MedWorm: Coronary 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)

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)

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)

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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...

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)

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)

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)

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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)

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)

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)

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...

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)

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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)

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)

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)

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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...

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)

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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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)

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)

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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...

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...

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)

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 (...

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...

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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)

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...

Same-Day Discharge After Percutaneous Coronary Intervention [Letters]

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

(Source: JAMA)

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

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

(Source: JAMA)

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)

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)

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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)

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...

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)

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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)

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)

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)

[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)

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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)

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)

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...

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...

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)

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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)

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)

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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...

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)

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...

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...

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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...

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...

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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 ...

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...

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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)

Thin-cap fibroatheroma and microchannel findings in optical coherence tomography correlate with subsequent progression of coronary atheromatous plaques

European Heart Journal — Sun, 01 Jan 2012 05:00:00 +0100

Conclusion Optical coherence tomography-based complex characteristics of TCFA and microchannel were the potential predictors of subsequent progression of NSCPs in patients with CAD. (Source: European Heart Journal)

Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy?

European Heart Journal — Sun, 01 Jan 2012 05:00:00 +0100

Conclusion Acute myocardial infarction with RBBB is frequently caused by the complete occlusion of the infarct-related artery and is more frequently treated with primary PCI when compared with AMI + LBBB. In-hospital mortality of patients with AMI and RBBB is highest from all ECG presentations of AMI. Restoration of coronary flow by primary PCI may lead to resolution of the conduction delay on the discharge ECG. Right bundle branch block should strongly be considered for listing in future guidelines as a standard indication for reperfusion therapy, in the same way as LBBB. (Source: European Heart Journal)

Relationship between discharge heart rate and mortality in patients after acute myocardial infarction treated with primary percutaneous coronary intervention

European Heart Journal — Sun, 01 Jan 2012 05:00:00 +0100

Conclusion In STEMI patients treated with primary PCI and optimal medical therapy, heart rate at discharge was an important predictor of mortality up to 4 years follow-up even after adjustment for parameters reflecting a greater infarct size and the presence of heart failure. (Source: European Heart Journal)

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Ischaemic postconditioning revisited: lack of effects on infarct size following primary percutaneous coronary intervention

European Heart Journal — Sun, 01 Jan 2012 05:00:00 +0100

Conclusion This randomized study suggests that p-cond during primary PCI does not reduce infarct size or improve myocardial function recovery at both short- and long-term follow-up and might have a potential harmful effect. (Source: European Heart Journal)

Increased interleukin‐1β levels are associated with left ventricular hypertrophy and remodelling following acute ST segment elevation myocardial infarction treated by primary percutaneous coronary intervention

Journal of Internal Medicine — Sun, 01 Jan 2012 05:00:00 +0100

Conclusions: IL‐1β levels after STEMI were strongly associated with impaired myocardial function and non‐infarct LV mass after 1 year, suggesting a potential role for IL‐1β as a predictor of maladaptive myocardial remodelling following reperfused MI. (Source: Journal of Internal Medicine)

High on Treatment Platelet Reactivity

Heart, Lung and Circulation — Sun, 01 Jan 2012 05:00:00 +0100

The addition of clopidogrel to aspirin for patients undergoing percutaneous coronary intervention (PCI) had significantly reduced cardiovascular events. However, despite dual antiplatelet therapy ischaemic events still occur, especially stent thrombosis, which is associated with a high mortality rate. Inter-individual response to clopidogrel is highly variable. It was shown that 4–46% could be considered as high on treatment platelet reactivity (HTPR). Recent studies had demonstrated a relationship between HTPR and ischaemic events in the setting of PCI. Actually the assessment of platelet reactivity in routine practice and its interpretation to make a decision is a debatable issue. (Source: Heart, Lung and Circulation)

Phenotyping Versus Genotyping for Prediction of Clopidogrel Efficacy and Safety: the PEGASUS‐PCI Study

Journal of Thrombosis and Haemostasis — Sun, 01 Jan 2012 05:00:00 +0100

Conclusions: Phenotyping of platelet response to clopidogrel was a better predictor of stent thrombosis than genotyping. (Source: Journal of Thrombosis and Haemostasis)

Hypotension due to dynamic left ventricular outflow tract obstruction after percutaneous coronary intervention.

