A prospective, randomized trial of intravascular-ultrasound guided compared to angiography guided stent implantation in complex coronary lesions: The AVIO trial

Alaide Chieffo, MD , Azeem Latib, MD , Christophe Caussin, MD , Patrizia Presbitero, MD , Stefano Galli, MD , Alberto Menozzi, MD , Ferdinando Varbella, MD , Fina Mauri, MD , Marco Valgimigli, MD , Chourmouzios Arampatzis, MD , Manuel Sabate, MD , Andrejs Erglis, MD , Bernhard Reimers, MD , Flavio Airoldi, MD , Mika Laine, MD , Ramon Lopez Palop, MD , Ghada Mikhail, MD , Philip MacCarthy, MD , Francesco Romeo, MD , Antonio Colombo, MD, FACC

Background: No randomized studies have thus far evaluated intravascular ultrasound (IVUS) guidance in the drug-eluting stent (DES) era. The aim was to evaluate if IVUS optimized DES implantation was superior to angiographic guidance alone in complex lesions.

01 enero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Intra-Procedural Stent ThrombosisA New Risk Factor for Adverse Outcomes in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes

Sorin J. Brener, MD; Ecaterina Cristea, MD; Ajay J. Kirtane, MD, SM; Margaret B. McEntegart, MD; Ke Xu, MS; Roxana Mehran, MD; Gregg W. Stone, MD

Objectives: The aim of this study was to examine the incidence, correlates, and consequences of intra-procedural stent thrombosis (IPST) in patients with acute coronary syndromes (ACS).

15 diciembre 2011

STROKE. Patent Foramen Ovale Closure and Medical Treatments for Secondary Stroke Prevention. A Systematic Review of Observational and Randomized Evidence

Georgios D. Kitsios, MD, PhD, MS; Issa J. Dahabreh, MD, MS; Abd Moain Abu Dabrh, MD; David E. Thaler, MD, PhD; David M. Kent, MD, MS

Background and Purpose—Patients discovered to have a patent foramen ovale in the setting of a cryptogenic stroke may be treated with percutaneous closure, antiplatelet therapy, or anticoagulants. A recent randomized trial (CLOSURE I) did not detect any benefit of closure over medical treatment alone; the optimal medical therapy is also unknown. We synthesized the available evidence on secondary stroke prevention in patients with patent foramen ovale and cryptogenic stroke.

01 enero 2013

AMERICAN JOURNAL OF CARDIOLOGY. Incidence and Outcomes of No-Reflow Phenomenon During Percutaneous Coronary Intervention Among Patients With Acute Myocardial Infarction

Robert W. Harrison, MD , Atul Aggarwal, MD , Fang-shu Ou, MS , Lloyd W. Klein, MD , John S. Rumsfeld, MD, PhD , Matthew T. Roe, MD, MHS , Tracy Y. Wang, MD, MHS , American College of Cardiology National Cardiovascular Data Registry

Previous studies describing the no-reflow phenomenon in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) were largely confined to single-center studies or small registries. To better characterize the incidence, predictors, and outcomes of the no-reflow phenomenon in a large contemporary population, we analyzed patients with AMI who were undergoing PCI of native coronary artery stenoses in the CathPCI Registry from January 1, 2004 through September 5, 2008 (n = 291,380). The angiographic no-reflow phenomenon was site reported using a standardized definition. No-reflow developed in 2.3% of the patients with AMI (n = 6,553) during PCI. Older age, ST-segment elevation AMI, prolonged interval from symptom onset to admission, and cardiogenic shock were clinical variables independently associated with the development of no-reflow (p <0.001). The angiographic factors independently associated with no-reflow included longer lesion length, higher risk class C lesions, bifurcation lesions, and impaired preprocedure Thrombolysis In Myocardial Infarction flow (p <0.001). No-reflow was associated with greater in-hospital mortality (12.6% vs 3.8%, adjusted odds ratio 2.20, 95% confidence interval 1.97 to 2.47, p <0.001) and unsuccessful lesion outcome (29.7% vs 6.6%, adjusted odds ratio 4.70, 95% confidence interval 4.28 to 5.17, p <0.001) compared to patients without no-reflow. In conclusion, the development of no-reflow, although relatively uncommon during PCI for AMI, is associated with adverse clinical outcomes. Upfront strategies to reduce the incidence of no-reflow could be considered for high-risk patients to improve outcomes.

