Radiographic contrast Archive 2000-2001
TCT 2002 Abstracts
TCT 2002 Expert Presentations
| Contrast Nephropathy "Redefined": Prognostic Impact and Status of New Therapeutic Approaches | R. Mehran |
The
impact of renal insufficiency on clinical outcomes in patients undergoing
percutaneous coronary interventions
Best PJ, et al.
J Am Coll Cardiol
2002;39:1113-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11923033
Renal insufficiency is a strong predictor of death and subsequent cardiac events
in a dose-dependent fashion during and after PCI. Patients with renal
insufficiency have more baseline cardiovascular risk factors, but renal
insufficiency is associated with an increased risk of death and other adverse
cardiovascular events, independent of all other measured variables.
Acetylcysteine
to prevent angiography-related renal tissue injury (the APART trial)
Diaz-Sandoval LJ, et al.
Am J Cardiol
2002;89:356-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11809444
Effect
of theophylline on contrast material-nephropathy in patients with chronic renal
insufficiency: controlled, randomized, double- blinded study
Huber W, et al.
Radiology 2002;223:772-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12034949
http://radiology.rsnajnls.org/cgi/content/full/223/3/772
http://radiology.rsnajnls.org/cgi/content/abstract/223/3/772
Prophylactic administration of 200 mg theophylline reduces the incidence of
contrast material-induced nephropathy in patients with chronic renal
insufficiency.
Changing
trends in incidence and predictors of radiographic contrast nephropathy after
percutaneous coronary intervention with use of fenoldopam
Kini AS, et al.
Am J Cardiol
2002;89:999-1002.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11950448
A
protocol for prevention of radiographic contrast nephropathy during percutaneous
coronary intervention: effect of selective dopamine receptor agonist fenoldopam
Kini AS, et al.
Catheter Cardiovasc Interv
2002;55:169-73.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11835641
The observed 4.7% incidence of radiographic contrast nephropathy (RCN) with
fenoldopam was significantly lower than 18.8% incidence in the historical
control group (P < 0.001). Our data suggest that fenoldopam is a useful
adjunct in the prevention of RCN during PCI, especially in diabetics
Prevention
of contrast media-associated nephropathy: randomized comparison of 2 hydration
regimens in 1620 patients undergoing coronary angioplasty
Mueller C, et al.
Arch Intern Med
2002;162:329-36.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11822926
Isotonic hydration is superior to half-isotonic hydration in the prevention
of contrast media-associated nephropathy.
Gadolinium
as an alternative contrast agent for diagnostic and interventional angiographic
procedures in patients with impaired renal function
Rieger J, et al.
Nephrol Dial Transplant
2002;17:824-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11981070
http://ndt.oupjournals.org/cgi/content/full/17/5/824
http://ndt.oupjournals.org/cgi/content/abstract/17/5/824
Gadopentetate dimeglumine is an alternative and safe radiographic contrast
agent for angiography and interventional procedures in patients with severe
pre-existing renal impairment. In this population with high risk for
contrast-induced acute renal failure, it is obviously less nephrotoxic than
iodinated contrast media.
Incidence
and prognostic importance of acute renal failure after percutaneous coronary
intervention
Rihal CS, et al.
Circulation
2002;105:2259-64.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12010907
http://www.circulationaha.org/cgi/content/full/105/19/2259
http://www.circulationaha.org/cgi/content/abstract/105/19/2259
The overall incidence of acute renal failure (ARF) after PCI is low.
Diabetic patients with baseline Cr values <2.0 mg/dL are at higher risk than
nondiabetic patients, whereas all patients with a serum Cr >2.0 are at high
risk for ARF. ARF was highly correlated with death during the index
hospitalization and after dismissal.
Fenoldopam
mesylate blocks reductions in renal plasma flow after radiocontrast dye infusion:
a pilot trial in the prevention of contrast nephropathy
Tumlin JA, et al.
Am Heart J
2002;143:894-903.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12040355
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a122118&target=
The results of this pilot trial suggest that fenoldopam mesylate is a
promising prophylactic agent for RCN and that larger multicenter trials should
be conducted to prove its efficacy.
Do
clinically relevant circulating concentrations of radiographic contrast agents
inhibit platelet-dependent arterial thrombosis?
Zhu Y, et al.
Thromb Res
2002;105:413-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12062543
Systemic administration of radiographic contrast agents (RCA) at doses that
achieve low, clinically relevant plasma concentrations can inhibit platelet-rich
thrombus formation after arterial injury. Antithrombotic properties of ionic RCA
appear to be greater than those of nonionic RCA.
Hypertrophic obstructive cardiomyopathy (alcool septal ablation) Archive 2000-2001
Websites
TCT 2002 Abstracts
Summaries of important articles from major peer-reviewed journals
| Role of Transcoronary Ablation of Septal Hypertrophy in Patients With HOCM | F. Gietzen | Circulation 2002;106:454-459 |
Nonsurgical
reduction of the septum effective in HCM
Shamim W, et al.
N Engl J Med
2002; 347:1326-1333. [ Oct 23, 2002
with slides / Researchers report that injection of pure ethanol into
the septal perforator vessels, causing a controlled infarction in the septum,
reduced outflow tract obstruction and improved functional capacity in patients
with hypertrophic cardiomyopathy. However, the procedure should still be
considered investigational, the researchers say.
See also:
http://www.medscape.com/viewarticle/445909
Nonalcoholic
percutaneous transluminal septal ablation for hypertrophic cardiomyopathy with
obstruction
Vanderheyden M, et al.
Am J Cardiol 2002;89:361-2.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11809446
Coronary State of the Art
Revascularization, Stenting and Outcomes of
Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock
Dauerman HL, Goldberg RJ, White K, et al, for the GRACE Investigators
Am J Cardiol. 2002;90(8):838-842
http://www.medscape.com/viewarticle/445909_3
Once more we can appreciate the poor
outcome of AMI patients with shock on admission. Although the results seem to
show a benefit from stenting, the nonrandomized and observational nature of the
study may have biased these results, and only patients who were candidates for
revascularization were considered for cardiac catheterization. Patients who were
too sick to undergo catheterization were probably treated conservatively,
resulting in a poorer outcome. As stated by the authors, revascularization was
considered during the whole length of the hospital stay, and out-of-hospital
mortality was not assessed. Nevertheless, this analysis provides important
information on "real-world" medicine and outcomes.