Texas Heart Institute Journal — Sat, 31 Dec 2011 08:54:03 +0100

Authors: Dahhan A, Mohammad A, Kapoor D, Sharma GK Abstract Persistent hypotension subsequent to percutaneous coronary intervention is attributed to access-site bleeding, re-infarction, or mechanical complications either of myocardial infarction or of the procedure itself (for example, pericardial tamponade). Dynamic left ventricular outflow tract obstruction after an uncomplicated percutaneous coronary intervention is an unusual, and to our knowledge not previously reported, complication that manifests itself as hypotension refractory to the usual therapy with inotropic agents. We discuss the clinical course, pathophysiology, diagnosis, and management of hypotension due to left ventricular outflow tract obstruction after percutaneous coronary intervention. Early recognition and ac...

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Process Factors Affecting Door to Percutaneous Coronary Intervention for Acute Myocardial Infarction Patients

American Journal of Medical Quality — Fri, 30 Dec 2011 05:00:00 +0100

The purpose of this cross-sectional study was to identify key predictor variables with the most impact on door-to-balloon time for acute myocardial infarction patients. The authors examined arrival, process, and patient-related variables from retrospective data from calendar years 2006 and 2007 within a single community hospital (N = 273). The door-to-balloon time ranged from 28 to 167 minutes, with an average of 76.77 (standard deviation ±24.5) minutes. Key predictor variables identified through multivariate linear regression included portable chest X-ray, presentation from walk-in versus ambulance, responding cardiology group, emergency department (ED) time of arrival (day 8 am to 5 pm or night 5 pm to 8 am), ED day of arrival (weekday or weekend), if a code R was called prior to ...

Early steroid withdrawal - impact on diabetes mellitus and kidney function in heart transplant recipients.

Annals of Transplantation — Fri, 30 Dec 2011 05:00:00 +0100

Conclusions: Patients with earlier steroid withdrawal presented DM and tended to present more severe stages of kidney failure more often. Despite lower frequency of CAV, they tended to require PCI equally often.<br /> PMID: 22210427 [PubMed - in process] (Source: Annals of Transplantation)

Stent Thrombosis Presenting With Cardiogenic ShockStent Thrombosis Presenting With Cardiogenic Shock

Medscape Today Headlines — Fri, 30 Dec 2011 04:00:00 +0100

This 68-year-old man complained of chest pain and rapidly developed cardiogenic shock 48 hours after primary percutaneous coronary intervention. What was the cause? Journal of Medical Case Reports (Source: Medscape Today Headlines)

Bivalirudin Inhibits Periprocedural Platelet Function and Tissue Factor Expression of Human Smooth Muscle Cells

Cardiovascular Therapeutics — Thu, 29 Dec 2011 05:00:00 +0100

Conclusions: Bivalirudin is better than UFH in reducing periprocedural platelet activation. Moreover, thrombin‐induced TF expression is inhibited by bivalirudin. Thus, bivalirudin seems to be a better anticoagulant during PCI than UFH. (Source: Cardiovascular Therapeutics)

Effect and Safety of Landiolol in Patients With Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Circulation Journal — Wed, 28 Dec 2011 05:00:00 +0100

Authors: Yoshiyama M PMID: 22214901 [PubMed - as supplied by publisher] (Source: Circulation Journal)

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Comparison of coronary artery bypass grafting with percutaneous coronary intervention for unprotected left main coronary artery disease.

Yonsei Medical Journal — Tue, 27 Dec 2011 03:58:38 +0100

Conclusion: Despite the fact that patients treated with PCI were at higher operative risk, PCI with DES was shown to be comparable to CABG in terms of mortality, stroke and ACS. However, the frequency of repeat revascularizations remains a constant concern with PCI. PMID: 22187233 [PubMed - in process] (Source: Yonsei Medical Journal)

The CD14++CD16+ monocyte subset and monocyte‐platelet interactions in patients with ST‐elevation myocardial infarction

Journal of Thrombosis and Haemostasis — Sun, 25 Dec 2011 05:00:00 +0100

Conclusion: The Mon2 ‘intermediate’ subset has unique dynamic and functional characteristics following STEMI and significant correlations with troponin, plasma cytokines and convalescent LV function. The persistent increase in MPA count 30 days after STEMI may affect monocyte subset functional activity. (Source: Journal of Thrombosis and Haemostasis)

Post percutaneous coronary intervention antiplatelet therapy: Current perceptions, prospects and perplexity.