01 febrero 2013

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS. Clinical outcomes after bare-metal stenting in diabetic patients with lesions carrying a low risk of restenosis

Pier Woudstra MD, Peter Damman MD, Marcel A.M. Beijk MD, PhD, Maik J.D. Grundeken MD, Ralf E. Harskamp MD, Karel T. Koch MD, PhD,José P.S. Henriques MD, PhD,Jan Baan Jr. MD, PhD, Marije M. Vis MD,Jan J. Piek MD, PhD, Jan G.P. Tijssen PhD, Robbert J. de Winter MD, PhD

Objective: To evaluate the clinical results of diabetic patients undergoing percutaneous coronary intervention (PCI) for coronary artery lesions carrying a low risk of restenosis treated with a bare-metal stent (BMS).

01 enero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Aortic Root Dimensions Among Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Lutz Buellesfeld, MD; Stefan Stortecky, MD; Bindu Kalesan, PhD; Steffen Gloekler, MD; Ahmed A. Khattab, MD; Fabian Nietlispach, MD; Valentina Delfine, MD; Christoph Huber, MD; Balthasar Eberle, MD; Bernhard Meier, MD; Peter Wenaweser, MD; Stephan Windecker, MD

Objectives: The aim of this study was to characterize aortic root dimensions of patients with aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR) and to evaluate sex differences.

01 enero 2013

AMERICAN JOURNAL OF CARDIOLOGY. Mean Platelet Volume and Long-Term Mortality in Patients Undergoing Percutaneous Coronary Intervention

Binita Shah, MD, MS , Brandon Oberweis, MD , Lakshmi Tummala, MD , Nicholas S. Amoroso, MD , Iryna Lobach, PhD , Steven P. Sedlis, MD , Eugene Grossi, MD , Jeffrey S. Berger, MD, MS

Increased platelet activity is associated with adverse cardiovascular events. The mean platelet volume (MPV) correlates with platelet activity; however, the relation between the MPV and long-term mortality in patients undergoing percutaneous coronary intervention (PCI) is not well established. Furthermore, the role of change in the MPV over time has not been previously evaluated. We evaluated the MPV at baseline, 30 days, 60 days, 90 days, 1 year, 2 years, and 3 years after the procedure in 1,512 patients who underwent PCI. The speed of change in the MPV was estimated using the slope of linear regression. Mortality was determined by query of the Social Security Death Index. During a median of 8.7 years, mortality was 49.3% after PCI. No significant difference was seen in mortality when stratified by MPV quartile (first quartile, 50.1%; second quartile, 47.7%; third quartile, 51.3%; fourth quartile, 48.3%; p = 0.74). For the 839 patients with available data to determine a change in the MPV over time after PCI, mortality was 49.1% and was significantly greater in patients with an increase (52.9%) than in those with a decrease (44.2%) or no change (49.1%) in the MPV over time (p <0.0001). In conclusion, no association was found between the baseline MPV and long-term mortality in patients undergoing PCI. However, increased mortality was found when the MPV increased over time after PCI. Monitoring the MPV after coronary revascularization might play a role in risk stratification.

01 febrero 2013

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS. Outcomes of transcatheter approach for initial treatment of pulmonary atresia with intact ventricular septum

Babar Sultan Hasan MD, Victor Bautista-Hernandez MD, PhD, Doff B. McElhinney MD, Joshua Salvin MD, MPH, Peter C. Laussen MBBS, Ashwin Prakash MD, Robert L. Geggel MD, Frank A. Pigula

Objective: To review the short and medium term outcome of transcatheter pulmonary valve perforation (PVP) in patients with pulmonary atresia-intact ventricular septum and non-right ventricular dependant coronary circulation (PA/IVS non-RVDCC).

