MedWorm: Angioplasty

Atrial fibrillation linked to adverse outcomes after PCI

MedWire News - Cardiology — Wed, 08 Feb 2012 14:07:01 +0100

Patients with periprocedural atrial fibrillation are at an increased risk for adverse outcomes after undergoing percutaneous coronary intervention, research suggests. (Source: MedWire News - Cardiology)

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Cost-effectiveness of bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitor for acute MI in the UK

NeLM - News — Wed, 08 Feb 2012 05:00:00 +0100

Source: Heart Area: News This model-based cost-utility analysis assessed the cost-effectiveness of bivalirudin versus heparin and glycoprotein IIb/IIIa inhibitor (H-GPI) in patients undergoing primary percutaneous coronary intervention (PPCI) for acute ST-segment elevation myocardial infarction (STEMI), and was provided for the NICE appraisal of bivalirudin use in STEMI patients undergoing PPCI. The model evaluated incremental costs, and incremental clinical effectiveness expressed as quality-adjusted life-years (QALYs) gained. The following findings were reported: . The main model (clinical events until the end of year 1) predicted bivalirudin and H-GPI patients to survive 11.52 and 11.35 (undiscounted) years on average, respectively, and to accrue 6.26 and 6...

Stenting Seldom Done for Left Main Disease (CME/CE)

MedPage Today Cardiovascular — Tue, 07 Feb 2012 15:53:45 +0100

(MedPage Today) -- Percutaneous coronary intervention is used for only a fraction of patients with unprotected left main coronary artery stenosis, researchers found. (Source: MedPage Today Cardiovascular)

Long‐term results of cephalad arteries percutanoeus transluminal angioplasty with stent implantation (The CAPTAS registry)

Catheterization and Cardiovascular Interventions — Mon, 06 Feb 2012 05:00:00 +0100

Conclusions: CAS is safe and successful procedure with low early and long‐term adverse events. Special attention should be put on patients with bilateral and left ICA stenoses. If possible, longer stents should be applied. © 2011 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)

Repeat percutaneous coronary revascularization: Indications and outcomes in a “Real World” cohort

Catheterization and Cardiovascular Interventions — Mon, 06 Feb 2012 05:00:00 +0100

Conclusions: In contemporary practice, patients undergoing a first stenting procedure have a low subsequent mortality, and the substantial majority (86.4%) requires no further revascularization over a median 3.8 year follow‐up. For those who do require repeat stenting, this is most commonly at a site remote from the first stent. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)

Cardiovascular Outcomes Using Intra-Aortic Balloon Pump in High-Risk Acute Myocardial Infarction With or Without Cardiogenic Shock: A Meta-Analysis

Journal of Cardiovascular Pharmacology and Therapeutics — Mon, 06 Feb 2012 05:00:00 +0100

Conclusion: The present meta-analysis suggests that patients with high-risk AMI without cardiogenic shock do not seem to benefit from the use of IABP as measured by in-hospital mortality, rate of reinfarction, and recurrent angina. However, in patients with AMI with cardiogenic shock (systolic blood pressure [SBP] < 90), there was significant reduction in mortality using IABP. The use of IABP is associated with increase in the rate of both moderate and severe bleeding. (Source: Journal of Cardiovascular Pharmacology and Therapeutics)

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From coronary care unit to acute cardiac care unit: the evolving role of specialist cardiac care

Heart — Mon, 06 Feb 2012 05:00:00 +0100

The development of primary angioplasty (PPCI) programmes for acute ST elevation myocardial infarction (STEMI) following Roger Boyle's report ‘Mending hearts and brains’ in 20061 has led to a marked shift in the role of the coronary care unit (CCU) in the UK. Some units no longer admit STEMI patients, while in PPCI centres the concentrated influx of patients previously treated across a network of hospitals has placed CCU beds and staff under considerable pressure. However, there are other factors changing and increasing the workload of acute cardiology, and the development of PPCI cannot be considered in isolation. In particular, the changing demographics of the population has led to an increasing proportion of elderly patients presenting to hospital with non-ST elevation myocar...

Case fatality rates for South Asian and Caucasian patients show no difference 2.5 years after percutaneous coronary intervention

Heart — Mon, 06 Feb 2012 05:00:00 +0100

Conclusion In this large PCI cohort, the in-hospital and longer-term mortality of South Asians appeared no worse than that of Caucasians. South Asians had higher rates of restenosis and CABG during follow-up. Data suggest that the excess coronary mortality for South Asians compared with Caucasians is not explained by differences in case-fatality rates. (Source: Heart)

ST-segment resolution after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction.

Cardiology Journal — Mon, 06 Feb 2012 00:36:02 +0100

Conclusions: In patients with STEMI undergoing PPCI, ST-segment resolution in electrocardiograms recorded 90-120 min after initiation of PPCI did not predict long-term mortality. (Cardiol J 2012; 19, 1: 61-69). PMID: 22298169 [PubMed - in process] (Source: Cardiology Journal)

Baseline NT-proBNP and biomarkers of inflammation and necrosis in patients with ST-segment elevation myocardial infarction: insights from the APEX-AMI trial

Journal of Thrombosis and Thrombolysis — Fri, 03 Feb 2012 17:52:05 +0100

Abstract Coronary plaque rupture is associated with a systemic inflammatory response. The relationship between baseline N-terminal pro B-type natriuretic peptide (NT-proBNP), a prognostic marker in patients with acute coronary syndromes, and systemic inflammatory mediators in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) is not well described. Of 5,745 STEMI patients treated with primary PCI in the APEX-AMI trial, we evaluated the relationship between baseline NT-proBNP levels and baseline levels of inflammatory markers and markers of myonecrosis in a subset of 772 who were enrolled in a biomarker substudy. Spearman correlations (r s) were calculated between baseline NT-proBNP levels and a pan...

Fibromuscular dysplasia: a differential diagnosis of vasculitis

Revista Brasileira de Reumatologia — Fri, 03 Feb 2012 10:19:07 +0100

A displasia fibromuscular (DFM) envolve artérias de pequeno e médio calibre e é uma causa bem conhecida de hipertensão em mulheres jovens caucasianas, quando envolve as artérias renais. A etiologia da DFM permanece desconhecida, a despeito de inúmeras teorias. Há suspeita de um componente genético, já que a doença atinge primariamente caucasianos. Também é descrita associação entre DFM e antígeno de histocompatibilidade HlA-DRw6. Os principais sítios acometidos são as artérias renais, cerebrais, carótidas, viscerais, ilíacas, subclávias, braquiais e poplíteas. As manifestações clínicas correlacionam-se com o sítio acometido, e a hipertensão arterial sistêmica é um sintoma frequente pelo acometimento das artérias renais em 60%-75% dos casos. O diagnóstico da D...

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Chronic mesenteric ischaemia: 28-year experience of endovascular treatment

European Radiology — Thu, 02 Feb 2012 18:12:25 +0100

Conclusion Technical success rates are improved with the use of stents; however, PTA use in the SMA seems to offer better primary patency rates. Key Points • Superior mesenteric artery (SMA) stenosis is often responsible for ischaemic symptoms. • Treatment with percutaneous transluminal angioplasty (PTA) seems superior to stenting • Although technical success rates are improved with the use of stents. • Higher mortality in the elderly and those presenting with nausea/vomiting/bloody stools. Content Type Journal ArticleCategory Vascular-InterventionalPages 1-13DOI 10.1007/s00330-011-2376-zAuthors Ulku Cenk Turba, Interventional Radiology, University of Virginia, Charlottesville, VA, USAWael E. Saad, Intervention...

PCI Upgraded in 'Appropriate Use' Updates (CME/CE)

MedPage Today Geriatrics — Thu, 02 Feb 2012 16:37:50 +0100

(MedPage Today) -- Percutaneous coronary intervention is now considered appropriate in relatively benign three-vessel disease, according to an update of criteria for revascularization of complex coronary artery disease. (Source: MedPage Today Geriatrics)

Conquering Atherosclerosis Starts With Improving Medical Education

The American Journal of Cardiology — Thu, 02 Feb 2012 14:05:53 +0100

The United States Department of Health and Human Services recently launched the Million Hearts initiative to prevent 1 million heart attacks and strokes over the next 5 years by implementing proved, effective, and inexpensive interventions. But why stop at a million? We already have all the information we need to eradicate atherosclerotic disease, which is a food-borne illness. Coronary artery disease is virtually nonexistent in large populations of individuals who consume plant-based nutrition. Some of the most renowned cardiovascular pathologists in the world have stated that maintaining a total cholesterol level >150 mg/dl is the true cause of this disease. Plaque regression occurs in >80% of patients who adopt a low-fat vegetarian diet. Cardiac positron emission tomographic scans show ...

A New Diagnostic Algorithm for Antibody‐Mediated Microcirculation Inflammation in Kidney Transplants

American Journal of Transplantation — Thu, 02 Feb 2012 05:00:00 +0100

We studied the significance of microcirculation inflammation in kidney transplants, including 329 indication biopsies from 251 renal allograft recipients, who were mostly nonpresensitized (crossmatch negative). Glomerulitis (g) and peritubular capillaritis (ptc) were often associated with antibody‐mediated rejection (65% and 75%, respectively), but were also found in other diseases in the absence of donor‐specific antibody (DSA): T‐cell‐mediated rejection (ptc, g), glomerulonephritis (g) and acute tubular necrosis (ptc). To develop rules for reducing the nonspecificity of microcirculation inflammation and defining the best grading thresholds associated with DSA, we built and validated a decision tree to predict DSA. The decision tree revealed that g + ptc sum (addition of g‐score...