Full text journal article May 2002
Cardiogenic Shock
Complicating Acute Myocardial Infarction in Elderly Patients: Does Admission to
a Tertiary Center Improve Survival?
The site of admission is not associated with improved outcomes for patients
with AMI and cardiogenic shock
Radial artery approach Archive 2001
RadialForce.Org
http://www.radialforce.org
Website belonging to organization of same name, devoted to transcatheter
procedures carried out via the radial artery. Pages on the technique,
publications, trials, cases, meetings, a small Forum section, and a products
directory. A tightly focused single-issue site, and well put together.
Access: No registration required
Features: case studies, discussion forum, lists of meetings, lists of
trials
How to do it
Radial Artery Puncture - Procedure
http://www.medstudents.com.br/proced/radial.htm
Full text journal article Jun 2002
Safety
and Feasibility of the Radial Approach for Primary Angioplasty in Acute
Myocardial Infarction During Pregnancy
A radial approach for PCI in AMI during pregnancy is feasible and may be a safe
alternative to a femoral approach.
Use of 5 French guiding catheters Archive 2000-2001
Miniaturization of the equipment for
percutaneous coronary interventions: a prospective study in 1,200 patients
Schoebel WA, et al.
J Invasive Cardiol 2003;15:6-11
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12499520
The study,
performed in 1,200 consecutive patients subjected to coronary angioplasty,
confirms that PCI was technically feasible using a 5 Fr guiding catheter in the
majority of consecutive patients (success rate: 92%). There were significant
differences in the success rate depending on the lesion type and the diameter
stenosis.
Closure devices Archive 2000-2001
Clinical studies and articles documenting post catheterization early ambulation without the use of closure devices, presented by Advanced Vascular Dynamics.
Angiographic
access site complications in the era of arterial closure devices
Meyerson SL, et al.
Vasc Endovascular Surg 2002;36:137-44.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11951100
These data demonstrate that closure devices facilitate arterial puncture
site repair without an increase in access site complications. These devices can
be safely utilized when rapid hemostasis is desired after coronary or peripheral
angiography
Randomized
comparison of Vasoseal and Angioseal closure devices in patients undergoing
coronary angiography and angioplasty
Shammas NW, et al.
Catheter Cardiovasc Interv 2002;55:421-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11948884
In the absence of GP IIb/IIIa inhibitors, VS and the 8 Fr AS devices have
statistically similar time to hemostasis and ambulation as well as device
failures and complication rates following coronary angiography and angioplasty.
CABG
AHA 2002 Meeting Coverage
Off-pump
CABG more cost-effective than traditional on-pump bypass
with slide / The first randomized cost-effectiveness trial of off-pump vs
on-pump CABG in the US shows a $2800 saving in using the beating-heart technique.
American Heart Association Scientific Sessions 2002.[ Nov 19, 2002 ]
ESC 2002 Meeting Coverage
First
off-pump study to show lower patency rates
with slides / A British team has reported, for the first time, a lower
graft patency rate following off-pump cardiac surgery compared with on-pump
cardiopulmonary bypass in a randomized trial comparing the 2 techniques. This is
a "serious" finding, says the lead investigator.
European Society of
Cardiology Congress 2002 [ Sep 02, 2002 ]
Summaries of important articles from major peer-reviewed journals
| Editorial: Protecting the Brain in Coronary Artery Bypass Graft Surgery | D. Mark | JAMA 2002;287: 11, 1448-1450 |
| Cognitive Outcome After Off-Pump and On-Pump CABG | D. Van Dijk | JAMA. 2002; 287:1405-1412 |
| Comparison of Stenting with MIDCAB for Stenosis of the LAD | A. Diegeler | N Engl J Med 2002;347:561-566 |
Cardiology Patient Pages
Angioplasty Versus Bypass Surgery for Coronary Artery Disease
Andrew D. Michaels and Kanu Chatterjee
Circulation 2002;106 187-190
http://circ.ahajournals.org/cgi/content/full/106/23/e187?etoc
The choice of angioplasty or bypass surgery is based on physician and
patient preference, as well as patient-specific characteristics, such as
diabetes or heart failure, which may favor one strategy over another.
Angioplasty should be considered when one, two, or even three arteries have
become narrowed, provided that the arteries are suitable for angioplasty. When
there is significant narrowing of the left main coronary artery or of all three
major coronary arteries, CABG should be considered. CABG is preferable in the
presence of diabetes and/or heart failure when two or three coronary arteries
are narrowed. If revascularization is feasible, either angioplasty or CABG is
indicated when medical treatment has failed to relieve angina.
Comparison of Stenting With Minimally
Invasive Bypass Surgery for Stenosis of the Left Anterior Descending Coronary
Artery
Diegeler A, Thiele H, Falk V, et al.
The New England Journal of Medicine. 2002;347(8):561-566
http://www.medscape.com/viewarticle/441576
News: Minimally
Invasive Bypass Best for High-Grade Proximal LAD Lesion
However, coronary artery stenting had fewer short-term adverse events.
News Dec 2002
High-Grade Stenosis of
Proximal LAD Responds Better to CABG Than Stenting
In patients with high-grade stenosis in the proximal left anterior
descending coronary artery (LAD), outcomes after coronary artery bypass grafting
(CABG) are better at 3-year follow-up than after angioplasty, according to a
report in the Journal of the American College of Cardiology for December 4.
Difference
between on- and off-pump CABG negligible at 12 months
Van Dijk et al.
JAMA 2002; 287: 1405-12. [ Mar 19, 2002 ]
One of the few randomized trials to compare cognitive outcomes after off-pump
and on-pump CABG has found cognitive function slightly improved at 3 months in
those who got off-pump procedures, but by 12 months, the difference between the
two groups was negligible.
Anemia
predictor of post-CABG mortality
Zindrou D et al.
Lancet 2002; 359: 1747-8. [ May 17, 2002 ]
An observational study notes that patients with preoperative anemia have a
5-fold increase in in-hospital death after CABG compared to nonanemic patients,
despite getting pre-op blood transfusions.