Cardiology Journal — Sat, 24 Dec 2011 18:12:03 +0100

Authors: Pant S, Neupane P, Kc R, Barakoti M Abstract Dual antiplatelet therapy (DAT) has become standard care for patients undergoing percutaneous coronary intervention (PCI). Following balloon injury and stent placement, the intima at the site is distressed, resulting in the activation of coagulation cascade and platelets. In the case of bare metal stents (BMS), it takes six to eight weeks for the stent surface to be covered with neointima. However, in the case of a drug-eluting stent (DES), the process of healing is delayed and neointima may not form for months or even years. To prevent the formation of platelet thrombi, dual antiplatelet therapy is given as a combination of aspirin and clopidogrel for three months in a case of BMS and for a minimum of one year in a case of DES....

Half of coronary patients are not instructed how to respond to symptoms of a heart attack.

Cardiology Journal — Sat, 24 Dec 2011 18:12:03 +0100

Conclusions: About half of patients after hospitalization due to CAD are not instructed how to respond to heart attack symptoms. This has not changed over the last decade and may contribute to the lack of shortening of prehospital delay. (Cardiol J 2011; 18, 6: 668-674). PMID: 22113755 [PubMed - in process] (Source: Cardiology Journal)

Prevention and Management of Contrast-Induced Acute Kidney Injury

Current Treatment Options in Cardiovascular Medicine — Sat, 24 Dec 2011 16:45:11 +0100

Opinion statement Contrast-induced acute kidney injury (AKI) is an important complication associated with coronary angiography, percutaneous coronary intervention, and computed tomography studies. The increasing utilization of contrast agents for imaging makes the importance of this complication even greater. Patients can be risk stratified for the risk of contrast-induced AKI by several clinical factors including hypotension, renal function, age, advanced heart failure, anemia, and diabetes mellitus. Contrast volume is also an important and modifiable risk factor for AKI. For the prevention of contrast-induced AKI, multiple approaches have been tried. The most effective prevention strategy is hydration. Normal saline has been the standard, but other options such as sodium...

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Final kissing ballooning and long-term clinical outcomes in coronary bifurcation lesions treated with 1-stent technique: results from the COBIS registry

Heart — Fri, 23 Dec 2011 05:00:00 +0100

Conclusions In patients treated with the 1-stent technique for bifurcation lesions, FKB after main vessel stenting may be harmful mainly due to increased TLR. Trial Registration Number clinicaltrials.gov number: NCT00851526. (Source: Heart)

Cardiovascular highlights from non-cardiology journals

Heart — Fri, 23 Dec 2011 05:00:00 +0100

Interventional cardiologyGenetic factors related to early stent thrombosis Dual anti-platelet therapy reduces cardiovascular events after percutaneous coronary intervention (PCI) by more than 80%. However, stent thrombosis can occur in 0.5–4% of patients within the first year following PCI, with the majority occurring in the first month. Cayla et al performed a case–control study using a candidate gene approach—looking in particular at genetic variations previously associated with clopidogrel pharmacogenetics and arterial thrombosis—in order to determine their impact on early stent thrombosis, in addition to established clinical and angiographic factors. The study was conducted across 10 centres in France over a 3-year period and involved 123 patients undergoing PCI...

Surgery for coronary artery disease

Surgery (Medicine Publishing) — Fri, 23 Dec 2011 00:08:11 +0100

Abstract: Coronary artery disease (CAD) is one of the commonest diseases in the western world, with over 100,000 deaths a year in the UK. It occurs as a result of mismatch between supply and demand of oxygen, usually due to atherosclerotic narrowing of one of more of the major coronary arteries. CAD can remain asymptomatic initially as the stenosis caused by the plaques may not be flow-limiting. As it progresses with time, patients present with angina, acute coronary syndromes or even sudden death. Treatment can be medical or surgical, including percutaneous coronary intervention (PCI) and/or coronary artery bypass grafting (CABG). CABG provides a safe and effective treatment for a large number of people with coronary artery disease for whom PCI and medications are unsatisfactory. With ove...

Stent Thrombosis: Understanding and Managing a Critical Problem

Current Treatment Options in Cardiovascular Medicine — Thu, 22 Dec 2011 16:37:52 +0100

Opinion statement Coronary artery stent thrombosis (ST), defined as the thrombotic occlusion of a stented segment, is an infrequent but serious complication of percutaneous coronary intervention (PCI). The clinical consequences of ST are severe, because acute stent occlusion results in myocardial infarction and death in up to 45% of cases. Specific patient and procedural characteristics increase the risk of ST, but optimized interventional techniques and antiplatelet therapies have the potential to decrease ST and improve cardiovascular outcomes following PCI. Content Type Journal ArticleCategory Coronary Artery Disease (PH Stone, Section Editor)Pages 1-17DOI 10.1007/s11936-011-0155-4Authors Julio F. Marchini, Cardiovascular Division, Brigham and Women’s Hospital, H...