CABG Outlasts Stenting for Survival (CME/CE)

MedPage Today Cardiovascular — Wed, 01 Feb 2012 16:40:03 +0100

FT. LAUDERDALE (MedPage Today) -- Coronary artery bypass grafing was associated with better longer-term survival compared with percutaneous coronary intervention in certain high-risk subgroups, the large observational ASCERT study showed. (Source: MedPage Today Cardiovascular)

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An artificial neural network to safely reduce the number of ambulance ECGs transmitted for physician assessment in a system with prehospital detection of ST elevation myocardial infarction

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: Our ANN had an excellent ability to predict STEMI and the need of acute PCI in ambulance ECGs, and has a potential to safely reduce the number of ECG transmitted to the CCU by almost two thirds. (Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine)

Stent design lowers angiographic but not clinical adverse events in stenting of symptomatic intracranial stenosis – results of a single center study with 100 consecutive patients

International Journal of Stroke — Wed, 01 Feb 2012 05:00:00 +0100

ConclusionDespite a high technical success, the rate of clinical adverse events at 30 days after intracranial angioplasty and stenting is high independently of the stent design. Thus, further development of intracranial stent systems and careful patient selection are mandatory. (Source: International Journal of Stroke)

Isoproterenol stress test during catheterization of patients with coarctation of the aorta

Pediatrics International — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: Significant pressure gradients over the coarctation site develop at IST in pediatric patients with repaired CoA or in preoperative patients with mild coarctation.© 2012 The Authors. Pediatrics International © 2012 Japan Pediatric Society (Source: Pediatrics International)

Aspirin and Angioplasty

Journal of the American College of Radiology : JACR — Wed, 01 Feb 2012 05:00:00 +0100

Every August for 30 years, the Federal Reserve Bank of Kansas City has convened a meeting in Jackson Hole, Wyoming. Attracting some of the world's best minds in finance and economics, the policy symposium covers topics such as emerging markets, economic growth, and global competiveness. (Source: Journal of the American College of Radiology : JACR)

Med Sci Monit 2012; 18(2):CR72-77 "Persistence of initial oral antidiabetic treatment in patients with type 2 diabetes mellitus"

Medical Science Monitor — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: The persistence of initial treatment with metformin and/or sulphonylureas is far from optimal. Better diabetic care and continuous patient education should be encouraged to achieve higher persistence of oral antidiabetic treatment in patients with type 2 diabetes. (Source: Medical Science Monitor)

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The Results of a Needs Assessment to Guide a Vascular Surgery Skills Simulation Curriculum

Annals of Vascular Surgery — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: Our needs assessment identified vascular procedures where simulation may be beneficial to improve the skill level of vascular trainees in Southern California. With economic and logistical constraints for simulation at each individual training facility, a potential approach to this educational challenge is a regional Southern California vascular surgery skills simulation center. (Source: Annals of Vascular Surgery)

Detection of periodontal bacteria in thrombi of patients with acute myocardial infarction by polymerase chain reaction

American Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: Three species of periodontal bacteria were detected in the thrombi of patients with acute myocardial infarction. This raises the possibility that such bacteria are latently present in plaque and also suggests that these bacteria might have a role in plaque inflammation and instability. (Source: American Heart Journal)

Reduced immediate ischemic events with cangrelor in PCI: A pooled analysis of the CHAMPION trials using the universal definition of myocardial infarction

American Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion: With the use of the universal definition of myocardial infarction, cangrelor was associated with a significant reduction in early ischemic events when compared with clopidogrel in patients with non–ST-elevation ACS undergoing PCI. (Source: American Heart Journal)

Circadian variations of ischemic burden among patients with myocardial infarction undergoing primary percutaneous coronary intervention

American Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Conclusion: This study demonstrates an independent correlation between the infarct size of STEMI patients treated by PPCI and the time of the day at which symptoms occurred. These results suggest that time of the day should be a critical issue to look at when assessing prognosis of patients with myocardial infarction. (Source: American Heart Journal)

Indications for percutaneous coronary interventions performed in US hospitals: a report from the NCDR®

American Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: A small proportion of PCI procedures were performed in patients with unclear indications, but there was wide variation across hospitals. On average, specialty hospitals performed more PCIs for unclear indications. Efforts to reduce variability should be pursued. (Source: American Heart Journal)

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Percutaneous coronary intervention outcomes in US hospitals with varying structural characteristics: Analysis of the NCDR®

American Heart Journal — Wed, 01 Feb 2012 05:00:00 +0100

Conclusions: Specialty hospitals appear to have lower rates of most adverse outcomes for PCI. Specialty hospitals may have developed expertise in narrow procedural areas that could be adapted to the larger population of general hospitals. (Source: American Heart Journal)

Angioplasty with autologous pericardium for bilateral coronary ostial stenosis in takayasu disease.

The Annals of Thoracic Surgery — Tue, 31 Jan 2012 04:19:03 +0100

This report describes successful patch angioplasty using glutaraldehyde-treated autologous pericardium of bilateral coronary ostial stenosis owing to Takayasu disease. PMID: 22269730 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

Encapsulated papillary thyroid carcinoma, follicular variant: A misnomer

Pathology International — Mon, 30 Jan 2012 05:00:00 +0100

In conclusion, a malignant diagnosis of EnFVPTC should not be used to cover this spectrum of tumors until uncertainty about the nature of this lesion is settled, whether it is benign, precancerous or malignant. (Source: Pathology International)

Intramyocardial Hemorrhage after Percutaneous Coronary Intervention

Echocardiography — Sun, 29 Jan 2012 14:01:04 +0100

(Echocardiography 2012;29:E50‐E51) (Source: Echocardiography)

Balloon angioplasty vs nitinol stent placement in the treatment of venous anastomotic stenoses of hemodialysis grafts after surgical thrombectomy

Journal of Vascular Surgery — Fri, 27 Jan 2012 11:25:15 +0100

In 2010, CPT code 36147 was created and bundles the work of establishing single catheter access with the diagnostic contrast imaging of the dialysis circuit. In 2012, the introductory wording was updated to clarify reporting concerns voiced by the insurance industry and coding groups. (Source: Journal of Vascular Surgery)

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Invited commentary

Journal of Vascular Surgery — Fri, 27 Jan 2012 11:25:14 +0100

The increasingly aggressive endovascular management of tibial artery occlusive disease is understandable given the fact that endovascular surgeons have routinely acquired increased technical skill and gained access to enabling endovascular hardware. However, the many options available to treat atheromatous lesions, including balloon angioplasty, cryoplasty, excisional atherectomy, rotational atherectomy, self-expanding stent placement, covered stent placement, balloon expandable stent placement, and drug-eluting stent placement, have driven the treatment of lesions faster than data has provided guidance. (Source: Journal of Vascular Surgery)

Cilostazol suppression of arterial intimal hyperplasia is associated with decreased expression of sialyl Lewis X homing receptors on mononuclear cells and E-selectin in endothelial cells

Journal of Vascular Surgery — Fri, 27 Jan 2012 11:25:14 +0100

Conclusions: These results demonstrate that the protective effect of cilostazol against neointimal hyperplasia may be mediated by its anti-inflammatory actions of mononuclear cells homing to endothelial cells by decreasing SLX and E-selectin expression. Clinical Relevance: It is reported that cilostazol inhibits neointimal hyperplasia by decreasing the expression of some cell-adhesion molecules. We evaluated the effects of cilostazol for the expression of sialyl Lewis X (SLX) on mononuclear cells and E-selectin on endothelial cells, which interaction is the first step of inflammation action. Cilostazol was thought to show the anti-inflammatory actions by decreasing SLX and E-selectin expression in addition to decreasing the expression of some cell-adhesion molecules. (Source: Journal of...

Effect of heart rate on hemodynamic endpoints under concomitant microvascular disease in a porcine model.

Am J Physiol Heart C... — Fri, 27 Jan 2012 05:00:00 +0100

Conclusion. Under MVD conditions, FFR, CDP, and LFC were not significantly influenced by changes in HR while they can significantly distinguish %AS and DP groups. PMID: 22287585 [PubMed - as supplied by publisher] (Source: Am J Physiol Heart C...)

First Experience in Humans Using Adipose Tissue–Derived Regenerative Cells in the Treatment of Patients With ST-Segment Elevation Myocardial Infarction

Journal of the American College of Cardiology — Thu, 26 Jan 2012 13:57:11 +0100

In preclinical animal models of acute myocardial infarction (AMI), administration of freshly isolated adipose tissue–derived regenerative cells (ADRCs) immediately after the AMI improved left ventricular (LV) function and myocardial perfusion (). The predominant working mechanism of ADRC therapy in AMI is believed to be through paracrine release of antiapoptotic, immunomodulatory, and proangiogenic factors. These factors evoke cardiomyocyte salvage and stimulate neoangiogenesis in the infarct border zone and eventually result in reduced infarct scar formation and adverse cardiac remodeling (). ADRCs comprise, among other cells, immune-competent cells, endothelial progenitor cells, and mesenchymal stem cells. The amount of these mesenchymal stem cells in freshly isolated adipose tissue di...

Alternative Techniques for Treatment of Complex Below-the Knee Arterial Occlusions in Diabetic Patients With Critical Limb Ischemia

CardioVascular and Interventional Radiology — Thu, 26 Jan 2012 06:55:41 +0100

Conclusion The use of alternative techniques seems feasible in case of a failed antegrade BTK revascularization attempt and could minimize failure rates in the treatment of complex occlusions while providing satisfying clinical success rates at 6 months. Content Type Journal ArticleCategory Clinical InvestigationPages 1-9DOI 10.1007/s00270-012-0344-xAuthors Roberto Gandini, Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine, IRCCS Policlinico di Tor Vergata, 00133 Rome, ItalyLuigi Uccioli, Department of Internal Medicine, IRCCS Policlinico di Tor Vergata, 00133 Rome, ItalyAlessio Spinelli, Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine, IRCCS Policlinico di Tor Vergata, 0...

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Changes in treatment and mortality of acute myocardial infarction in Estonian tertiary and secondary care hospitals in 2001 and 2007

BMC Research Notes — Thu, 26 Jan 2012 05:00:00 +0100

Conclusions: AMI treatment improved in both types of hospitals, while the improvement was more pronounced in tertiary care. Still, better treatment did not result in a significantly lower mortality. Higher age and cardiovascular risk are posing a challenge for AMI treatment. (Source: BMC Research Notes)

Percutaneous Coronary Intervention in Patients with Severe Aortic Stenosis: Implications for Transcatheter Aortic Valve Replacement.

Circulation — Thu, 26 Jan 2012 05:00:00 +0100

CONCLUSIONS: PCI can be performed in patients with severe symptomatic AS and CAD without an increased risk of short term mortality compared to propensity matched patients without AS. Patients with EF ≤30% and STS score ≥10% are at a highest risk of 30-day mortality after PCI. This finding has significant implications in the management of severe CAD in high risk severe symptomatic AS patients being considered for TAVR. PMID: 22282327 [PubMed - as supplied by publisher] (Source: Circulation)

Changes in BNP, hs-CRP and TIMI risk index with addition of tirofiban during primary percutaneous coronary intervention for acute STEMI: a prospective observational cohort study.

Anadolu Kardiyol Der... — Thu, 26 Jan 2012 05:00:00 +0100

CONCLUSION: It was concluded at the end of them PCI application in STEMI that the addition of tirofiban treatment in patients with ≥TIMI 2 flow and anterior location MI could decrease the expected rise in BNP and CRP values. PMID: 22281789 [PubMed - as supplied by publisher] (Source: Anadolu Kardiyol Der...)

Bare Metal Stent Thrombosis in Patients With Acute Coronary Syndrome.

Circulation Journal — Thu, 26 Jan 2012 05:00:00 +0100

Conclusions: The incidence of ST in ACS patients was higher than classically described. Clopidogrel discontinuation and resumption of smoking are involved. Efforts should be made to improve patient education and secondary prevention. PMID: 22277320 [PubMed - as supplied by publisher] (Source: Circulation Journal)

[Composed angioplasty of the multilevel right common and internal carotid artery stenoses with implantation stents with used of proximal and distal protection system.]

Kardiologia Polska — Wed, 25 Jan 2012 06:54:02 +0100

We present a case of a 73 year-old man with, long-segment thigh stenosis in the right common and internal carotid artery with occlusion left common carotid artery. Complex angioplasty with modification proximal and distal system protection was successful performed. There were no procedure-related complications. We concluded that in very complex, multilevel lesions in carotid artery, there is a place for safe double system protection. This maneuver can increase safe of the carotid artery stenting and minimise potential complications. Kardiol Pol 2012; 70, 1: 88-90. PMID: 22267437 [PubMed - as supplied by publisher] (Source: Kardiologia Polska)

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[Stent implantation in recoarctation of aorta in infant.]