Off-pump
surgery may have particular benefits for elderly
Demaria
RG et al.
Circulation 2002; 106: published online before print September 17,
2002.
with slide / A new retrospective study shows bypass on beating hearts
was associated with reduced stroke and mortality for the over-80 age group.
Off-pump
surgery does not compromise longer-term outcomes, study says
Angelini GD et al.
Lancet 2002; 359: 1194-9. [ Apr 04, 2002 ]
UPDATED with slides / Investigators from two, serial, randomized
trials comparing off-pump and on-pump coronary artery bypass surgery (CABG) have
pooled their trial results and found that beating heart surgery significantly
lowers in-hospital morbidity without compromising outcomes within the first 3
years postprocedure.
Diabetes
should not preclude vascular surgery
Hamdan AD et al.
Arch Surg 2002; 137: 417-21. [ Apr 17, 2002 ]
with slide / Challenging the entrenched wisdom regarding the
perioperative risks of vascular surgery for diabetic patients, a new study
suggests that diabetic status should not preclude patients from being considered
for vascular surgery procedures.
Coronary
artery bypass grafting in patients over 70 years old: the influence of age and
surgical technique on early and mid-term clinical outcomes
Ascione
R, et al.
Eur
J Cardiothorac Surg
2002;22:124-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12103385
with slide / Off-pump cardiac surgery is associated with a large
reduction in complications in overweight patients compared with conventional
by-pass surgery, a new UK study suggests.
Radial
artery grafts respond like LIMAs to flow-mediated dilation in vivo
Al-Bustami KH et al.
J
Am Coll Cardiol 2002; 39: 573-7. [ Feb 25, 2002 ]
with slide / After falling in and out of favor with surgeons, the
radial artery has been revived as a CABG option, despite scant evidence of its
long-term biologic function. Now British researchers report they have 3-week and
6-month in vivo data showing that the grafts respond to stimuli in a manner
similar to the left internal mammary artery after CABG.
PCI
valid alternative to CABG in high-risk patients
Morrison
DA et al.
J Am Coll Cardiol 2002; 39: 266-73.
[ Jan 23, 2002 ]
with slide / Analysis of outcomes in two patient registries support
the randomized findings of the AWESOME trial which showed PCI is a valid
alternative to CABG for some medically refractory high-risk patients.
Full text journal article May
2002
Surgical Coronary
Revascularization in Geriatric Patients
Less invasive techniques (MIDCAB, off-pump) have enabled surgeons to operate
on the elderly with improved results.
Full text journal article Jun
2002
Coronary Artery Bypass
Grafting (CABG): Reassessing Efficacy, Safety, and Cost
A review of recent studies examines the factors influencing temporary
survival advantages of CAD patients after CABG.
Evaluation
of the effectiveness of off-pump coronary artery bypass grafting in high-risk
patients: an observational study
Chamberlain
MH, et al.
Ann
Thorac Surg
2002;73:1866-73.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12078783
Off-pump coronary artery bypass grafting is safe, effective, and associated with
reduced morbidity in high-risk patients compared with conventional coronary
artery revascularization.
Totally
endoscopic coronary artery bypass grafting on cardiopulmonary bypass with
robotically enhanced telemanipulation: Report of forty-five cases
Dogan S, et al.
J Thorac Cardiovasc Surg
2002;123:1125-31.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12063459
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a121305&target=
The present data show the feasibility of closed chest single- and
double-vessel revascularization, with good clinical results. However, procedural
time is prolonged and the complex endoscopic and endoaortic occlusion techniques,
as well as the extensive anesthesiologic monitoring, are demanding. The need for
conversion to an open procedure diminished after a relatively short learning
curve. All postulated benefits of totally endoscopic surgery other than
excellent cosmesis must be evaluated in larger cohorts.
Anterior
spinal artery syndrome after elective coronary artery bypass grafting
Geyer TE, et al.
Ann Thorac Surg
2002;73:1971-3.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12078809
A 65-year-old patient with ischemic heart disease and hypertensive
nephropathy had paraplegia develop after elective coronary artery
revascularization caused by anterior spinal infarction. Spinal complications are
rare after coronary artery bypass grafting. The possible mechanisms of spinal
cord injury are discussed, and the relevant literature is reviewed.
The
effect of clopidogrel incombination with aspirin when
given before coronary
artery bypass grafting
Hongo RH, et al.
J Am Coll Cardiol
2002;40:231-237.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12106925
Clopidogrel in combination with aspirin before CABG is associated with
higher postoperative bleeding and morbidity. These findings raise concern
regarding the routine administration of clopidogrel before anticipated coronary
stent implantation
Right
internal mammary artery and radial artery composite in situ pedicle graft in
coronary artery bypass grafting
Sajja LR, et al.
Ann Thorac Surg
2002;73:1856-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12078781
Myocardial revascularization using proximal RIMA and RA in situ pedicle
graft was safe in patients with diabetes and in obese and chronic obstructive
pulmonary disease patients. This graft was useful to revascularize posterior
descending artery, posterolateral ventricular branches of right coronary artery,
and obtuse marginal branches where a left internal mammary artery and RA
composite graft cannot be used because of technical reasons. Its usage was not
associated with sternal wound infection.
Hemodynamic
collapse during off-pump coronary artery bypass grafting
Vassiliades TA, Jr., et al.
Ann Thorac Surg
2002;73:1874-9; discussion 1879.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12078784
The causes of hemodynamic collapse during elective OPCAB were ischemic,
mechanical, or a combination of both. A detailed review of our five and a half
year experience has revealed a number of suggestions for improving the conduct
of the operation.
Comparison
of recovery patterns for patients undergoing coronary artery bypass grafting and
minimally invasive direct coronary artery bypass in the early discharge period
Zimmerman L, et al.
Prog Cardiovasc Nurs
2002;17:132-41.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12091762
Minimally invasive direct coronary artery bypass patients reported fewer
postoperative or cardiac-related problems, as only 5% indicated a problem with
heart failure at both 2 and 4 weeks, and 36% reported being very nervous or
having emotional problems at 4 weeks. Unlike postoperative problems, there were
numerous similarities in postprocedural symptoms between these two groups.