Inducible cardiac ischemia is related with a decrease in whole blood Toll-like receptor 2 and 4 response

Clinical Science — Thu, 22 Dec 2011 05:00:00 +0100

In conclusion, inducible ischemia is associated with a decrease in whole blood TLR-2 and -4 response. These results point to a regulating role of TLRs in order to prevent excessive inflammatory events known to occur during acute ischemia. (Source: Clinical Science)

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Efficacy and safety of a high loading dose of clopidogrel administered prehospitally to improve primary percutaneous coronary intervention in acute myocardial infarction: the randomized CIPAMI trial

Clinical Research in Cardiology — Wed, 21 Dec 2011 20:13:37 +0100

Conclusions Early inhibition of the platelet ADP-receptor with a high loading dose of 600 mg clopidogrel given in the prehospital phase in patients with STEMI scheduled for primary PCI is safe, did not increase pre-PCI patency of the infarct vessel, but was associated with a trend towards a reduction in clinical events. Content Type Journal ArticleCategory Original PaperPages 1-8DOI 10.1007/s00392-011-0393-1Authors Uwe Zeymer, Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, GermanyHans-Richard Arntz, Medizinische Klinik II, Charité Campus Benjamin Franklin, Berlin, GermanyBernd Mark, Klinikum Ludwigshafen, Medizinische Klinik B, Ludwigshafen, GermanyStephan Fichtlscherer, Universitätsklinikum, Frankfurt/Main, GermanyGerald Werner, Klinikum Darmsta...

Modified clopidogrel loading dose according to platelet reactivity monitoring in patients carrying ABCB1 variant alleles in patients with clopidogrel resistance.

European Journal of Internal Medicine — Wed, 21 Dec 2011 17:14:54 +0100

CONCLUSIONS: Increased and adjusted clopidogrel loading dose according to platelet reactivity monitoring attenuated clopidogrel resistance in carriers of ABCB1 mutant allele. PMID: 22153531 [PubMed - in process] (Source: European Journal of Internal Medicine)

ESC Calls For European Studies Exploring Readmissions To Hospital Following PCI

Health News from Medical News Today — Wed, 21 Dec 2011 08:00:00 +0100

The European Society of Cardiology (ESC) welcomes the spotlight that a US study has placed on the importance of measuring rates of rehospitalisation following percutaneous coronary intervention (PCI) procedures. The research, published today in JACC Cardiovascular InterventionsÂ¹, represents one of the first studies to explore PCI readmissions and highlights the need for similar studies to be initiated across Europe to improve patient care... (Source: Health News from Medical News Today)

An audit of diagnostic reference levels in interventional cardiology and radiology: are there differences between academic and non-academic centres?

Radiation Protection Dosimetry — Wed, 21 Dec 2011 05:00:00 +0100

A wide variation in patient exposure has been observed in interventional radiology and cardiology. The purpose of this study was to investigate the patient dose from fluoroscopy-guided procedures performed in non-academic centres when compared with academic centres. Four procedures (coronary angiography, percutaneous coronary intervention, angiography of the lower limbs and percutaneous transluminal angioplasty of the lower limbs) were evaluated. Data on the dose–area product, fluoroscopy time and number of images for 1000 procedures were obtained from 23 non-academic centres and compared with data from 5 academic centres. No differences were found for cardiology procedures performed in non-academic centres versus academic ones. However, significantly lower doses were delivered to pa...

Predicting Clopidogrel Response Using DNA Samples Linked to an Electronic Health Record.

Clinical Pharmacology and Therapeutics — Wed, 21 Dec 2011 05:00:00 +0100

Authors: Delaney JT, Ramirez AH, Bowton E, Pulley JM, Basford MA, Schildcrout JS, Shi Y, Zink R, Oetjens M, Xu H, Cleator JH, Jahangir E, Ritchie MD, Masys DR, Roden DM, Crawford DC, Denny JC Abstract Variants in ABCB1 and CYP2C19 have been identified as predictors of cardiac events during clopidogrel therapy initiated after myocardial infarction (MI) or percutaneous coronary intervention (PCI). In addition, PON1 has recently been associated with stent thrombosis. The reported effects of these variants have not yet been replicated in a real-world setting. We used BioVU, the Vanderbilt DNA repository linked to de-identified electronic health records (EHRs), to find data on patients who were on clopidogrel treatment after an MI and/or a PCI; among these, we identified those who had e...