Kardiologia Polska — Wed, 25 Jan 2012 06:54:02 +0100

We present the case of a 12 month-old infant with critical coarctaion of aorta, arch hypoplasia, atrial and ventricular septal defects who underwent interventional treatment with stent implantation due to recoarctation of aorta. In neonatal period the patient went through complete surgical correction. At the age of four months balloon angioplasty of recurrent coractation was conducted. Eight months later the patient was hospitalised with heart failure (HF) symptoms. Clinical and echographic examination confirmed critical stenosis of aortic isthmus. We performed heart catheterisation with stent implantation to transverse and descending arch with immediate reduction of gradient from 45 mm Hg to 0 mm Hg, widening of the isthmus from 2 to 8 mm and gradual regression of HF symptoms. At 3 years ...

First-in-man study of paclitaxel-eluting stent BiOSS (Bifurcation Optimisation Stent System) dedicated for coronary bifurcation stenoses: three months results.

Kardiologia Polska — Wed, 25 Jan 2012 06:54:02 +0100

Conclusions: The BiOSS bifurcation dedicated stent is a feasible device, with promising safety and short-term clinical effectiveness/ profile. Kardiol Pol 2012; 70, 1: 45-52. PMID: 22267425 [PubMed - in process] (Source: Kardiologia Polska)

Primary percutaneous angioplasty, thrombolysis and conservative treatment in low-risk patients with ST-elevation myocardial infarction: effects on short- and long-term mortality.

Kardiologia Polska — Wed, 25 Jan 2012 06:54:02 +0100

Conclusions: No significant differences in 30-day or long-term mortality rates between conservative therapy, PCI or thrombolysis groups in low-risk STEMI patients were observed. Kardiol Pol 2012; 70, 1: 1-5. PMID: 22267414 [PubMed - in process] (Source: Kardiologia Polska)

Inadequate Reporting of Concomitant Drug Treatment in Cardiovascular Interventional Head‐to‐Head Trials

Clinical Cardiology — Wed, 25 Jan 2012 05:00:00 +0100

Conclusions:Poor reporting of medical treatment at discharge might reflect an underestimation of secondary prevention in patients undergoing cardiac surgery or interventional procedures in head‐to‐head interventional trials. Thus, discussion of optimal revascularization procedure has to remain open, even in terms of concomitant medical treatment of patients.Additional Supporting Information may be found in the online version of this article.The authors have no funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)

Drug-eluting stent implantation for coronary artery disease: current stents and a comparison with bypass surgery.

Current Opinion in Pharmacology — Wed, 25 Jan 2012 05:00:00 +0100

Authors: Head SJ, Bogers AJ, Kappetein AP Abstract Percutaneous coronary intervention (PCI) with bare-metal stents (BMS) has been performed increasingly ever since its introduction in the late 1970s. BMS have been replaced by drug-eluting stents (DES), and many interventional cardiologists consider this as a breakthrough therapy that might compete with coronary artery bypass grafting (CABG) as the standard treatment for coronary artery disease. Several DES are currently used and elute different agents. This review described what these agents are and provides an overview regarding the outcomes and associated adverse events. More importantly, this review compares outcomes of PCI with DES to CABG for patients with left anterior descending coronary artery involvement, left main involve...

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Randomized Comparison of the Efficacy and Safety of Zotarolimus-Eluting Stents vs. Sirolimus-Eluting Stents for Percutaneous Coronary Intervention in Chronic Total Occlusion.

Circulation Journal — Wed, 25 Jan 2012 05:00:00 +0100

Conclusions: The effectiveness and safety of ZES are similar to those of SES and therefore it is a good treatment option in patients undergoing PCI for CTO with DESs. PMID: 22277317 [PubMed - as supplied by publisher] (Source: Circulation Journal)

Medtronic Completes Enrollment of Extreme Risk Patient Group in CoreValve(R) U.S. Pivotal Trial

News from Angioplasty.Org — Wed, 25 Jan 2012 03:00:00 +0100

Medtronic, Inc. (NYSE: MDT) today announced it has completed patient enrollment in the extreme risk study in its CoreValve U.S. Pivotal Trial. The company also received approval from the U.S. Food and Drug Administration (FDA) for an extended investigation (under the FDA's Continued Access Policy) to continue enrolling extreme risk patients under a Continued Access Study protocol. In the Trial's second study evaluating high risk patients for aortic valve surgery, enrollment completion is anticipated later this year. (Source: News from Angioplasty.Org)

Positive thoughts boost physical activity after PCI

MedWire News - Cardiology — Wed, 25 Jan 2012 00:00:00 +0100

Patients who receive positive affect/self-affirmation intervention after undergoing percutaneous coronary intervention achieve a significant increase in physical activity, a study suggests. (Source: MedWire News - Cardiology)

Non-invasive assessment of atherosclerotic coronary lesion length using multidetector computed tomography angiography: comparison to quantitative coronary angiography

The International Journal of Cardiovascular Imaging — Tue, 24 Jan 2012 07:32:54 +0100

Abstract Multidetector computed tomography angiography (CTA) provides information on plaque extent and stenosis in the coronary wall. More accurate lesion assessment may be feasible with CTA as compared to invasive coronary angiography (ICA). Accordingly, lesion length assessment was compared between ICA and CTA in patients referred for CTA who underwent subsequent percutaneous coronary intervention (PCI). 89 patients clinically referred for CTA were subsequently referred for ICA and PCI. On CTA, lesion length was measured from the proximal to the distal shoulder of the plaque. Quantitative coronary angiography (QCA) was performed to analyze lesion length. Stent length was recorded for each lesion. In total, 119 lesions were retrospectively identified. Mean lesion length o...

Evaluation of dose requirements for prolonged bivalirudin administration in patients with renal insufficiency and suspected heparin-induced thrombocytopenia

Journal of Thrombosis and Thrombolysis — Tue, 24 Jan 2012 07:30:11 +0100

Abstract Bivalirudin, a direct thrombin inhibitor, is indicated for patients with suspected heparin-induced thrombocytopenia (HIT) with anticipated percutaneous coronary intervention (PCI). Data is limited on dose selection among patients with renal insufficiency, particularly with prolonged infusion durations. The study cohort comprised 73 patients with renal dysfunction who received bivalirudin for suspected HIT with or without acute coronary syndrome. We reviewed individual pharmacy and medical records for laboratory and bivalirudin dosing information, medical comorbidities, and adverse clinical outcomes during administration. When estimated glomerular filtration rate (eGFR) was calculated by the Cockcroft–Gault (CG; ml/min) formula, the average bivalirudin dose (mg/k...

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Local Extension at the Hilum Region Is Associated With Worse Long-Term Survival in Stage I Non-Small Cell Lung Cancers [ORIGINAL ARTICLES: GENERAL THORACIC]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

Conclusions Proximal tumor extension into bronchus, invasions into extrapericardial pulmonary vessels, and tumor size were the most important risk factors for 5-year survival with central-type stage I NSCLC. Tumor extension in the hilum was highly related to prognosis and might provide pertinent information to accurately define a tumor ("T") subclass. (Source: The Annals of Thoracic Surgery)

Angioplasty With Autologous Pericardium for Bilateral Coronary Ostial Stenosis in Takayasu Disease [CASE REPORTS]

The Annals of Thoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

This report describes successful patch angioplasty using glutaraldehyde-treated autologous pericardium of bilateral coronary ostial stenosis owing to Takayasu disease. (Source: The Annals of Thoracic Surgery)

Clinical outcomes of intracoronary eptifibatide bolus only versus intracoronary bolus and intravenous infusion of eptifibatide in primary percutaneous coronary intervention.

Acute Cardiac Care — Tue, 24 Jan 2012 05:00:00 +0100

Authors: Soon D, Ho HH, Loh KK, Ooi YW, Foo D, Jafary FH, Ong PJ Abstract Intracoronary bolus of eptifibatide during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has been shown to result in higher local platelet glycoprotein IIb/IIIa receptor occupancy with improved microvascular perfusion. It is unclear whether intracoronary administration of eptifibatide in a larger patient population results in favourable clinical outcomes. We evaluated the safety and efficacy of two regimens of intracoronary eptifibatide (bolus only versus bolus followed by intravenous infusion) in patients undergoing primary PCI for ST-elevation MI. They were divided into two groups: Group A (n = 67) who received fixed-dose intracoronary eptifibatide bolus only and Group B ...

PCI hospital number increases, patient access unchanged

MedWire News - Cardiology — Tue, 24 Jan 2012 00:00:00 +0100

The number of hospitals performing percutaneous coronary intervention increased between 2001 and 2006, but this increase was not associated with a significant change in the number of individuals with access to the procedure, say US researchers. (Source: MedWire News - Cardiology)

Adult stem cells could improve angioplasy outcome; Study to explore usage

ScienceDaily Headlines — Mon, 23 Jan 2012 18:36:36 +0100

A researcher is studying what role adult stem cells might play in repairing damaged coronary arteries, following angioplasty/stenting. (Source: ScienceDaily Headlines)

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Randomized Controlled Trial of Positive Affect Induction to Promote Physical Activity After Percutaneous Coronary Intervention [Original Investigation]

Archives of Internal Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Conclusion Patients who receive PA intervention after percutaneous coronary intervention are able to achieve a sustained and clinically significant increase in physical activity by 12 months. Trial Registration clinicaltrials.gov Identifier: NCT00248846 (Source: Archives of Internal Medicine)

Reconsidering Transfer for Percutaneous Coronary Intervention Strategy: Time Is of the Essence [Editorial]

Archives of Internal Medicine — Mon, 23 Jan 2012 05:00:00 +0100

(Source: Archives of Internal Medicine)

Factors Associated With 30-Day Readmission Rates After Percutaneous Coronary Intervention [Original Investigation]

Archives of Internal Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Conclusions Nearly 1 in 10 patients undergoing PCI were readmitted within 30 days. Thirty-day readmission after PCI was associated with a higher risk of 1-year mortality. (Source: Archives of Internal Medicine)

Prediction Is Very Hard, Especially About the Future: Comment on "Factors Associated With 30-Day Readmission Rates After Percutaneous Coronary Intervention" [Invited Commentary]

Archives of Internal Medicine — Mon, 23 Jan 2012 05:00:00 +0100

(Source: Archives of Internal Medicine)

High-dose statin before percutaneous coronary intervention lowers risk of periprocedural myocardial infarction and 30-day major cardiac adverse events

Evidence-Based Medicine — Mon, 23 Jan 2012 05:00:00 +0100

Context In the current era, periprocedural myocardial infarction (MI) can still occur in a significant proportion of percutaneous coronary interventions (PCIs).1 Large periprocedural ischaemic events are associated with harm; however, even small increases in cardiac enzymes have been associated with increased long-term mortality.2 Attempts to enhance the safety of PCI have typically occurred through the use of potent antiplatelet agents (eg, aspirin, ADP receptor blockers (clopidogrel and prasugrel) and glycoprotein inhibitors (abciximab and eptifibatide)), as well as antithrombin agents (eg, unfractionated heparin, low-molecular weight heparin and bivalirudin). Although antiplatelet and antithrombin agents are effective at reducing ischaemic events, a cost from their use is sometimes paid...