Fatigue, shortness of breath, and pain were the major symptoms reported
postdischarge by both groups in this study. In addition, sleeping problems were
also fairly prevalent in the coronary artery bypass grafting group, which is
understandable, considering the fatigue ratings. Physiologic and psychosocial
functioning varied minimally between the two procedures. While there were many
similarities in the recovery patterns of both groups, the occurrence of
postprocedural problems and symptoms of these two patient groups should be
considered by clinicians to further tailor patient education
MIDCAB
Haemodynamic
and EKG changes in patients undergoing minimally invasive direct coronary artery
bypass
Baraka AS, et al.
Middle East J Anesthesiol
2002;16:387-96.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11949201
Coronary occlusion in patients undergoing MIDCAB can result in ST segment
elevation, followed by reperfusion ventricular extrasystoles. The reperfusion
arrhythmias were observed in patients showing a significant elevation of the ST
segment during coronary occlusion; risk factors included a preoperative history
of arrhythmia, unstable angina, recent MI, and/or 70% LAD stenosis. The rapid
restoration of the control ST segment level and the significant increase of
cardiac output following coronary reperfusion suggest that isoflurane anesthesia
may have provided a degree of myocardial protection during coronary clamping and
reperfusion.
Minimally
invasive coronary artery bypass grafting versus percutaneous transluminal
coronary angioplasty with stenting in isolated high-grade stenosis of the
proximal left anterior descending coronary artery: Six months' angiographic and
clinical follow-up of a prospective randomized study
Drenth
DJ, et al.
J Thorac Cardiovasc Surg
2002;124:130-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12091818
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a122525&target=
After 6 months, surgical intervention had a significantly better
angiographic outcome than stenting in patients with an isolated high-grade
stenosis of the proximal left anterior descending coronary artery. Clinical
outcome did not significantly differ between treatments.
Minimally
invasive direct coronary artery bypass for completely obstructed left anterior
descending coronary artery
Hayashi Y, et al.
J Cardiovasc Surg (Torino)
2002;43:11-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11803321
The
MIDCAB procedure appears useful even in patients with completely obstructed LAD,
despite the long anastomosis time. However, the indications for this procedure
are limited by any perceived difficulty in harvesting the LITA by indirect
vision or in performing the anastomosis based on the size or quality of the LAD.
Intensive preoperative angiography evaluation is essential and conversion to a
median full-sternotomy is necessary for cases in which we cannot confirm the
feasibility of MIDCAB.
MIDCAB
for redo patients using the LITA-RA composite graft
Kano M, et al.
Kyobu Geka
2002;55:252-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11889816
The
MIDCAB procedure using the left internal thoracic artery (LITA)-radial artery
(RA) composite graft is safe and useful to regulate the bypass graft length and
avoid the widely harvest of LITA in redo operation.
The
superiority of pulmonary function after minimally invasive direct coronary
artery bypass
Ohkado A, et al.
Jpn J Thorac Cardiovasc Surg
2002;50:66-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11905060
MIDCAB
provides better recovery of pulmonary function early postoperatively than other
procedures thanks to minithoracotomy rather than avoidance of cardiopulmonary
bypass.
Coronary
artery bypass grafting without cardiopulmonary bypass: MIDCAB and OPCAB
Okada M, et al.
Kyobu Geka
2002;55:483-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12058461
Minimally
invasive direct coronary artery bypass grafting via left anterior small
thoracotomy (MIDCAB) and coronary artery bypass grafting without cardiopulmonary
bypass (OPCAGB) are accepted technique as less invasive than conventional
coronary artery bypass grafting (CABG).
Use
of MIDCAB procedure for redo coronary artery bypass
Pascucci S, et al.
J Cardiovasc Surg (Torino)
2002;43:143-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11887045
The
results of this study indicate that MIDCAB using IMA grafts for reoperation is a
safe procedure with low risk for morbidity and mortality. This surgical
technique is a useful alternative to conventional redo CABG in selected patients
when complete revascularisation is not indicated.
MIDCAB
in the patient with ischemic heart disease and chronic renal failure
Shiiku C, et al.
Kyobu Geka 2002;55:89-92.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11797414
MIDCAB
is thought to be effective for patients who have chronic renal failure, because
they are able to resume hemodialysis in early postoperative period for
controlling water and electolyte
TCT 2002 Meeting Coverage
TCT 2002 Expert Presentations
| Management Issues in the Diabetic Patient with Coronary Artery Disease: Glycemic Control, Adjunctive Pharmacology, and Revascularization Strategies | B. j. Gersh |
ACC 2002 Meeting Coverage
| The Diabetic Syndrome: Impact of Percutaneous Coronary Intervention |
TCT 2002 Abstracts
Diabetes
and atherosclerosis: epidemiology, pathophysiology, and management
Beckman JA, et al.
Jama
2002;287:2570-81.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12020339
Diabetes mellitus markedly increases the risk of myocardial infarction, stroke,
amputation, and death. The metabolic abnormalities caused by diabetes induce
vascular dysfunction that predisposes this patient population to atherosclerosis.
Blood pressure control, lipid-lowering therapy, angiotensin-converting enzyme
inhibition, and antiplatelet drugs significantly reduce the risk of
cardiovascular events. Although diabetic patients undergo revascularization
procedures because of acute coronary syndromes or critical limb ischemia, the
outcomes are less favorable than in nondiabetic cohorts. Since most patients
with diabetes die from complications of atherosclerosis, they should receive
intensive preventive interventions proven to reduce their cardiovascular risk.
Proteinuria,
serum creatinine, and outcome of percutaneous coronary intervention in patients
with diabetes mellitus
Reeder
GS, et al.
Am J Cardiol
2002;89:760-4.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11897221
The
effect of type II diabetes mellitus on platelet aggregation in patients who
underwent percutaneous transluminal coronary angioplasty
Sagcan A, et al.
Coron Artery Dis
2002;13:45-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11917198
Collagen- induced platelet aggregation response was greater in patients with
tIIDM than in nondiabetic patients. This makes us think that tIIDM patients
could need more potent antiplatelet therapy before PTCA after the blood glucose
levels have been regulated.
Review
Metformin does not increase fatal or nonfatal lactic acidosis or blood
lactate levels in type 2 diabetes mellitus
http://www.acpjc.org/Content/137/3/issue/ACPJC-2002-137-3-088.htm
Salpeter
S, Greyber E, Pasternak G, Salpeter E.
Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes
mellitus.
Cochrane Database Syst Rev. 2002;(2):CD002967 (latest version 27 Feb
2002).
[PubMed
ID: 12076461]
In patients with type 2 diabetes mellitus,
metformin does not increase the risk for fatal or nonfatal lactic acidosis or
increase blood lactate levels compared with placebo or other hypoglycemic
therapies.
Full text journal article Jun
2002
Coronary
Stent Implantation in Patients Older Than 75 Years of Age: Clinical Profile and
Initial and Long-Term (3 Years) Outcome
Revascularization achieved in the elderly has a similar 5-year event-free
survival rate compared to younger patients.
Full text journal article Mar
2002
Long-Term Outcome of
Primary Percutaneous Transluminal Coronary Angioplasty (PTCA) for Low-Risk Acute
Myocardial Infarction (AMI) in Patients Older Than 80 Years: A Single-Center,
Open, Randomized Trial
Primary PTCA in octogenarians in the setting of low-risk AMI offers little
benefit with regards to clinical outcomes.
Full text journal article May
2002
Cardiogenic Shock
Complicating Acute Myocardial Infarction in Elderly Patients: Does Admission to
a Tertiary Center Improve Survival?
The site of admission is not associated with improved outcomes for patients
with AMI and cardiogenic shock
Full text journal article May
2002
Surgical Coronary
Revascularization in Geriatric Patients
Less invasive techniques (MIDCAB, off-pump) have enabled surgeons to operate
on the elderly with improved results.
Coronary
artery bypass grafting in patients over 70 years old: the influence of age and
surgical technique on early and mid-term clinical outcomes
Ascione R, et al.
Eur J Cardiothorac Surg
2002;22:124-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12103385
Early but not mid- term mortality is higher in patients aged 75 or more years
when compared with those aged 70-74 years. Off-pump coronary artery bypass
surgery is safe and effective in the elderly population.
Stroke
complicating percutaneous coronary interventions: incidence, predictors, and
prognostic implications
Fuchs S, et al.
Circulation
2002;106:86-91.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12093775
http://www.circulationaha.org/cgi/content/full/106/1/86
http://www.circulationaha.org/cgi/content/abstract/106/1/86
Stroke associated with contemporary PCI is associated with substantial increased
mortality. Elderly patients who experience intraprocedural complications
necessitating the use of IABP are at particularly high risk.
Survival
after coronary revascularization in the elderly
Graham MM, et al.
Circulation
2002;105:2378-84.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12021224
http://www.circulationaha.org/cgi/content/full/105/20/2378
http://www.circulationaha.org/cgi/content/abstract/105/20/2378
Elderly patients paradoxically have greater absolute risk reductions
associated with surgical or percutaneous revascularization than do younger
patients. The combination of these results with a recent randomized trial
suggests that the benefits of aggressive revascularization therapies may extend
to subsets of patients in older age groups.
Risk
and predictors of stroke after myocardial infarction among the elderly: results
from the Cooperative Cardiovascular Project
Lichtman JH, et al.
Circulation
2002;105:1082-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11877359
http://www.circulationaha.org/cgi/content/full/105/9/1082
http://www.circulationaha.org/cgi/content/abstract/105/9/1082
The risk of stroke after myocardial infarction is substantial, with about 1
in 40 patients suffering an ischemic stroke within 6 months of discharge. Simple
clinical factors can predict the risk of stroke and, based on these factors, we
identified 20% of older patients who have a 1 in 25 chance of being hospitalized
for a stroke within 6 months of discharge.
Development
of a risk adjustment mortality model using the American College of
Cardiology-National Cardiovascular Data Registry (ACC-NCDR) experience:
1998-2000
Shaw RE, et al.
J Am Coll Cardiol
2002;39:1104-12.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11923032
A risk adjustment model for in-hospital mortality after PCI was successfully
developed using a contemporary multi-center registry. This model is an important
tool for valid comparison of in-hospital mortality after PCI.
Cost-effectiveness
of a conservative, ischemia-guided management strategy after non-Q-wave
myocardial infarction: results of a randomized trial
Barnett PG, et al.
Circulation
2002;105:680-4.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11839621
http://www.circulationaha.org/cgi/content/full/105/6/680
http://www.circulationaha.org/cgi/content/abstract/105/6/680
A conservative, ischemia-guided strategy of selective coronary angiography and
revascularization for patients who develop objective evidence of recurrent
ischemia is more cost-effective than a strategy of routine coronary angiography
after uncomplicated non-Q-wave myocardial infarction.
Cost
effectiveness of eptifibatide in acute coronary syndromes; an economic analysis
of Western European patients enrolled in the PURSUIT trial. The Platelet IIa/IIb
in unstable Angina: Receptor Suppression Using Integrilin Therapy
Brown
RE, et al.
Eur Heart J
2002;23:50-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11741362
Routine eptifibatide use was associated with a reduction in the combined
end-point of death and myocardial infarction at 30 days, which was sustained at
6 months. Long-term projections indicate a modest increase in survival in
eptifibatide patients. These data translate into cost-effectiveness ratios that
compare favourably with other new technologies that are currently in use.
Cost
effectiveness of invasive strategy in unstable coronary disease-- what are we
waiting for?
Davie AP, et al.
Eur Heart J
2002;23:1-3.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11741352
The
use of the glycoprotein IIb/IIIa receptor antagonists during percutaneous
coronary intervention
Marmur JD, et al.
J Interv Cardiol
2002;15:71-84.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12053687
Evidence indicates that the majority of patients with acute coronary
syndromes without ST segment elevation who are scheduled to undergo PCI should
be pretreated with a GPIIb/IIIa receptor antagonist.
Discrepancy
between angiography and intravascular ultrasound when analysing small coronary
arteries
Briguori C, et al.
Eur Heart J
2002;23:247-54.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11792140
A high percentage of vessels measuring < or =2.75 mm are large vessels with a
high plaque burden. This condition is particularly prevalent in females, with
lesions in the proximal or middle left anterior descending artery, and in obtuse
marginal and diagonal branches.