01 enero 2013

AMERICAN HEART JOURNAL. Differential prognostic impact of high on-treatment platelet reactivity among patients with acute coronary syndromes versus stable coronary artery disease undergoing percutaneous coronary intervention

Duk-Woo Park, MD , Jung-Min Ahn, MD , Hae-Geun Song, MD , Jong-Young Lee, MD , Won-Jang Kim, MD , Soo-Jin Kang, MD , Sung-Cheol Yun, PhD , Seung-Whan Lee, MD , Young-Hak Kim, MD , Cheol Whan Lee, MD , Seong-Wook Park, MD , Seung-Jung Park, MD

Background: High on-treatment platelet reactivity (HTPR) after clopidogrel is associated with a higher risk of cardiovascular events after percutaneous coronary intervention (PCI). However, it remains unclear whether HTPR is of similar prognostic value for different clinical presentations.

01 enero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Percutaneous Transcatheter Aortic Valve Closure Successfully Treats Left Ventricular Assist Device–Associated Aortic Insufficiency and Improves Cardiac Hemodynamics

Kishan S. Parikh, MD; Amit K. Mehrotra, MD, MBA; Mark J. Russo, MD, MSC; Roberto M. Lang, MD; Allen Anderson, MD; Valluvan Jeevanandam, MD; Benjamin H. Freed, MD; Jonathan D. Paul, MD; Janet Karol, MSN; Sandeep Nathan, MD, MS; Atman P. Shah, MD

Objectives: This study sought to assess the effectiveness of a novel percutaneous method to treat left ventricular assist device (LVAD)–associated severe aortic insufficiency (AI) in a series of patients determined to be poor reoperative candidates.

01 enero 2013

AMERICAN JOURNAL OF CARDIOLOGY. Characteristics and Outcomes of Patients With ST-Segment Elevation Myocardial Infarction Excluded from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial

Luigi Fiocca, MD , Giulio Guagliumi, MD , Roberta Rossini, MD , Helen Parise, ScD , Giuseppe Musumeci, MD , Vasile Sirbu, MD , Nikoloz Lortkipanidze, MD , Jennifer Yu, MD , Laurian Mihalcsik, MD , Angelina Vassileva, MD , Orazio Valsecchi, MD , Antonello Gavazzi, MD , Roxana Mehran, MD , Gregg W. Stone, MD

Randomized controlled trials assessing new drugs and devices tend to exclude subjects who are at greatest risk. The Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial incorporated broader inclusion criteria in an attempt to include a more representative spectrum of patients presenting with ST-segment elevation myocardial infarction (STEMI). To identify the differences between this modern trial and the real world, we analyzed the characteristics and outcomes of patients with STEMI who were screened but not enrolled at a high-volume recruiting center. Of 318 consecutive patients with STEMI who were screened, 200 (62.9%) were randomized, and 118 (37.1%) were excluded. The baseline characteristics and 30-day and 1-year clinical outcomes were compared in the 2 groups. The excluded patients had numerous high-risk features compared to those randomized, including being older (67.0 ± 12.8 vs 63.0 ± 11.4 years, p = 0.004), more often had had a previous MI (34.7% vs 8.0%, p <0.001), Killip class III-IV (27.4% vs 4.0%, p <0.001), and lower hemoglobin (13.4 ± 2.3 vs 14.8 ± 1.5 g/dl, p <0.001). The excluded patients had markedly greater 30-day and 1-year rates of all-cause mortality (17.4% vs 2.0%, p <0.001, and 27.6% vs 2.5%, p <0.001, respectively), major adverse cardiovascular events (death, MI, ischemia-driven target vessel revascularization, and stroke), major bleeding, and net adverse clinical events (major adverse cardiovascular events or major bleeding). On multivariate analysis, Killip class III-IV at presentation, age, left ventricular ejection fraction, and final Thrombolysis In Myocardial Infarction flow grade 3 were independent predictors of outcome. In conclusion, despite the broadened entry criteria of the HORIZONS-AMI trial, 37.1% of all patients presenting with STEMI at a center with a high rate of enrollment were judged to be ineligible and were excluded. The excluded patients had a significantly greater risk profile and markedly increased mortality and adverse events compared to the trial-eligible group.