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Percutaneous mitral valve repair in a ventilator‐dependant patient

Anaesthesia — Mon, 23 Jan 2012 05:00:00 +0100

SummaryI report the case of a 57‐year‐old patient admitted to the intensive care unit with severe community‐acquired pneumonia, complicated by prolonged mechanical ventilation of the lungs and intractable cardiac failure. He underwent percutaneous coronary angioplasty of the right coronary artery, but this did not improve his clinical condition. He was subsequently found to be suffering from mitral valve prolapse, that was felt to be the cause of recurrent episodes of severe pulmonary oedema. As open surgery was felt to be not feasible, the patient underwent percutaneous repair of his mitral valve using the MitraClip® device, and, after months of ventilatory support, was then weaned from the ventilator in a matter of days. While the procedure itself and the technology employed are s...

Why the United States Center for Medicare and Medicaid Services should not extend reimbursement indications for carotid artery angioplasty/stenting.

Vascular — Mon, 23 Jan 2012 05:00:00 +0100

Authors: Abbott AL, Adelman MA, Alexandrov AV, Barnett HJ, Beard J, Bell P, Björck M, Blacker D, Buckley CJ, Cambria RP, Comerota AJ, Connolly ES, Davies AH, Eckstein HH, Faruqi R, Fraedrich G, Gloviczki P, Hankey GJ, Harbaugh RE, Heldenberg E, Kittner SJ, Kleinig TJ, Mikhailidis DP, Moore WS, Naylor R, Nicolaides A, Paraskevas KI, Pelz DM, Prichard JW, Purdie G, Ricco JB, Riles T, Rothwell P, Sandercock P, Sillesen H, Spence JD, Spinelli F, Tan A, Thapar A, Veith FJ, Zhou W PMID: 22271806 [PubMed - as supplied by publisher] (Source: Vascular)

Treatment for intermittent claudication and the effects on walking distance and quality of life.

Vascular — Mon, 23 Jan 2012 05:00:00 +0100

In conclusion, this network meta-analysis indicates that supervised exercise therapy is more effective in both increasing walking distance and physical quality of life, compared with no treatment. Angioplasty and surgery also increase walking distance, compared with no treatment, but results for physical quality of life are less convincing. PMID: 22271802 [PubMed - as supplied by publisher] (Source: Vascular)

Efficacy of frequent blood pressure and heart rate monitoring for early identification of bleeding following percutaneous coronary intervention

International Journal of Nursing Practice — Sat, 21 Jan 2012 02:15:27 +0100

This study was performed in order to identify the efficacy of frequent blood pressure (BP) and heart rate (HR) monitoring for early identification of bleeding following PCI. The descriptive study was conducted at the cardiology unit of a university hospital with a study sample of 1292 patients. Data collection instruments were designed by the authors. In a comparison of the presence of abnormal BP‐HR between the groups with and without bleeding, the difference was not significant on arrival and not at 15, 45 and 60 min posttransfer. There is no association between the frequent vital sign measurement in the first hour and early diagnosis of bleeding. The frequency of follow up after PCI should be based on the patient's condition, the nurse's clinical expertise and the institutional prot...

Imaging in the Management of Ischemic Cardiomyopathy: Special Focus on Magnetic Resonance

Journal of the American College of Cardiology — Fri, 20 Jan 2012 13:57:13 +0100

Heart failure of ischemic origin has become increasingly common over the last decade because of the improved survival of patients with acute myocardial infarction. Revascularization with coronary bypass grafting or percutaneous coronary intervention plays a pivotal role in patients with ischemic cardiomyopathy, although these interventions are often associated with relatively high peri-procedural risk. The pathophysiological substrate of ischemic cardiomyopathy is heterogeneous, varying from predominantly hibernating myocardium to irreversible scarring. There is evidence to suggest that patients with hibernating myocardium benefit most from revascularization, whereas medical therapy is associated with an adverse prognosis. Therefore, noninvasive testing is recommended by relevant guideline...

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Is Renal Function-Based Contrast Dosing of Radiographic Contrast Media in Patients Undergoing Percutaneous Coronary Intervention Sufficient to Delineate Safe Limits of Contrast Dose?

Journal of the American College of Cardiology — Fri, 20 Jan 2012 13:57:13 +0100

The observational study by Gurm et al. () showed that the ratio of contrast volume to creatinine clearance (CV/CCC) is a simple tool that can help reduce the risk of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention. The most important preventive measure is reducing the CV, and this article focused on defining the dose range that would optimize patient safety. However, the proposed formula has several shortcomings in high-risk patients. (Source: Journal of the American College of Cardiology)

Reply

Journal of the American College of Cardiology — Fri, 20 Jan 2012 13:57:13 +0100

We welcome Drs. Kalra and Fenster's interest in our work delineating the association between renal function–based contrast dose and the risk of renal complications in patients undergoing percutaneous coronary intervention (). They argued that in high-risk patients, and especially among patients with cardiogenic shock, the incidence of contrast-induced nephropathy (CIN) is unacceptably high, even when the ratio of contrast volume to creatinine clearance is (Source: Journal of the American College of Cardiology)

Carotid stenting versus endarterectomy.

Annual Review of Medicine — Fri, 20 Jan 2012 09:00:58 +0100

Authors: Doig D, Brown MM Abstract Since the landmark NASCET and ECST trials demonstrated the superiority of carotid endarterectomy over medical therapy in the prevention of stroke for patients with symptomatic carotid artery stenosis, surgical intervention as a part of secondary prevention of stroke has become widespread. However, the newer technology of carotid artery angioplasty and stenting challenges this mode of intervention, promising the benefits of a procedure under local anesthesia and potentially avoiding the surgical complications of cranial nerve palsy and hematoma. Pooled evidence from randomized controlled trials of endarterectomy versus stenting shows a higher rate of stroke or death in the stenting groups-but this finding is mitigated to an extent by the lower inci...

Radial versus femoral access for primary percutaneous coronary intervention: is there a preferred route to the heart?

Heart — Fri, 20 Jan 2012 05:00:00 +0100

In their paper published in Heart, Mamas et al report on a meta-analysis of studies comparing radial with the more traditional femoral access route for primary percutaneous coronary intervention (PCI) in patients presenting with ST elevation myocardial infarction (STEMI)1 (see page 303.). Even though radial access PCI currently appears to be an evolving technique, this approach has in fact been in use for a long time. In the 1940s, the radial approach was used by Radner in Sweden for diagnostic aortographies.2 In 1960, Mason Sones Jr, a paediatric cardiologist at Cleveland Clinic, performed the first coronary angiography via a brachial artery cut-down. This technique was replaced by the femoral artery approach in the 1960s by Melvin Judkins, a radiologist at the University of Oregon in Por...

High platelet reactivity to multiple agonists during aspirin and clopidogrel treatment is indicative of a global hyperreactive platelet phenotype

Heart — Fri, 20 Jan 2012 05:00:00 +0100

To the Editor The study performed by Breet et al1 supported our previous suggestion that a cut-off of >550 aspirin reaction units (ARU) was too high to identify high on-treatment platelet reactivity (HPR).2 The cut-off defined by the highest quartile (461 ARU) from our study2 is remarkably similar to the 454 ARU cut-off value associated with 1-year outcomes in the Breet et al study.1 Moreover, across ARU quartiles, reactivity to ADP and collagen significantly increased.2 In a new analysis of 558 patients undergoing elective percutaneous coronary intervention during aspirin and clopidogrel treatment, we observed that aggregations induced by 5 μM ADP and 0.5 mg/ml arachidonic acid (AA) correlated well (r=0.625), as measured by light transmittance aggregometry (...

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The Authors' reply

Heart — Fri, 20 Jan 2012 05:00:00 +0100

We thank Dr Jeong and colleagues for their comments1 regarding the incidence of dual high on-treatment platelet reactivity in patients undergoing elective percutaneous coronary intervention and its impact on clinical outcome.2 They raise several important issues. First, they provide additional information on the optimal cut-off value of the VerifyNow platelet function test to detect high on-aspirin platelet reactivity. Due to a lack of consensus on the optimal method to quantify high on-aspirin platelet reactivity and on the cut-off value associated with clinical risk, the measurement of platelet reactivity has not been widely implemented and included in the guidelines. Furthermore, the correlation between platelet function tests is moderate and the different tests identify other patients...

Transradial PCI approach linked to lower mortality than transfemoral

MedWire News - Cardiology — Fri, 20 Jan 2012 00:00:00 +0100

The transradial approach is associated with a lower 2-year mortality rate than the transfemoral approach in patients undergoing percutaneous coronary intervention, an analysis suggests. (Source: MedWire News - Cardiology)

Elevated Admission Microalbuminuria Predicts Poor Myocardial Blood Flow and 6‐Month Mortality in ST‐Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Clinical Cardiology — Thu, 19 Jan 2012 05:00:00 +0100

Conclusions:Admission MA levels are associated with impaired myocardial flow and poor prognosis in STEMI patients undergoing primary PCI. © 2012 Wiley Periodicals, Inc.The authors have no funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)

A Venotomy and Manual Propulsion Technique to Treat Native Arteriovenous Fistulas Occluded by Thrombi

American Journal of Roentgenology — Thu, 19 Jan 2012 05:00:00 +0100

CONCLUSION. The venotomy and manual propulsion technique is effective and safe for the removal of chronic and organized thrombi from occluded native AVFs. (Source: American Journal of Roentgenology)

Gender Differences in Outcomes of Endovascular Treatment of Infrainguinal Peripheral Artery Disease

Vascular and Endovascular Surgery — Thu, 19 Jan 2012 05:00:00 +0100

Conclusions: Women have better patency rates compared with men following treatment of some CLI lesions. Interestingly, women are treated more frequently for CLI when compared to men. For some lesion types in women, PTA alone was equivalent to PTA + S. Our results suggest that outcomes may be optimized by tailoring interventions to gender. (Source: Vascular and Endovascular Surgery)

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Intracoronary versus intravenous high-dose bolus plus maintenance administration of tirofiban in patients undergoing primary percutaneous coronary intervention for acute ST elevation myocardial infarction

Journal of Thrombosis and Thrombolysis — Wed, 18 Jan 2012 06:48:37 +0100

In conclusion, this regimen improved myocardial reperfusion and coronary flow, and reduced myocardial necrosis, but failed to improve clinical outcomes at 30 days. Content Type Journal ArticlePages 1-8DOI 10.1007/s11239-012-0685-yAuthors Basar Candemir, Cardiology Department, Ankara University, Ibni Sina Hastanesi, 06600 Ankara, TurkeyMustafa Kilickap, Cardiology Department, Ankara University, Ibni Sina Hastanesi, 06600 Ankara, TurkeyOzgur Ulas Ozcan, Cardiology Department, Ankara University, Ibni Sina Hastanesi, 06600 Ankara, TurkeyCansin Tulunay Kaya, Cardiology Department, Ankara University, Ibni Sina Hastanesi, 06600 Ankara, TurkeyMenekse Gerede, Cardiology Department, Ankara University, Ibni Sina Hastanesi, 06600 Ankara, TurkeyAydan Ongun Ozdemir, Cardiology Department, A...