Quantitative
angiographic methods for appropriate end-point analysis, edge-effect evaluation,
and prediction of recurrent restenosis after coronary brachytherapy with gamma
irradiation
Lansky AJ, et al.
J Am Coll Cardiol
2002;39:274-80.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11788219
In WRIST, not only was (192)Ir therapy effective in reducing restenosis, but it
also reduced the lesion length of treatment failures by 50%, and it was not
associated with edge proliferation. The restenosis rate obtained from the vessel
segment inclusive of the dose fall-off zones was the best correlate of TVR and
should become a standard analysis site in all vascular brachytherapy trials.
Quantitative
coronary angiography in regression trials: a review of methodologic
considerations, endpoint selection, and limitations
Lansky AJ, et al.
Am J Cardiol
2002;89:4B-9B.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11879660
Several quantitative angiographic methods (visual assessment, digital
hand-held calipers, and automated edge detection) have been successfully used to
assess coronary atherosclerosis regression. These methods are applicable for (1)
continuous measures of disease progression and regression, including
patient-based, segment-based, and lesion-based analyses; and (2) categorical
assessment of disease progression and regression (the use of a predefined
threshold to categorize the course of disease). Angiographic methods and
criteria for assessing disease progression each have distinct advantages and
disadvantages, which accounts for the methodologic diversity seen in clinical
trials.
Progression
of coronary atherosclerosis quantified by analysis of 3-D reconstruction of left
coronary arteries
Wellnhofer E, et al.
Atherosclerosis
2002;160:483-93.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11849675
Quantitative measurements on 3-D reconstructed coronary trees are a useful
investigative tool for the assessment of progression of coronary atherosclerosis.
Haziness
on coronary angiogram after percutaneous transluminal coronary angioplasty
evaluated with angioscopy
Kanamasa
K, et al.
Angiology
2002;53:171-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11952107
It appears that percutaneous transluminal coronary angioplasty-induced large
surface disruption and white thrombus likely play an important role in
increasing haziness.
New
techniques for the evaluation of the vulnerable plaque
El-Shafei A, et al.
J Invasive Cardiol
2002;14:129-37.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11870268
AHA 2002 Presentations
The
Impact of Race on Clinical Outcome after Percutaneous Coronary Intervention
by
Dr. Laurent Leborgne .
TCT 2002 Meeting Coverage
| Women with Atherosclerotic Disease | A. J. Lansky |
TCT 2002 Expert Presentations
| Special Considerations for Women wtih Atherosclerotic Vascular Disease: Epidemiology and Clinical Diagnosis, Estrogen and Tailored Pharmacology, and Revascularization Alternatives | A. J. Lansky |
Improved
outcomes for women undergoing contemporary percutaneous coronary intervention: a
report from the National Heart, Lung, and Blood Institute Dynamic registry
Jacobs AK, et al.
J Am Coll Cardiol
2002;39:1608-14.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12020487
Despite persistent high-risk characteristics in women, gender differences in
outcomes in patients undergoing contemporary PCI have decreased, and outcomes in
women have improved.
Gender
differences in clinical outcome after coronary artery stenting with use of
glycoprotein IIb/IIIa inhibitors
Iakovou I, et al.
Am J Cardiol
2002;89:976-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11950440
Sex-based
analysis of outcome in patients with acute myocardial infarction treated
predominantly with percutaneous coronary intervention
Mehilli J, et al.
Jama
2002;287:210-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11779263
Despite their more advanced age and greater prevalence of diabetes or
hypertension, women with AMI who were treated with a reperfusion strategy
largely based on percutaneous coronary interventions show a similar outcome as
men
Website on Percutaneous
Transvenous Mitral Commisurotomy (PTMC)
http://www.ptmc.org.tw/
This site is devoted to providing an
overview of Percutaneous Transvenous Mitral Commisurotomy (PTMC). Introduced in
1984 by Dr. Kanji Inoue, PTMC has opened a new dimension in the treament of
patients with mitral stenosis. Previously, the only mechanical therapy for
selected symptomatic patients with significant mitral stenosis was either that
of open or closed sugical commissurotomy. Extensive clinical studies have
established PTMC as a minimally invasive, non-surgical procedure, and a safe and
effective therapeutic modality in selected patients with mitral stenosis.
TCT
2002 Meeting Coverage
| CRP May Predict Risk Better Than Lipid Profile | P. Ridker |
Summer in Seattle 2002
| Percutaneous Treatment of Mitral Valve Regurgitation | T. Feldman |
TCT 2002 Abstracts
TCT 2002 Expert Presentations
| The Appropriate Use of Statin Therapy in Patiens with Vascular Disease: The Impact of New Guidelines and Treatment Strategies | S. Smith |
ESC 2002 Meeting Coverage
Latest
Results With New Lipid-Lowering Therapies
Linda Brookes, MSc
Digital
flat panel system could cut radiation exposure
Digital flat-panel cardiac x-ray imaging could significantly decrease
radiation exposure during angiographic procedures compared with conventional
image-intensifier-based systems. In addition, removing the "grid" from
these systems will cut radiation by a third.
European Society of
Cardiology Congress 2002
[ Sep 01, 2002 ]
ACC 2002 Meeting Coverage
| Controversies in Interventional Cardiology | |
| LIPS Study Shows Benefits of Statins Post-PCI | P. W. Serruys |
LIPS:
Fluvastatin reduces events post-PCI
The 4-year Lescol Intervention Prevention Study (LIPS) has shown that using
fluvastatin in patients undergoing percutaneous coronary intervention reduces
the risk of major adverse cardiovascular events (MACE) by 22%. This is the first
prospective statin cardiac outcome trial to exclusively study the postprimary
PCI population and thus has major implications, says the lead investigator.
American College of Cardiology 51st Annual Scientific Session.
[ Mar 20, 2002 ]
LIPS
published: Fluvastatin reduces events post-PCI
Serruys PWJC et al.
JAMA
News Jun 2002
Fluvastatin
Reduces Cardiac Events After PCI
The drug is effective even in patients with normal cholesterol.
Full text journal article Sep 2002
Update on the Management
of Dyslipidemia
Cardiovascular disease continues to be the leading cause of death in the United
States.