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N.Y. Stenting Often Means Return Visit to Hospital (CME/CE)

MedPage Today Public Health — Tue, 20 Dec 2011 16:15:14 +0100

(MedPage Today) -- Roughly one out of every six patients in New York who undergo a percutaneous coronary intervention need to be readmitted within 30 days, researchers found. (Source: MedPage Today Public Health)

ESC calls for European studies exploring readmissions to hospital following PCI

European Society of Cardiology — Tue, 20 Dec 2011 10:47:38 +0100

The European Society of Cardiology welcomes the spotlight that a US study has placed on the importance of measuring rates of rehospitalisation following percutaneous coronary intervention (PCI) procedures. The research, published today in JACC Cardiovascular Interventions¹, represents one of the first studies to explore PCI readmissions and highlights the need for similar studies to be initiated across Europe to improve patient care. Topics: Percutaneous Cardiovascular Intervention (PCI) (Source: European Society of Cardiology)

P2Y12 platelet inhibition in clinical practice

Journal of Thrombosis and Thrombolysis — Tue, 20 Dec 2011 06:48:40 +0100

The objectives of this review are to discuss the pharmacological limitations of the P2Y12 inhibitor clopidogrel, and describe the novel alternative P2Y12 inhibitors prasugrel and ticagrelor and the clinical implications of the introduction of these new medicines. Content Type Journal ArticlePages 1-11DOI 10.1007/s11239-011-0667-5Authors Peter Damman, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsPier Woudstra, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsWichert J. Kuijt, Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The NetherlandsRobbert J. de Winter, Department of Cardiology, Academic Medical Center, University of Amsterdam, A...

Systematic review: comparative effectiveness of adjunctive devices in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention of native vessels

BMC Cardiovascular Disorders — Tue, 20 Dec 2011 05:00:00 +0100

Conclusions: In patients with STEMI, for most devices, few RCTs evaluated final health outcomes over a long period of follow-up. Due to insufficient data, the safety of these devices is unclear. (Source: BMC Cardiovascular Disorders)

Intracoronary or intravenous abciximab in primary PCI?

Modern Medicine — Tue, 20 Dec 2011 05:00:00 +0100

NEW YORK (Reuters Health) - Intracoronary infusion of abciximab may have advantages over intravenous (IV) administration in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI), researchers suggest. (Source: Modern Medicine)

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Clopidogrel and proton pump inhibitors: is there a significant drug-drug interaction?

Canadian Journal of Cardiovascular Nursing — Tue, 20 Dec 2011 00:30:04 +0100

Authors: Shmulevich E, Friger M, Gilutz H, Azab AN Abstract Dual antiplatelet therapy with aspirin and clopidogrel is among the most efficacious treatment for patients after acute coronary syndromes and for those who have had a percutaneous coronary intervention and coronary stent implantation. Patients who are treated with dual antiplatelet therapy are usually also ordered medications that reduce the secretion of gastric acid (such as H2 receptor blockers or proton pump inhibitors [PPIs]) in order to decrease the risk of gastrointestinal bleeding and dyspepsia. Numerous observational studies reported that omeprazole (a PPI) attenuates the antiplatelet activity and clinical effectiveness of clopidogrel and causes adverse cardiovascular events. Based on these findings, several medic...

Optimal Management of Antiplatelet Therapy and Proton Pump Inhibition Following Percutaneous Coronary Intervention

Current Treatment Options in Cardiovascular Medicine — Mon, 19 Dec 2011 16:54:29 +0100

Opinion statement Dual antiplatelet therapy (aspirin and a P2Y12 antagonist) is required after the insertion of a coronary artery stent. If the stent has been inserted in the context of an acute coronary syndrome (ACS), then clopidogrel or a high-potency P2Y12 antagonist such as prasugrel or ticagrelor should be considered. Current indications for the use of prasugrel in this situation include ST elevation, diabetes, or previous stent thrombosis on clopidogrel therapy. If the stent has been inserted electively for stable ischemic heart disease, then the patient should normally receive clopidogrel. Next, it is important to consider the patient’s bleeding risk. The CRUSADE score can be used to determine the likelihood of a subsequent gastrointestinal (GI) bleed. For patient...