Tailoring clopidogrel dose according to multiple electrode aggregometry decreases the rate of ischemic complications after percutaneous coronary intervention

Journal of Thrombosis and Thrombolysis — Tue, 17 Jan 2012 07:11:02 +0100

Abstract Multiple studies have shown a correlation between high on-treatment platelet reactivity (HPR) and ischemic complications after percutaneous coronary interventions (PCI); however, the role of platelet reactivity testing in order to adjust clopidogrel dose is debated. We sought to determine whether a strategy incorporating platelet reactivity testing with the Multiplate analyzer to tailor the dose of clopidogrel is superior to standard clopidogrel treatment after PCI. Between May 2008 and June 2009, 192 consecutive patients undergoing PCI were randomized to a tailored treatment strategy using the Multiplate analyzer or to uniform administration of 75 mg clopidogrel. In the tailored group, platelet function was assessed 24 h after clopidogrel loading, and p...

Management of Infrapopliteal Peripheral Arterial Occlusive Disease

Current Treatment Options in Cardiovascular Medicine — Tue, 17 Jan 2012 07:07:16 +0100

Opinion statement The management of infrapopliteal peripheral arterial occlusive disease (PAD) is challenging. For patients with asymptomatic disease or claudication, exercise and optimal medical management, including antiplatelet agents, blood pressure control, statin therapy and tight glucose control for patients with diabetes mellitus, are the mainstays of therapy. However, patients with isolated tibial artery occlusive disease often have diabetes mellitus or renal insufficiency and present with critical limb ischemia (CLI). CLI is advanced occlusive disease marked by the development of rest pain, ischemic ulceration, or gangrene and is associated with a high mortality rate. Limb salvage requires an intervention in cases of CLI, but careful operative planning is require...

Same-Day Discharge After Percutaneous Coronary Intervention [Letters]

JAMA — Tue, 17 Jan 2012 05:00:00 +0100

(Source: JAMA)

Same-Day Discharge After Percutaneous Coronary Intervention--Reply [Letters]

JAMA — Tue, 17 Jan 2012 05:00:00 +0100

(Source: JAMA)

Diffuse unilateral pediatric arteriopathy: successful treatment with repeated angioplasty.

Diagnostic and Interventional Radiology : The Turkish Society of Radiology — Tue, 17 Jan 2012 05:00:00 +0100

We report a three-year-old girl exhibiting severe long-segment stenoses and occlusions with diffuse arterial involvement of the upper and lower extremities on the right side. The obstructive lesions, which caused atrophy of the right limb and chronic ulceration of the foot, were treated successfully with repeated percutaneous transluminal angioplasty. Obstructive peripheral arterial disease can cause growth retardation of the involved extremity, which can be salvaged by repeated endovascular therapy even in a small growing child. PMID: 22252447 [PubMed - as supplied by publisher] (Source: Diagnostic and Interventional Radiology : The Turkish Society of Radiology)

Contents of second peak in the circadian variation of acute myocardial infarction in the Japanese population.

Journal of Cardiology — Tue, 17 Jan 2012 05:00:00 +0100

CONCLUSIONS: There were two peaks in the onset of STEMI in a Japanese population in Tokyo. The second peak was significantly dominated by the older female group. Age and gender influenced the second peak in the circadian variation of AMI in a Japanese population in Tokyo. PMID: 22260874 [PubMed - as supplied by publisher] (Source: Journal of Cardiology)

Letters: When the Heart Hurts (1 Letter)

NYT Health — Mon, 16 Jan 2012 19:14:18 +0100

Letters to the editor. (Source: NYT Health)

Gut Bacteria Influence The Severity Of Heart Attacks In Rats

Health News from Medical News Today — Mon, 16 Jan 2012 08:00:00 +0100

New research published online in the FASEB Journal suggests that the types and levels of bacteria in the intestines may be used to predict a person's likelihood of having a heart attack, and that manipulating these organisms may help reduce heart attack risk. This discovery may lead to new diagnostic tests and therapies that physicians use to prevent and treat heart attacks. In addition, this research suggests that probiotics may be able to protect the heart in patients undergoing heart surgery and angioplasty... (Source: Health News from Medical News Today)

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Prevalence, Predictors, and Outcomes of Conservative Medical Management in Non-ST-Segment Elevation Acute Coronary Syndromes in Gulf RACE-2

Angiology — Mon, 16 Jan 2012 05:00:00 +0100

We assessed the prevalence, predictors, and in-hospital and long-term outcomes of conservative medical management for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) compared with percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG). This prospective study conducted from October 2008 to June 2009 in 65 hospitals from 6 Arabian Gulf countries included 30-day and 1-year mortality follow-up for 3661 patients. Compared with conservative management group (2859 patients; 78.1%), the PCI group (638; 17.4%) had significantly better unadjusted and adjusted in-hospital (odds ratio [OR]: 0.40, 95% confidence interval [CI]: 0.17-0.97), 30-day (OR: 0.44, 95% CI: 0.24-0.76) and 1-year (OR: 0.58, 95% CI: 0.40-0.87) mortality rates. Comparison w...

Effect of Statins Therapy Prior to Percutaneous Coronary Intervention

Journal of Interventional Cardiology — Mon, 16 Jan 2012 05:00:00 +0100

Conclusion: Statins therapy among PCI patients seems to be associated with a significant mortality advantage at early and long‐term follow‐up. However, currently early statins use before intervention still cannot serve as a routine strategy of treatment. Further large‐scale randomized studies are critically required to demonstrate the importance of early treatment with statins in pre‐PCI. (J Interven Cardiol 2012;**:1–7) (Source: Journal of Interventional Cardiology)

Circulating endothelial progenitor cells do not contribute to regeneration of endothelium after murine arterial injury

Cardiovascular Research — Mon, 16 Jan 2012 05:00:00 +0100

Conclusion Endothelial regeneration after vascular injury did not involve circulating EPCs but was mediated solely by migration of ECs from the adjacent healthy endothelium. (Source: Cardiovascular Research)

I{kappa}BNS regulates interleukin-6 production and inhibits neointimal formation after vascular injury in mice

Cardiovascular Research — Mon, 16 Jan 2012 05:00:00 +0100

Conclusion IBNS down-regulates TLR4 expression, NF-B activity, and IL-6 production after vascular injury. IBNS might suppress intimal hyperplasia caused by vascular inflammation such as atherosclerosis, and restenosis after angioplasty. (Source: Cardiovascular Research)

The Retrograde Technique for Recanalization of Chronic Total Occlusions: A Step-by-Step Approach

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Jan 2012 05:00:00 +0100

Chronic total occlusion recanalization still represents the final frontier in percutaneous coronary intervention. Retrograde chronic total occlusion recanalization has recently become an essential complement to the classical antegrade approach. In experienced hands, the retrograde technique currently has a high success rate with a low complication profile, despite frequent utilization in the most anatomically and clinically complex patients. Since its initial description, important changes have occurred that make the technique faster and more successful. We propose a step-by-step approach of the technique as practiced at experienced centers in North America. Because the technique can vary substantially, we describe the different alternatives to each step and offer what we perceived to be t...

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Examination of the In Vivo Mechanisms of Late Drug-Eluting Stent Thrombosis: Findings From Optical Coherence Tomography and Intravascular Ultrasound Imaging

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Jan 2012 05:00:00 +0100

Conclusions In this in vivo case-controlled study, the presence of uncovered stent struts as assessed by OCT and positive vessel remodeling as imaged by IVUS were associated with LST after DES. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Transradial Versus Transfemoral Intervention for Acute Myocardial Infarction: A Propensity Score-Adjusted and -Matched Analysis From the REAL (REgistro regionale AngiopLastiche dell'Emilia-Romagna) Multicenter Registry

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Jan 2012 05:00:00 +0100

Conclusions In patients undergoing angioplasty for acute myocardial infarction, transradial treatment is associated with decreased 2-year mortality rates and a reduction in the need for vascular surgery and/or blood transfusion compared with transfemoral intervention. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Quantifying the Learning Curve in the Use of a Novel Vascular Closure Device: An Analysis of the NCDR (National Cardiovascular Data Registry) CathPCI Registry

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Jan 2012 05:00:00 +0100

Conclusions An institutional-level learning curve for the initial national experience of StarClose was triphasic, likely indicating changes in patient selection and expansion of number of operators during the initial phases of device adoption. The rate of learning was influenced by several institutional factors, including overall procedural volume, utilization for percutaneous coronary intervention procedures, and teaching status. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Contemporary Use and Effectiveness of N-Acetylcysteine in Preventing Contrast-Induced Nephropathy Among Patients Undergoing Percutaneous Coronary Intervention

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Jan 2012 05:00:00 +0100

Conclusions Use of NAC is common and has steadily increased over the study period but does not seem to be associated with improved clinical outcomes in real-world practice. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Cardiovascular Mortality and Heart Failure Risk Score for Patients After ST-Segment Elevation Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention (Data from the Leiden MISSION! Infarct Registry)

The American Journal of Cardiology — Sun, 15 Jan 2012 05:00:00 +0100

In conclusion, the current risk model demonstrates for the first time that 8 parameters readily available during the hospitalization of patients with STEMI treated with primary percutaneous coronary intervention can accurately stratify patients at long-term follow-up (≤4 years after the index infarction) into low-, intermediate-, and high-risk categories. (Source: The American Journal of Cardiology)

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Protein Kinase C Delta Promotes Adventitial Cell Migration to Neointima by Upregulation of Monocyte Chemoattractant Protein-1 in Smooth Muscle Cells

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:19 +0100

Introduction: Accumulating evidence suggests that adventitial cells directly contribute to neointima formation by migrating into the intima. We have previously reported that gene transfer of Protein kinase C delta(PKC δ) attenuates intimal hyperplasia by inducing apoptosis of smooth muscle cells (SMCs). More recently, we showed that PKCδ mediates expression of monocyte chemoattractant protein-1(MCP-1). in the current study, we tested the hypothesis that PKCδ promotes adventitial cell migration by stimulating SMCs to produce chemokines such as MCP-1. Methods: In vitro migration of isolated adventitial cells was evaluated by chemotaxis assay. Gene transfer to SMCs was achieved by intraluminal perfusion with adenoviruses expressing PKCδ(AdPKCδ) or empty vector (AdNull) following rat caro...