CME Circle Sep 2002
The Metabolic Syndrome and Cardiovascular Disease: Challenges and
Opportunities CME
Adult Treatment Panel III guidelines have refocused attention on the
metabolic syndrome and its connection to cardiovascular disease. Criteria to
define the syndrome and therapeutic approaches are discussed, many within the
context of landmark cardiovascular trials.
Full text journal article Jun 2002
Routine Statin Treatment
After Acute Coronary Syndromes?
Examine more insight into the beneficial effects of statin therapy.
Statin Treatment Following Coronary Artery
Stenting and One-Year Survival
Schomig A, Mehilli J, Holle H, et al.
J Am Coll Cardiol 2002;40(5):854-861
http://www.medscape.com/viewarticle/443185_2
This is a very interesting study that indicates that statin therapy in
patients with CAD who undergo stenting may have a beneficial impact on 1-year
survival. The limitations of such a nonrandomized retrospective study are
obvious and should be taken into consideration. Nevertheless, these results only
provide further support that CAD patients should be treated aggressively with
statins, especially those with proven CAD and, even more so, those with known
multivessel disease. Further prospective, randomized, double-blinded, secondary
prevention studies should be done to support these results.
Full text journal article Jan 2002
Emergent Cardiovascular
Risk Factor: Homocysteine
Learn how elevated homocysteine can be easily identified with appropriate
testing and treated by dietary modification.
Summaries of important articles from major peer-reviewed journals
| Which Patients Benefit From Percutaneous Mitral Balloon Valvuloplasty? | I. F. Palacios | Circulation. 2002;105:1465 |
| Percutaneous Left Atrial Appendage Transcatheter Occlusion to Prevent Stroke | H. Sievert | Circulation 2002;105:1887 |
| Editorial: PFO and Recurrent Stroke: Another Paradoxical Twist | J. Halperin V. Fuster |
Circulation 2002 ;105: 2580-2582 |
| Effect of Medical Treatment in Stroke Patients With Patent Foramen Ovale (PFO) | S. Homma | Circulation 2002;105: 2625-2631 |
Clinician Update
Contemporary Management of Patent Foramen Ovale
Bernhard Meier and James E. Lock
Circulation 2003;107 5-9
http://circ.ahajournals.org/cgi/content/full/107/1/5?etoc
Recurrent paradoxical embolism in the presence of a PFO associated with an
atrial septal aneurysm is currently the only unequivocal indication for PFO
closure. A percutaneous attempt should always precede surgical closure; the
latter is unlikely to be rendered more difficult in case of a failed
percutaneous attempt. None of the patients of the authors in the past 5 years
required a surgical intervention. Hence, surgical PFO closure seems completely
supplanted by the percutaneous approach. This is supported by the fact that
recurrence rates for cerebrovascular accidents or transient ischemic attacks
after surgical closure have been reported as 4% to 20% per year.
Because percutaneous closure may take less than 30 minutes under local
anesthesia and can be performed as an outpatient procedure with very small risk
and inconvenience for the patient, indications are bound to widen, especially if
controlled trials and large series confirm that PFO closure reduces the
life-long risk of recurrent stroke and perhaps other ailments.
Transcatheter
closure of patent foramen ovale in patients with paradoxical embolism:
intermediate-term risk of recurrent neurological events
Du ZD, et al.
Catheter Cardiovasc Interv
2002;55:189-94.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11835645
Preliminary intermediate results of 18 patients who underwent transcatheter
PFO closure for paradoxical embolism using DAS-Angel Wings occluder or Amplatzer
devices. Transcatheter closure of PFO seems to be an effective alternative
therapy in the prevention of presumed paradoxical emboli. Further study is
needed to identify patients most likely to benefit from this intervention.
ASD
occluder used to close left atrial appendage
Switzerland's Bernhard Meier--a fellow with Andreas Grüntzig on the
first-ever angioplasty procedure in 1977--is blazing trails again. His use
during a live case demonstration of an ASD occluder to close the LAA in a
patient with AF, rather than the dedicated device with CE Mark approval for the
indication, may bring an element of competition to this new field.
[ Jul 24, 2002 ]
Is Percutaneous Left
Atrial Appendage Transcatheter Occlusion an Alternative to Oral Anticoagulation
in Patients With Atrial Fibrillation? *
Response
Claudia Stollberger, et al
Circulation 2003;107 11-12
http://circ.ahajournals.org/cgi/content/full/107/1/e11?etoc
European
cardiologists offer new horizons in percutaneous valve replacements
UPDATED with video / At the Paris Course on Revascularization,
cardiologists were presented with a glimpse into several procedures of the
future, foremost among them a detailed review of the first-ever percutaneous
aortic valve replacement. The procedure was conducted on April 16, 2002 by Alain
Cribier, a pioneer in the development of balloon valvuloplasty.
[ Jun 03, 2002 ]
Follow-up of first-ever
human percutaneous aortic valve replacement case
Cribier A et al.
Circulation 2002; 106:3006-3008. Dec
10, 2002
with slide / Implanted in April and the talk of the Paris
Course on Revascularization, the first percutaneously implanted heart valve
spurred talk of "a new era in interventional cardiology." The case
description details a very sick patient who showed no recurring heart failure
but who died from serious noncardiac complications 17 weeks after the
procedure.
http://www.theheart.org/documents/page.cfm?from=590001200&doc_id=33498
Expert Presentation
A
slight stroke reduction seen in MIRACL
MIRACL INvestigators
Circulation 2002; 106:
published online before print September 2, 2002.
Intensive treatment with atorvastatin for patients with acute coronary
syndromes patients reduces stroke by half, without causing hemorrhagic stroke,
according to a substudy of the MIRACL trial, but editorialists note the number
of events is small and the findings need confirmation.
New
HERS data support wider statin use in women
Herrington DM
et al.
Circulation 2002; 105: published online before print June 3, 2002.
with slide / A new analysis of the HERS data shows that statin use
among women taking HRT reduced cardiovascular events, venous thromboembolic
events and total mortality, and may even have attenuated the adverse effects of
HRT. Yet despite these findings, the time is not yet right for blanket use of
statins among postmenopausal women, says the lead investigator.
FDA
approves first skin cholesterol test
A new, noninvasive test measures the cholesterol present in skin using a
small applicator pad and reagent solution, and is intended as a supplement
to--not a replacement for--standard blood tests.