The Role of von Willebrand Factor and ADAMTS13 in the No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention.

Texas Heart Institute Journal — Mon, 19 Dec 2011 09:30:03 +0100

Authors: Zhao B, Li J, Luo X, Zhou Q, Chen H, Shi H Abstract We prospectively studied the correlations between plasma levels of von Willebrand factor and its cleaving protease-a disintegrin and metalloproteinase with thrombospondin type I motif, member 13 (ADAMTS13)-in 126 patients who did or did not develop no-reflow phenomenon after primary percutaneous intervention for acute ST-segment-elevation myocardial infarction. Quantitative plasma levels of von Willebrand factor and ADAMTS13 were measured by immunoturbidometric assay.Angiographic no-reflow was observed in 46 (37%) of the 126 patients. At admission, plasma levels of von Willebrand factor were significantly higher in the no-reflow group (P < 0.001), but levels of ADAMTS13 at admission were similar in the 2 groups (P = 0....

First Human Trial of KW39 Slotted-Tube Stents for Percutaneous Coronary Intervention.

Texas Heart Institute Journal — Mon, 19 Dec 2011 09:30:03 +0100

Authors: Tanaka M, Tsuno NH, Mitsudo K, Kadota K, Tatami R, Kato M, Kato K, Nogami A, Ishikawa O, Takahashi K Abstract The KW39 stent is a balloon-expandable, stainless-steel, slotted-tube stent, newly designed to adjust to the shape of the coronary arteries. We evaluated the clinical efficacy and safety of KW39 stent-based percutaneous coronary interventions in human native coronary arteries. A total of 105 patients (110 lesions), with a diagnosis of stable angina, acute coronary syndrome, or asymptomatic myocardial ischemia, were included in this prospective study. The primary endpoint was the target-lesion revascularization rate at the conclusion of a 6-month follow-up period. The secondary endpoints were the rates of technical and procedural success and the rate of major advers...

ESC calls for European studies exploring readmissions to hospital following PCI

EurekAlert! - Medicine and Health — Mon, 19 Dec 2011 05:00:00 +0100

(European Society of Cardiology) The European Society of Cardiology welcomes the spotlight that a US study has placed on the importance of measuring rates of re-hospitalization following percutaneous coronary intervention procedures. (Source: EurekAlert! - Medicine and Health)

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30-Day Readmission for Patients Undergoing Percutaneous Coronary Interventions in New York State

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 19 Dec 2011 05:00:00 +0100

Conclusions Future efforts to reduce readmissions should be directed toward the recognition of patients most at risk, and the reasons they are readmitted. Staging also should be examined from a cost-effectiveness standpoint as a function of patients' unique risk factors. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Republished Education in Heart: New P2Y12 inhibitors

Postgraduate Medical Journal — Mon, 19 Dec 2011 05:00:00 +0100

The management and prevention of arterial thrombosis has been transformed by the recognition of the role of platelets in this process and the development of effective antiplatelet drugs. The limited role of thromboxane A2 in platelet activation explains why aspirin therapy, which effectively inhibits release of thromboxane A2 by platelets, is insufficient in high risk conditions such as acute coronary syndromes (ACS) or percutaneous coronary intervention (PCI). The platelet P2Y12 receptor, one of two adenosine diphosphate (ADP) receptors on platelets, plays a central and unique role in platelet activation through amplifying the effects of numerous platelet agonists (figure 1).1 Platelet activation leads not only to aggregation but also to the release of pro-thrombotic and pro-inflammatory ...

Ultrasound Enhanced Prehospital Thrombolysis Using Microbubbles Infusion in Patients with Acute ST Elevation Myocardial Infarction: Pilot of the Sonolysis Study

Ultrasound in Medicine and Biology — Mon, 19 Dec 2011 05:00:00 +0100

Abstract: In animal studies, transthoracic ultrasound and microbubbles have shown to dissolve thrombi in ST elevation myocardial infarction (STEMI). To examine this effect in patients, we have initiated the Sonolysis trial. In this pilot study of 10 patients with a first acute STEMI, we investigated the safety and feasibility of this trial. After pretreatment in the ambulance, five patients were randomized to receive microbubbles with three-dimensional (3-D) guided high mechanical index impulses (1.18) for 15 min, whereas the control group received placebo without ultrasound. Subsequently, primary percutaneous coronary intervention (PPCI) was performed, if indicated. All patients successfully underwent study treatment and PPCI. No significant difference between treatment and control group ...