Quality Measures for Assessing Hospital Mortality: Evaluation Using Instrumental Variable Analysis

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:01 +0100

Conclusions: Composite measures forecast large differences in hospital mortality with surgery. Based on instrumental variable analysis, these differences in mortality are not due to unmeasured hospital differences in patient severity of illness, indicating that composite measures can be useful quality indicators for public reporting and pay-for-performance. (Source: Journal of Surgical Research)

Genome-Wide Differences in Inflammatory Gene Expression Predict Success Versus Failure in Lower Extremity Angioplasty/Stenting

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:00 +0100

(Source: Journal of Surgical Research)

Use of drug-eluting stents for the treatment of vertebral artery stenosis

Radiologia Brasileira — Sat, 14 Jan 2012 19:42:51 +0100

CONCLUSION: The present study suggests that vertebral artery angioplasty with paclitaxel-eluting stents is a feasible and promising technique in terms of safety and effectiveness in the prevention of recurrent ischemia and restenosis. (Source: Radiologia Brasileira)

Aldosterone, mortality, and acute ischaemic events in coronary artery disease patients outside the setting of acute myocardial infarction or heart failure

European Heart Journal — Sat, 14 Jan 2012 05:00:00 +0100

Conclusion Our results demonstrate that, in patients with CAD but without heart failure or acute MI, the level of aldosterone is strongly and independently associated with mortality and the occurrence of acute ischaemic events. (Source: European Heart Journal)

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[Study of incidence and treatment of acute myocardial infarction by evaluating the financing database: 2004-2009].

Orvosi Hetilap — Fri, 13 Jan 2012 21:00:34 +0100

Conclusions: Authors conclude that the financing database is suitable to evaluate the major aspects of care and to support healthcare management decisions, while the appropriateness of treatment and the effectiveness of different interventions can be assessed by prospective databases satisfying the needs of special aspects and can therefore be used for detailed assessments. Orv. Hetil., 2012, 153, 102-112. PMID: 22236416 [PubMed - in process] (Source: Orvosi Hetilap)

[Endovascular treatment of carotid stenosis: an experience in the Hospital Universitario Central de Asturias].

Revista de Neurologia — Fri, 13 Jan 2012 18:28:21 +0100

CONCLUSIONS. In our hospital CAS is considered an effective and safe technique, with a rate of complications that is within the parameters that justify its indication. PMID: 22234567 [PubMed - in process] (Source: Revista de Neurologia)

Potential Pitfalls of Meta-Analyses of Observational Studies in Cardiovascular Research

Journal of the American College of Cardiology — Fri, 13 Jan 2012 13:52:06 +0100

We enjoyed reading the systematic review and meta-analysis by Vlaar et al. () on the most appropriate percutaneous coronary intervention (PCI) strategy in patients with acute myocardial infarction (AMI) and concomitant multivessel disease (MVD). Despite the Bayesian analyses, this study is potentially limited by the chosen methodological approach. (Source: Journal of the American College of Cardiology)

The microbiome and disease: Gut bacteria influence the severity of heart attacks in rats

ScienceDaily Headlines — Fri, 13 Jan 2012 00:34:34 +0100

New research suggests the types and levels of intestinal bacteria may be used to predict a person's likelihood of having a heart attack, and manipulating these organisms may help reduce risk. This discovery may lead to new tests and therapies that physicians use to prevent and treat heart attacks. In addition, this research suggests probiotics may be able to protect the heart in patients undergoing heart surgery and angioplasty. (Source: ScienceDaily Headlines)

Intramyocardial hematoma with epicardial rupture following percutaneous coronary intervention

Journal of Clinical Ultrasound — Thu, 12 Jan 2012 05:00:00 +0100

We describe here the case of 63‐year‐old man in whom an intramyocardial hematoma with epicardial rupture occurred after PCI. The patient was treated conservatively with a successful outcome. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2012. (Source: Journal of Clinical Ultrasound)

Multiple sclerosis: a chronic infective cerebrospinal venulitis?

Phlebology — Thu, 12 Jan 2012 05:00:00 +0100

Authors: Thibault PK Abstract The aetiology proposed for the development of chronic cerebrospinal venous insufficiency (CCSVI) associated with multiple sclerosis (MS) has been the presence of congenital truncular venous malformations. However, this hypothesis is not consistent with the epidemiology or geographical incidence of MS and is not consistent with many of the ultrasonographic or radiographical findings of the venous disturbances found in MS patients. However, the probability of a venous aetiology of MS remains strong based on evidence accumulated from the time the disorder was first described.The method used in this review was to search PubMed for all past medical publications related to vascular, venous, haematological, epidemiological, biochemical, and genetic investigat...

Systemic levels of endothelin correlate with systemic inflammation and not with myocardial injury or left ventricular ejection fraction in patients undergoing percutaneous coronary intervention and on-pump coronary artery bypass grafting

Interactive CardioVascular and Thoracic Surgery — Thu, 12 Jan 2012 05:00:00 +0100

Endothelin (ET-1) is a potent vasoconstrictor. We compared patterns of ET-1 in percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and correlated it with markers of inflammation. Patients with multivessel disease were enrolled in a prospective randomized study of PCI vs. on-pump CABG. Procedural myocardial injury was assessed biochemically (CK-MB) and with new late gadolinium enhancement (LGE) on magnetic resonance imaging (MRI) one week postprocedure. ET-1 was measured at baseline, 1 h, 6 h, 12 h, 24 h and one week postprocedure. Log ET-1 values were compared between PCI and CABG and between patients without significant myocardial injury. Measurement of ET-1 values was performed in 36 PCI and 31 CABG patients. Baseline ET-1 values were si...

Patch angioplasty and neo-ostium creation for intramural left coronary artery

Interactive CardioVascular and Thoracic Surgery — Thu, 12 Jan 2012 05:00:00 +0100

Anomalous aortic origin of the coronary artery is a rare cardiac anomaly which induces myocardial ischemia and is associated with sudden death. We operated on a 25-year-old female with syncopal episodes who had an intramural left coronary artery. A neo-ostium was created in the left sinus but the initial neo-ostium seemed small because of the hypoplastic intramural segment of the left coronary artery. Therefore, saphenous vein patch angioplasty was added for ostial enlargement. The patient was symptom-free at one year follow-up and exercise stress test was negative for ischemia. (Source: Interactive CardioVascular and Thoracic Surgery)

Percutaneous Transluminal Pulmonary Angioplasty for Distal-Type Chronic Thromboembolic Pulmonary Hypertension.

Circulation Journal — Thu, 12 Jan 2012 05:00:00 +0100

Authors: Yamada N PMID: 22240603 [PubMed - as supplied by publisher] (Source: Circulation Journal)

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Options to Overcome Clopidogrel Response Variability.

Circulation Journal — Thu, 12 Jan 2012 05:00:00 +0100

Authors: Park KW, Kim HS Abstract Oral antiplatelet agents targeting the platelet P2Y12 receptor are an integral component of treating patients with acute coronary syndrome and those undergoing percutaneous coronary intervention. Clopidogrel has been the most commonly used agent in this respect worldwide. However, there are certain shortcomings of clopdiogrel, the most important of which is the wide response variability of platelet inhibition. The response to clopidogrel is affected by various clinical variables, genetic variations involved in its activation, and drug-drug interactions. Therefore, clinicians are faced with challenges in situations where high inhibition of platelets is necessary and in cases where the response to clopidogrel may be suboptimal. There are various ways...

The challenging topic of diabetic foot revascularization: does the angiosome-guided angioplasty may improve outcome.

The Journal of Cardiovascular Surgery — Wed, 11 Jan 2012 12:56:38 +0100

Authors: Alexandrescu V, Hubermont G Abstract The angiosome model was first pioneered by Jan Taylor in 1987 by his influential anatomical works in the plastic reconstructive surgery field. The concept depicts the human body into three-dimensional blocks of tissue, fed by specific arterial and venous irrigation sources, the "angiosomes". Adjacent angiosomes are linked by a vast compensatory collateral web "the choke vessels". This collateral network provides a remarkable "rescue system" in non-atherosclerotic and non-diabetic patients. However, it could be dramatically damaged in chronic limb ischemia (CLI) subjects witnessing miscellaneous systemic arterial disease. The angiosome concept may provide useful information on the human vascular anatomy and related pathology, with specif...

Primary amputation: is there still a place for it?

The Journal of Cardiovascular Surgery — Wed, 11 Jan 2012 12:55:33 +0100

Authors: Setacci F, Sirignano P, De Donato G, Galzerano G, Cappelli A, Palasciano G, Setacci C Abstract Diabetic foot (DF) continues to present a significant challenge to the vascular surgeon. Despite great advances in the treatment of DF, including open revascularization and endovascular techniques, significant numbers of amputations are still performed. The effect of aggressive revascularization on ultimate limb salvage rates continues to be debated. In the US the amputation rate has increased from 19 to 30 per 100000 persons years over the last two decades primarily due to an increase in diabetes and advancing age. Despite advances in cardiovascular treatment, in patients over 85 year of age an amputation rate of 140 per 100000 persons/year has been reported with a primary amput...

Is digital arteries recanalization useful to preserve the foot functionality and avoid toes amputation, after pedal recanalization? Clinical results.

The Journal of Cardiovascular Surgery — Wed, 11 Jan 2012 12:55:24 +0100

CONCLUSION: Endovascular recanalization of digital branches in patients with CLI and distal wounds on the toes is feasible and safe; represent a support to avoid minor amputations or surgical skin lesion healing. PMID: 22231531 [PubMed - in process] (Source: The Journal of Cardiovascular Surgery)

Tibial microdissection for diabetic wounds.

The Journal of Cardiovascular Surgery — Wed, 11 Jan 2012 12:54:47 +0100

We present two cases of targeted recanalizations in the tibial and pedal trunks for plantar and forefoot diabetic ischemic tissue defects, following an angiosome-model for perfusion. PMID: 22231535 [PubMed - in process] (Source: The Journal of Cardiovascular Surgery)

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New Generation Drug-Eluting Stents Associated With Lower Rates Of Mortality And Restenosis Than Bare Metal Stents

Health News from Medical News Today — Wed, 11 Jan 2012 08:00:00 +0100

A registry - which includes every patient in Sweden having percutaneous coronary intervention (PCI) for the treatment of acute and stable coronary artery disease - has found that PCI implantations using a new generation of drug-eluting stents is associated with lower rates of relapse (restenosis), stent thrombosis and subsequent mortality than older generation drug-eluting stents and bare-metal stents... (Source: Health News from Medical News Today)

Frequency of heparin/platelet factor 4-dependent platelet antibodies in patients undergoing angioplasty and stenting for cardiovascular disease and their role for on-clopidogrel platelet reactivity

Clinical Research in Cardiology — Wed, 11 Jan 2012 06:56:58 +0100

Conclusion H/PF4 antibodies are not rare in patients undergoing angioplasty and stenting. However, these antibodies are not associated with the occurrence of HRPR. Content Type Journal ArticleCategory Original PaperPages 1-8DOI 10.1007/s00392-011-0411-3Authors Thomas Gremmel, Department of Internal Medicine II, Medical University of Vienna, Vienna, AustriaKarin Frühwirth, Clinical Department for Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, AustriaChristoph W. Kopp, Department of Internal Medicine II, Medical University of Vienna, Vienna, AustriaAlexandra Kaider, Core Unit for Medical Statistics and Informatics, Section of Clinical Biometrics, Medical University of Vienna, Vienna, AustriaSabine St...