01 febrero 2013

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS. Objective quantification of aortic valvular structures by cardiac computed tomography angiography in patients considered for transcatheter aortic valve implantation

Grigorios Korosoglou MD, Gitsios Gitsioudis MD, Irina Waechter-Stehle PhD, Juergen Weese PhD, Ulrike Krumsdorf MD, Emmanuel Chorianopoulos MD, Waldemar Hosch MD, Hans-Ulrich Kauczor MD, Hugo A. Katus MD, Raffi Bekeredjian MD

Purpose: To test the ability of a model-based segmentation of the aortic root for consistent assessment of aortic valve structures in patients considered for transcatheter aortic valve implantation (TAVI) who underwent 256-slice cardiac computed tomography (CT).

01 enero 2013

JACC: CARDIOVASCULAR INTERVENTIONS. Left Main Coronary Atherosclerosis Progression, Constrictive Remodeling, and Clinical Events

Rishi Puri, MBBS; Kathy Wolski, MPH; Kiyoko Uno, MD, PhD; Yu Kataoka, MD; Karilane L. King, MS; Timothy D. Crowe, MS; Samir R. Kapadia, MD; E. Murat Tuzcu, MD; Steven E. Nissen, MD; Stephen J. Nicholls, MBBS, PhD

Objectives: The aim of this study was to evaluate the progression of atherosclerosis within the left main coronary artery (LMCA) in association with risk factor modifying therapies.

01 enero 2013

AMERICAN JOURNAL OF CARDIOLOGY. Effect of Body Mass Index on Short- and Long-Term Outcomes After Transcatheter Aortic Valve Implantation

Robert M.A. van der Boon, MSc , Alaide Chieffo, MD , Nicolas Dumonteil, MD , Didier Tchetche, MD , Nicolas M. Van Mieghem, MD , Gill L. Buchanan, MBChB , Olivier Vahdat, MD , Bertrand Marcheix, MD, PhD , Patrick W. Serruys, MD, PhD , Jean Fajadet, MD , Antonio Colombo, MD, PhD , Didier Carrié, MD, PhD , Ron T. van Domburg, PhD , Peter P.T. de Jaegere, MD, PhD , PRAGMATIC-Plus Researchers

Better outcomes have been reported after percutaneous cardiac intervention in obese patients (“obesity paradox”). However, limited information is available on the effect of the body mass index on the outcomes after transcatheter aortic valve implantation (TAVI). We, therefore, sought to determine the effect of the body mass index on the short- and long-term outcomes in patients who underwent TAVI. The population consisted of 940 patients, of whom 25 (2.7%) were underweight, 384 had a (40.9%) normal weight, 372 (39.6%) were overweight, and 159 (16.9%) were obese. Overall, the obese patients were younger (79.7 ± 6.4 years vs 81.7 ± 7.3 and 80.8 ± 7.0 years, p = 0.008) and had a greater prevalence of preserved left ventricular and renal function. On univariate analysis, obese patients had a greater incidence of minor stroke (1.3% vs 0 and 0.3%, p = 0.03), minor vascular complications (15.7% vs 9.1% and 11.6%, p = 0.028) and acute kidney injury stage I (23.3% vs 10.7% and 16.1%, p <0.001). After adjustment, body mass index, as a continuous variable, was associated with a lower risk of mortality at 30 days (odds ratio 0.93, 95% confidence interval 0.86 to 0.98, p = 0.023) and no effect on survival after discharge (hazard ratio 1.01, 95% confidence interval 0.96 to 1.07, p = 0.73). In conclusion, obesity was associated with a greater incidence of minor, but no major, perioperative complications after TAVI. After adjustment, obesity was associated with a lower risk of 30-day mortality and had no adverse effect on mortality after discharge, underscoring the “obesity paradox” in patients undergoing TAVI.