Impact of Periprocedural Atrial Fibrillation on Short-Term Clinical Outcomes Following Percutaneous Coronary Intervention

The American Journal of Cardiology — Mon, 19 Dec 2011 05:00:00 +0100

There are few data on the incidence and clinical outcomes of patients with atrial fibrillation (AF) treated in the era of percutaneous coronary intervention (PCI). We analyzed 30-day clinical outcomes in 3,307 consecutive patients with and without AF (sinus rhythm) undergoing PCI from January 2007 through December 2008 enrolled in a multicenter Australian registry. Periprocedural AF was present in 162 patients (4.9%). AF was associated with older age (74.1 ± 8.9 vs 63.9 ± 11.9 years, p (Source: The American Journal of Cardiology)

Usefulness of Transient and Persistent No Reflow to Predict Adverse Clinical Outcomes Following Percutaneous Coronary Intervention

The American Journal of Cardiology — Mon, 19 Dec 2011 05:00:00 +0100

The no reflow phenomenon is reported to occur in >2% of all percutaneous coronary interventions (PCIs) and portends a poor prognosis. We analyzed data from 5,286 consecutive patients who underwent PCI from the Melbourne Interventional Group (MIG) registry from April 2004 through January 2008 who had 30-day follow-up completed. Patients without no reflow (normal reflow, n = 5,031) were compared to 255 (4.8%) with no reflow (n = 217 for transient no reflow, n = 38 for persistent no reflow). Patients with transient or persistent no reflow were more likely to present with ST-elevation myocardial infarction (MI) or cardiogenic shock (p (Source: The American Journal of Cardiology)

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Radial-access PCI trumps femoral access in STEMI patients

MedWire News - Cardiology — Mon, 19 Dec 2011 02:31:42 +0100

ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention have significantly better outcomes when operators access the heart via the radial artery, research shows. (Source: MedWire News - Cardiology)

Why cardiothoracic surgeons must tweet and blog

The Journal of Thoracic and Cardiovascular Surgery — Sat, 17 Dec 2011 21:02:14 +0100

Health care systems around the world are under stress and are being reformed. New models of care are required for a rapidly aging population. Care that is currently hospital based must be transferred to the community. Cardiothoracic surgery provides treatments that may be very effective but remain very invasive and expensive. The specialty lags behind general surgery, which has changed dramatically during the past 10 to 15 years. Many cardiac treatments, previously undertaken through open surgery, are now available with a catheter, carried out by cardiologists. Although percutaneous coronary intervention numbers remain stable, numbers of coronary artery bypass grafting operations, for many years staple fare for cardiac surgeons, are falling precipitously in both the United States and the U...

Evaluation of in-stent neointimal tissue components using integrated backscatter intravascular ultrasound: comparison of drug-eluting stents and bare-metal stents

The International Journal of Cardiovascular Imaging — Sat, 17 Dec 2011 16:42:16 +0100

Abstract Although in-stent restenosis (ISR) occurs after drug-eluting stents (DES) implantation, neointimal tissue characteristics have not been fully investigated. We assessed neointimal tissue components using integrated backscatter intravascular ultrasound (IB-IVUS) after DES and bare-metal stents (BMS) implantation. Fifty-seven consecutive patients with 61 lesions underwent repeated percutaneous coronary intervention (PCI) for the treatment of ISR (DES: 24 lesions, BMS: 37 lesions). PCI was performed using plain old balloon angioplasty (POBA). Before PCI, we assessed neointimal tissue characteristics using IB-IVUS. Neointima was divided into four categories: category 1 (−11 to −29 dB), category 2 (−29 to −35 dB), category 3 (−35 to −49 dB), an...

Reduced door‐to‐balloon times in acute ST‐elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

International Journal of Clinical Practice — Sat, 17 Dec 2011 02:27:21 +0100

Conclusions: Institution of an on‐site cardiology team‐based approach in the ED significantly reduces D2B time in STEMI patients eligible for primary PCI. (Source: International Journal of Clinical Practice)

Sex-specific benefits of sirolimus-eluting stent on long-term outcomes in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: Insights from the Multicenter Evaluation of Single High-Dose Bolus Tirofiban Versus Abciximab With Sirolimus-Eluting Stent or Bare-Metal Stent in Acute Myocardial Infarction Study trial