Contemporary use of glycoprotein IIb/IIIa inhibitors.

Thrombosis and Haemostasis — Wed, 11 Jan 2012 05:00:00 +0100

Authors: Kristensen SD, Würtz M, Grove EL, De Caterina R, Huber K, Moliterno DJ, Neumann FJ Abstract Platelet glycoprotein IIb/IIIa inhibitors (GPI) are antithrombotic agents preventing the binding of fibrinogen to GP IIb/IIIa receptors. Thus, GPI interfere with interplatelet bridging mediated by fibrinogen. Currently, three generic GPI with different antithrombotic properties are available for intravenous administration: abciximab, eptifibatide, and tirofiban. The development of oral GPI was abandoned, whereas intravenous GPI were introduced in various clinical settings during the 1990s, yielding substantial benefit in the treatment of acute coronary syndromes, particularly during percutaneous coronary interventions. Results of the many randomised trials evidenced the efficacy of...

For primary PCI, radial approach has advantages over femoral

Modern Medicine — Wed, 11 Jan 2012 05:00:00 +0100

NEW YORK (Reuters Health) - Access for percutaneous coronary intervention (PCI) is best obtained through the radial artery, a new meta-analysis shows. (Source: Modern Medicine)

Percutaneous Coronary Intervention With Drug-Eluting Stent Implantation vs. Coronary Artery Bypass Grafting for Multivessel Coronary Artery Disease in Metabolic Syndrome Patients With Acute Myocardial Infarction.

Circulation Journal — Wed, 11 Jan 2012 05:00:00 +0100

Conclusions: PCI-DES had an equivalent 12-month mortality risk to CABG for the treatment of multivessel disease in metabolic syndrome patients with AMI. CABG is more favorable for STEMI patients in terms of MACCE. PMID: 22240598 [PubMed - as supplied by publisher] (Source: Circulation Journal)

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Midterm Outcomes and Risk Stratification after Endovascular Therapy for Patients with Critical Limb Ischaemia due to Isolated Below-the-knee Lesions.

PubMed: Eur J Vasc Endovasc ... — Tue, 10 Jan 2012 05:00:00 +0100

CONCLUSIONS: Despite relatively high mortality and re-intervention rates, limb salvage rate was acceptable after EVT for CLI patients with isolated BTK lesions. Risk stratification allows occurrence estimation for each end point. PMID: 22240338 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

When is Supervised Exercise Therapy Considered Useful in Peripheral Arterial Occlusive Disease? A Nationwide Survey among Vascular Surgeons.

PubMed: Eur J Vasc Endovasc ... — Tue, 10 Jan 2012 05:00:00 +0100

CONCLUSION: Although the vast majority of Dutch vascular surgeons consider SET as an important treatment option for PAOD, SET should receive more emphasis in clinical practice since arguments not to refer for SET are outdated. Furthermore, vascular surgeons agree that lifestyle management should be integrated in SET. PMID: 22240337 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Comparative long‐term efficacy and safety of drug‐eluting stent versus coronary artery bypass grafting in ostial left main coronary artery disease

Catheterization and Cardiovascular Interventions — Tue, 10 Jan 2012 05:00:00 +0100

Conclusions: DES implantation for ostial LMCA lesions showed similar 5‐year outcomes of death, major adverse events, and TVR compared with CABG. Although meticulous adjustments decreased baseline difference between the two treatments, the absence of statistical significance could be attributable to the size of the study sample and hidden bias. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)

Outcomes of primary percutaneous coronary intervention for acute myocardial infarction with unprotected left main coronary artery occlusion

Catheterization and Cardiovascular Interventions — Tue, 10 Jan 2012 05:00:00 +0100

Conclusions: Despite performance of primary PCI, patients with AMI due to LMCA occlusion were associated with >50% in‐hospital mortality. Hemodynamic deficit upon arrival was the major determinant of their poor hospital outcomes. The hospital survivors, however, were associated with favorable long‐term outcomes. © 2012 Wiley Periodicals, Inc. (Source: Catheterization and Cardiovascular Interventions)

Fistula between right coronary artery vein graft and right atrium as an immediate complication of percutaneous coronary intervention

Catheterization and Cardiovascular Interventions — Tue, 10 Jan 2012 05:00:00 +0100

We report the first case of a fistula between SVG and the right atrium (RA) as an immediate complication after a percutaneous coronary intervention (PCI) in an 86‐year‐old female. She presented with inferior ST‐elevation myocardial infarction (STEMI) and was treated with thrombolytic therapy in a peripheral hospital, which was unsuccessful. PCI to SVG to the right coronary (RCA) was complicated by a fistula to RA. Cardiac magnetic resonance (CMR) confirmed the site of the fistula and also presence of a significant arteriovenous (AV) shunt. Reversal of anticoagulation had no effect on fistula closure. Therefore, a covered stent was deployed for closure of the fistula to avoid long‐term complications of the significant AV shunt. In summary, the diagnosis and appropriate management of...

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Volcano Corporation Announces Preliminary 4QTR Revenues for 2011

News from Angioplasty.Org — Mon, 09 Jan 2012 21:40:00 +0100

Volcano Corporation (NASDAQ: VOLC) said today it expects total revenues for the fourth quarter of 2011 will be approximately $92.7 million, bringing expected full year 2011 revenues to approximately $343.5 million. (Source: News from Angioplasty.Org)

New Drug-Eluting Stents: Lower Mortality and Less Restenosis Than First Gen DES or Bare Metal Stents

News from Angioplasty.Org — Mon, 09 Jan 2012 16:10:00 +0100

A new report in the European Heart Journal, analyzing 94,384 stent placements, finds that the new generation of drug-eluting stents (Medtronic's Endeavor Resolute, Abbott's XienceV and Xience Prime, and Boston Scientific's Promus and Promus Element) are associated with lower rates of restenosis, stent thrombosis and mortality than either the first generation drug-eluting stents or bare-metal stents. (Source: News from Angioplasty.Org)

New 'real-world' reassuring data from the SCAAR registry

EurekAlert! - Medicine and Health — Mon, 09 Jan 2012 05:00:00 +0100

(European Society of Cardiology) A registry -which includes every patient in Sweden having percutaneous coronary intervention for the treatment of acute and stable coronary artery disease- has found that PCI implantations using a new generation of drug-eluting stents is associated with lower rates of relapse, stent thrombosis and subsequent mortality than older generation drug-eluting stents and bare-metal stents. (Source: EurekAlert! - Medicine and Health)

Retrospective Analysis of Surgery Versus Endovascular Intervention in Takayasu Arteritis: A Multicenter Experience.

Circulation — Mon, 09 Jan 2012 05:00:00 +0100

CONCLUSIONS: The overall 5-years arterial complication rate was of 44%. Biological inflammation increased the likelihood of complications after revascularization in patients with TA. PMID: 22230484 [PubMed - as supplied by publisher] (Source: Circulation)

The Pattern of Platelet Response to Clopidogrel in Iranian Patients After Percutaneous Coronary Intervention.

The Journal of Clinical Pharmacology — Mon, 09 Jan 2012 05:00:00 +0100

In this study, the authors investigated the response to clopidogrel in Iranian patients after PCI. Patients who were candidates for elective PCI were enrolled in this study. All patients had received aspirin 80 to 325 mg daily for ≥1 week before PCI. Blood samples were taken from patients at baseline, 2 hours after taking a 600-mg loading dose of clopidogrel, and 24 hours and 30 days after stenting. Platelet aggregation was measured by light transmittance aggregometry with adenosine diphosphate (5 and 20 μM) and arachidonic acid (500 and 5000 μg/mL). One hundred twelve patients were included (79 men, 33 women). Maximal and minimal clopidogrel nonresponsiveness occurred at 2 hours (26%) and 48 hours (13%) after taking 600 mg clopidogrel, respectively. Pretreatment platelet reactivity ha...

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Fulminant Postpartum Cerebral Vasoconstriction Syndrome [Original Contribution]

Archives of Neurology — Mon, 09 Jan 2012 05:00:00 +0100

Conclusions Postpartum vasoconstriction can be fatal, with rapid progression of vasoconstriction, ischemia, and brain edema. Clinicians need to be aware of the potential consequences of this condition. Postpartum women with acute neurologic symptoms require prompt investigation with noninvasive cerebrovascular imaging and close monitoring for possible secondary deterioration. (Source: Archives of Neurology)

Nurr1 Haplotypes are Associated with Femoropopliteal Restenosis/Re-occlusion after Percutaneous Transluminal Angioplasty.

PubMed: Eur J Vasc Endovasc ... — Sat, 07 Jan 2012 05:00:00 +0100

In this study, association of nuclear receptor related 1 protein (Nurr1) haplotypes to the restenosis/re-occlusion rate after femoropopliteal PTA was investigated. Patients (n = 142) with disabling claudication or critical limb ischaemia, who had undergone technically successful femoropopliteal PTA, were prospectively followed up by vascular ultrasound imaging 12 months after the procedure. Nurr1 haplotypes 2 and 3 were associated significantly with the restenosis/re-occlusion rate (adjusted odds ratio 1.6, 95% confidence interval (CI) 1.1-2.3 and 2.0, 1.3-2.8, respectively) on univariate analysis. PMID: 22230598 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

New generation drug-eluting stents associated with lower mortality/restenosis than bare metal stents

European Society of Cardiology — Fri, 06 Jan 2012 15:16:51 +0100

A registry -which includes every patient in Sweden having percutaneous coronary intervention (PCI) for the treatment of acute and stable coronary artery disease- has found that PCI implantations using a new generation of drug-eluting stents is associated with lower rates of relapse (restenosis), stent thrombosis and subsequent mortality than older generation drug-eluting stents and bare-metal stents. Topics: Percutaneous Cardiovascular Intervention (PCI) (Source: European Society of Cardiology)

Assessment of the relation between IVUS measurements and clinical outcome in elderly patients after sirolimus-eluting stent implantation for de novo coronary lesions

The International Journal of Cardiovascular Imaging — Thu, 05 Jan 2012 17:07:25 +0100

This study aimed to evaluate the impact of vascular response assessed by intravascular ultrasound (IVUS) imaging on clinical outcomes in elderly patients (≥75 years) undergoing percutaneous coronary intervention (PCI) for de novo lesions with sirolimus-eluting stent (SES) implantation. Repeat coronary angiography with IVUS was performed 1 year after SES-based PCI for de novo lesions in 136 elderly patients (≥75 years) and 427 younger counterparts (<75 years) (219 lesions and 635 lesions, respectively). Major adverse cardiac events (MACE) including cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR) during 2-year follow-up were recorded. Despite similar angiographic in-stent restenosis and TLR and IVUS-detected incomplete...

Noninvasive Positive Pressure Ventilation against Reperfusion Pulmonary Edema following Percutaneous Transluminal Pulmonary Angioplasty

Advances in Pharmacological Sciences — Thu, 05 Jan 2012 14:27:20 +0100

A 69-year-old man with chronic thromboembolic pulmonary hypertension (CTEPH) was on amblatory oxygen inhalation therapy (3 L/min) and scheduled for percutaneous transluminal pulmonary angioplasty (PTPA). The patient's New York Heart Association functional status was class III with recent worsening of dyspnea and apparent leg edema. Transthoracic echocardiography revealed right ventricular enlargement with mean pulmonary artery pressure of 42 mmHg. After PTPA, he was complicated with postoperative reperfusion pulmonary edema, and noninvasive positive pressure ventilation (NPPV) was applied immediately. Hypoxemia was successfully treated with 15 days of NPPV. Although mean pulmonary artery pressure was unchanged, his brain natriuretic peptide level decreased from preoperati...

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Why the United States Center for Medicare and Medicaid Services (CMS) Should not Extend Reimbursement Indications for Carotid Artery Angioplasty/Stenting.

PubMed: Eur J Vasc Endovasc ... — Thu, 05 Jan 2012 05:00:00 +0100

Authors: Abbott AL, Adelman MA, Alexandrov AV, Barnett HJ, Beard J, Bell P, Björck M, Blacker D, Buckley CJ, Cambria RP, Connolly ES, Comerota AJ, Davies AH, Eckstein HH, Faruqi R, Fraedrich G, Gloviczki P, Hankey GJ, Harbaugh RE, Heldenberg E, Kittner SJ, Kleinig TJ, Mikhailidis DP, Moore WS, Naylor R, Nicolaides A, Paraskevas KI, Pelz DM, Prichard JW, Purdie G, Ricco JB, Riles T, Rothwell P, Sandercock P, Sillesen H, Spence JD, Spinelli F, Tan A, Thapar A, Veith FJ, Zhou W PMID: 22226698 [PubMed - as supplied by publisher] (Source: PubMed: Eur J Vasc Endovasc ...)

Differences Between Asian and White Outcomes Following PCIDifferences Between Asian and White Outcomes Following PCI

Medscape Today Headlines — Thu, 05 Jan 2012 04:00:00 +0100

South Asians develop coronary artery disease at an earlier age and also have a higher prevalence than white Europeans. Do they respond differently to percutaneous coronary intervention? International Journal of Clinical Practice (Source: Medscape Today Headlines)

Percutaneous Coronary Intervention and Drug-Eluting Stent Use Among Patients ≥85 Years of Age in the United States

Journal of the American College of Cardiology — Wed, 04 Jan 2012 18:27:39 +0100

This study assessed the comparative effectiveness of drug-eluting stents (DES) versus bare-metal stents (BMS) among patients ≥85 years of age. Background: Despite an aging population, little is known about the comparative effectiveness of DES versus BMS among patients age ≥85 years undergoing percutaneous coronary intervention (PCI). Methods: We examined 471,006 PCI patients age ≥65 years at 947 hospitals in the National Cardiovascular Data Registry between 2004 and 2008 and linked to Medicare claims data. Long-term outcomes (median follow-up 640.8 ± 423.5 days) were compared between users of DES and BMS. Results: Patients age ≥85 years comprise an increasing proportion of PCIs performed among elderly subjects, yet rates of DES use declined the most in this age group. Compar...

Primary percutaneous coronary intervention and intravascular ultrasound imaging for coronary thrombosis after cisplatin-based chemotherapy

Heart and Vessels — Wed, 04 Jan 2012 16:59:49 +0100

Abstract Although cisplatin is indispensable for the chemotherapy treatment of many malignancies, cisplatin-associated thrombosis is attracting increasing attention. However, experience of primary percutaneous coronary intervention (PCI) and intravascular ultrasound imaging (IVUS) for coronary thrombosis, possibly due to cisplatin-based chemotherapy, has been limited. Case 1 with postoperative gastric cancer developed acute myocardial infarction (AMI) on the sixth day of the second chemotherapy course with conventional doses of cisplatin and tegafur gimeracil oteracil potassium. Emergency coronary angiography (CAG) showed a filling defect in the proximal left anterior descending coronary artery (LAD) concomitant with no reflow in the distal LAD. Case 2 with advanced lung c...

Tirofiban versus abciximab: tirofiban is administered at suboptimal dosages when evaluated in an arterial thrombosis model in non-human primates

Clinical and Experimental Medicine — Wed, 04 Jan 2012 16:59:34 +0100

Abstract To prevent thrombosis in high-risk acute coronary syndrome patients undergoing percutaneous coronary intervention for re-vascularisation, concomitant administration of a glycoprotein IIb/IIIa inhibitor, such as abciximab, tirofiban or eptifibatide, is recommended. Abciximab and eptifibatide are mostly preferred over tirofiban, which is less effective in preventing ischaemic events. We compared the efficacy and bleeding potential of escalating doses of tirofiban and abciximab in non-human primates. The efficacy of tirofiban and abciximab in inhibiting cyclic flow reductions (CFRs) was tested in a high shear arterial thrombosis model. Bleeding was evaluated with the template bleeding time and an incision bleeding model. Abciximab completely inhibited arterial thromb...

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The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2011

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

There have been rapid advances in oral anticoagulation. The oral factor Xa inhibitors rivaroxaban and apixaban and the oral direct thrombin inhibitor dabigatran recently have been rigorously evaluated. These novel anticoagulants will usher in a new paradigm for perioperative anticoagulation. Perioperative blood conservation in cardiac surgery recently has been highlighted in the updated guidelines by the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons. These recommendations reflect a comprehensive evaluation of the recent evidence to optimize transfusion practice. Transcatheter mitral valve repair continues to mature. Transcatheter aortic valve implantation for aortic stenosis has entered the clinical mainstream, with randomized trials showing its superiori...

Advances in the Management of Carotid Artery Disease: Focus on Recent Evidence and Guidelines

Journal of Cardiothoracic and Vascular Anesthesia — Wed, 04 Jan 2012 16:41:50 +0100

Recent landmark randomized trials and society guidelines have significantly revised the management of carotid artery disease. Duplex ultrasonography is the recommended initial diagnostic test for the assessment of extracranial carotid artery stenosis. Carotid artery imaging is reasonable in select patients scheduled for coronary artery bypass graft (CABG) surgery. Carotid revascularization can be achieved safely and effectively with carotid endarterectomy or carotid artery stenting. Because each procedure has a different risk/benefit profile, the optimal approach is to match the particular patient to the intervention that maximizes outcome benefit. Carotid revascularization is recommended in patients scheduled for CABG surgery when the carotid artery stenosis is symptomatic and/or bilatera...

Triple antithrombotic therapy after PCI for STEMI ups bleeding rates

Modern Medicine — Wed, 04 Jan 2012 05:00:00 +0100

NEW YORK (Reuters Health) - After percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI), triple antithrombotic therapy significantly increases the risk of major bleeding compared to dual antiplatelet therapy, researchers report. (Source: Modern Medicine)

Amount of ST wave resolution in patients with and without spontaneous coronary reperfusion in the infarct -related artery after primary PCI: an observational study.

Anadolu Kardiyol Der... — Wed, 04 Jan 2012 05:00:00 +0100

CONCLUSION: Mean ST wave resolution was lower in patients with spontaneous coronary reperfusion who were treated with primary PCI compared to their counterparts who did not have spontaneous coronary reperfusion on initial coronary angiography. PMID: 22214740 [PubMed - as supplied by publisher] (Source: Anadolu Kardiyol Der...)

Improved clinical outcome after invasive management of patients with recent myocardial infarction and proven myocardial viability: Primary results of a randomized controlled trial (VIAMI-trial)

Trials — Tue, 03 Jan 2012 05:00:00 +0100

Background: Patients with ST-elevation myocardial infarction (STEMI) not treated with primary or rescue percutaneous coronary intervention (PCI) are at risk for recurrent ischemia, especially when viability in the infarct-area is present. Therefore, an invasive strategy with PCI of the infarct-related coronary artery in patients with viability would reduce the occurrence of a composite end point of death, reinfarction, or unstable angina (UA). Methods: Patients admitted with an (sub)acute myocardial infarction, who were not treated by primary or rescue PCI, and who were stable during the first 48 hours after the acute event, were screened for the study. Eventually, we randomly assigned 216 patients with viability (demonstrated with low-dose dobutamine echocardiography) to an invasive or a ...

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Off-pump CABG better than PCI for three-vessel coronary artery disease

Modern Medicine — Tue, 03 Jan 2012 05:00:00 +0100

NEW YORK (Reuters Health) - Long-term outcomes are better for patients with three-vessel coronary artery disease when they undergo off-pump coronary artery bypass grafting rather than percutaneous coronary intervention with a drug-eluting stent (DES), according to the results of a Korean study. (Source: Modern Medicine)

The beneficial effect on myocardial perfusion of adenosine in patients treated with primary percutaneous coronary intervention for acute myocardial infarction.

Clinical and Experimental Pharmacology and Physiology — Tue, 03 Jan 2012 05:00:00 +0100

This study investigated the effects of intravenous adenosine on myocardial perfusion and segmental contractile function when used as an adjunct of primary PCI in patients with acute ST segment elevation myocardial infarction (STEMI). 2. Patients were randomly assigned to receive intravenous adenosine (n=35) or saline (n=34) within 12 h of STEMI. Myocardial contrast echocardiography (MCE) and velocity vector imaging (VVI) were performed 7 days after primary PCI. Serial echocardiography was performed on Days 7 and 30. 3. Capillary blood volume (A) (6.34±1.98 dB vs 5.64±1.84 dB, P=0.03) and myocardial blood velocity (β) (0.13±0.04s(-1) vs 0.1±0.04 s(-1) , P=0.01) were higher in the adenosine group than in control patients. Myocardial blood flow (A×β) was 0.82±0.37 dB/s with adenos...

Berberine ameliorates inflammation in patients with acute coronary syndrome following percutaneous coronary intervention.

Clinical and Experimental Pharmacology and Physiology — Tue, 03 Jan 2012 05:00:00 +0100

Authors: Meng S, Wang LS, Huang ZQ, Zhou Q, Sun YG, Cao JT, Li YG, Wang CQ Abstract 1. Inflammation is central to the pathogenesis of acute coronary syndrome (ACS) and is associated with adverse clinical outcomes after percutaneous coronary intervention (PCI). Recent in vitro work from us and others has shown the anti-inflammatory effect of berberine, a main component of the traditional Chinese medicine umbellatine. We further tested whether berberine had beneficial effect on ACS patients following PCI. 2. 130 ACS patients undergoing PCI were recruited in this study. 61 patients were treated with berberine (300mg, 3 times a day, for 30 days) in addition to standard therapy while the remaining patients received standard therapy alone. Circulating inflammatory markers were measur...

Drug-Eluting Stents Lower Event Rates in Oldest Patients (CME/CE)

MedPage Today State Required CME — Mon, 02 Jan 2012 20:00:00 +0100

(MedPage Today) -- In the oldest of patients undergoing percutaneous coronary intervention, adverse-event rates were lower with drug-eluting stents than with bare-mental stents, researchers found, despite the fact that use of those stents declined significantly in that population. (Source: MedPage Today State Required CME)