American Heart Journal — Fri, 16 Dec 2011 02:35:17 +0100

Conclusions: In this analysis, the clinical benefit of SES use, over BMS, at 3-year follow-up was restricted to men and was not observed among women. (Source: American Heart Journal)

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Maryland may consider law banning some hospitals from cardiac stent surgeries

bizjournals.com Health Care:Physician Practices headlines — Thu, 15 Dec 2011 23:49:41 +0100

Maryland health care regulators said Thursday they will consider recommending a state law allowing them to bar some hospitals from cardiac stent surgeries. A panel of state health care industry stakeholders has suggested the Maryland Health Care Commission seek oversight of what are known as "percutaneous coronary intervention services." The commission already oversees such procedures when they are required by acute medical events, but the recommendation would extend that to more elective-type procedures... (Source: bizjournals.com Health Care:Physician Practices headlines)

Mechanism of catheter thrombosis: comparison of the antithrombotic activities of fondaparinux, enoxaparin, and heparin in vitro and in vivo

Blood — Thu, 15 Dec 2011 05:00:00 +0100

This study was undertaken to identify the responsible mechanism and to develop strategies for its prevention. Percutaneous coronary intervention catheter segments shortened plasma clotting times from 971 ± 92 to 352 ± 22 seconds. This activity is factor XII (fXII) dependent because it was attenuated with corn trypsin inhibitor and was abolished in fXII-deficient plasma. Heparin and enoxaparin blocked catheter-induced clotting at 0.5 and 2 anti-Xa U/mL, respectively, whereas fondaparinux had no effect. Addition of fondaparinux to bivalirudin or low-dose heparin attenuated catheter-induced clotting more than either agent alone. In a rabbit model of catheter thrombosis, a 70 anti-Xa U/kg intravenous bolus of heparin or enoxaparin prolonged the time to catheter occlusion by 4.6- ...

Adverse outcomes after PCI not increased at centers without onsite surgery

MedWire News - Cardiology — Thu, 15 Dec 2011 00:00:00 +0100

Percutaneous coronary intervention performed at centers without onsite surgery is not associated with an increased risk for in-hospital mortality or emergency bypass surgery, US researchers suggest. (Source: MedWire News - Cardiology)

Gender differences in symptoms of myocardial ischaemia

European Heart Journal — Wed, 14 Dec 2011 05:00:00 +0100

Conclusion This prospective study with ECG-affirmed ischaemia found no statistically significant differences in women's and men's rates of chest and other typical symptoms during ischaemia, although women were more likely to experience throat and jaw discomfort. Currently both popular press and some patient education materials suggest women experience myocardial ischaemia differently from men. Steps to ensure women and health professionals are alert for the classic symptoms of myocardial ischaemia in women, as well as men, may be warranted. (Source: European Heart Journal)

Myocardial function may improve equally in diabetic patients following both multivessel percutaneous coronary intervention and coronary artery bypass grafting: results from a CARDia trial substudy

European Journal of Echocardiography — Wed, 14 Dec 2011 05:00:00 +0100

Conclusion Optimal revascularization in diabetic patients with multivessel disease remains controversial. This subset analysis of the CARDia trial suggests both PCI and CABG achieve similar improvement in reversible ischaemia. (Source: European Journal of Echocardiography)

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PCI With No Surgeon on Standby Appears Safe (CME/CE)

MedPage Today Surgery — Tue, 13 Dec 2011 23:13:16 +0100

(MedPage Today) -- Percutaneous coronary intervention without surgical backup did not increase the risk of inhospital mortality or need for emergency bypass surgery, according to a systematic review of published literature. (Source: MedPage Today Surgery)

Coronary patients who returned to work had stronger internal locus of control beliefs than those who did not return to work.

British Journal of Health Psychology — Tue, 13 Dec 2011 05:00:00 +0100

Conclusions. Patients' control beliefs and educational level are significant psychosocial factors associated with RTW following PCI and CABG treatment. Implications for hospital treatment and rehabilitation programs are discussed. PMID: 22151690 [PubMed - as supplied by publisher] (Source: British Journal of Health Psychology)

Percutaneous Coronary Intervention at Centers With and Without On-site Surgery: A Meta-analysis [Review]

JAMA — Tue, 13 Dec 2011 05:00:00 +0100

Conclusion Percutaneous coronary interventions performed at centers without on-site surgery, compared with centers with on-site surgery, were not associated with a higher incidence of in-hospital mortality or emergency bypass surgery. (Source: JAMA)