[ Jun 25, 2002 ]
News (italian)
La somministrazione di
statine prima dellimpianto di stent coronarico riduce lincidenza di infarto
miocardico non-Q periprocedurale
Sulle pagine Brief Rapid Communication di Circulation č stato pubblicato un
lavoro che dimostra che con la somministrazione di statine prima di una
procedura interventistica coronarica di impianto di stent sia possibile ridurre
lincidenza di infarto miocardico non-Q secondario alla procedura stessa.
The adult patient with native coarctation of
the aorta: balloon angioplasty or primary stenting?
Zabal C, et al.
Heart 2003;89:77-83
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12482798
Mid term outcome in adult patients with native aortic coarctation receiving
percutaneous treatment is strongly related to the immediate residual gradient.
When treating these cases, efforts should be made to obtain gradients under 10
mm Hg, either by angioplasty alone or by placing a stent. Patients with discrete
aortic coarctation have similar mid term results when the immediate residual
gradient is </= 10 mm Hg despite the implantation of a stent. To achieve
these gradients, patients with hypoplastic isthmus or tubular coarctation should
be treated with primary stenting. Further studies including exercise tests and
non-invasive imaging are still needed before definitive conclusions can be drawn.
Editorial
Coarctation of the aorta
in adults: do we need surgeons?
Mullen MJ.
Heart 2003;89:3-5
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12482776
Mild
therapeutic hypothermia to improve the neurologic outcome after cardiac arrest
N Engl J Med
2002;346:549-56.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11856793
http://content.nejm.org/cgi/content/full/346/8/549
http://content.nejm.org/cgi/content/abstract/346/8/549
In patients who have been successfully resuscitated after cardiac arrest due to
ventricular fibrillation, therapeutic mild hypothermia increased the rate of a
favorable neurologic outcome and reduced mortality.
Outcome
and prognostic factors of restenosis after percutaneous treatment of native
hemodialysis fistulas
Clark TW, et al.
J Vasc Interv Radiol
2002;13:51-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11788695
http://www.jvir.org/cgi/content/full/13/1/51
http://www.jvir.org/cgi/content/abstract/13/1/51
Despite modest primary patency rates in our experience, high assisted and
secondary patency rates can be achieved with percutaneous intervention in native
arteriovenous fistulas. These findings emphasize the need for close surveillance
of native fistulas and a low threshold for diagnostic fistulography after
initial intervention. The most detrimental determinant of outcome was lesion
length > or =2 cm.
Review
Coronary
anomalies: incidence, pathophysiology, and clinical relevance
Angelini P, et al.
Circulation
2002;105:2449-54.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12021235
http://www.circulationaha.org/cgi/content/full/105/20/2449
Management
of coronary artery fistulae. Patient selection and results of transcatheter
closure
Armsby LR, et al.
J Am Coll Cardiol
2002;39:1026-32.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11897446
A comparison of the results of this study with those in the recent
transcatheter and surgical literature shows similar early effectiveness,
morbidity and mortality. Of 39 patients considered for TCC, occlusion devices
were placed in 33 patients (85%) at 35 procedures and included coils in 28,
umbrella devices in 6 and a Grifka vascular occlusion device in 1. From data
available, transcatheter closure (TCC) of coronary artery fistulae (CAF) is an
acceptable alternative to surgery in most patients.
Cardiovascular
effects of sildenafil during exercise in men with known or probable coronary
artery disease: a randomized crossover trial
Arruda-Olson AM, et al.
Jama 2002;287:719-25.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11851538
In men with stable CAD, sildenafil had no effect on symptoms, exercise
duration, or presence or extent of exercise-induced ischemia, as assessed by
exercise echocardiography.
Systolic
compression of the left anterior descending coronary artery: a case series,
review of the literature, and therapeutic options including stenting
Berry JF, et al.
Catheter Cardiovasc Interv
2002;56:58-63.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11979535
Six cases of various presentations of left anterior descending (LAD)
myocardial bridging were found on coronary angiography. Generally a benign
condition, this finding can result in ischemia or infarction as seen in some of
these cases. Treatments varied from stenting in three patients to medical
therapy in the remaining patients. A thorough evaluation in this population
should include functional testing for ischemia, intravascular ultrasound to
assess wall thickness, and coronary flow reserve measurements in order to
determine the significance of the these bridges. Stenting may have a role in
select patients. However, additional studies are needed.
Early
and sustained survival benefit associated with statin therapy at the time of
percutaneous coronary intervention
Chan AW, et al.
Circulation 2002;105:691-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11839623
http://www.circulationaha.org/cgi/content/full/105/6/691
http://www.circulationaha.org/cgi/content/abstract/105/6/691
In this large study cohort, statin therapy among PCI patients seems to be
associated with a significant mortality advantage at early and intermediate-term
follow-up.
Folic
acid improves endothelial function in coronary artery disease via mechanisms
largely independent of homocysteine lowering
Doshi SN, et al.
Circulation
2002;105:22-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11772871
http://www.circulationaha.org/cgi/content/full/105/1/22
http://www.circulationaha.org/cgi/content/abstract/105/1/22
The results of this study suggest that folic acid improves endothelial
function in CAD acutely by a mechanism largely independent of homocysteine.
Multifrequency
transcranial Doppler technique distinguishes gas bubbles from solid emboli
Brucher R, Russell D.
Stroke 2002; 33:1969-1974, 1975-1980. [ Aug 15, 2002 ]
with slide / More precise detection of emboli in the carotid arteries
with this technology, which is already available in Europe, may help flag
patients most at risk for neurological decline after cardiac surgery, the
researchers say.
The
changing face of infective endocarditis
Hoen B et al.
JAMA 2002;288:75-81. [ Jul 02, 2002 ]
Physicians should remain vigilant in the detection and prevention of
infective endocarditis. While the incidence of the
disease has remained stable in France, the profile of the disease continues to
change over time.
Revascularization
best for patients with viable myocardium and LV dysfunction
Allman KC et al.
J Am Coll Cardiol 2002; 1151-8. [ Apr 03, 2002 ]
Establishing the presence or absence of myocardial viability in patients with
severe coronary artery disease (CAD) and left ventricular (LV) dysfunction may
help to identify those who would benefit most from revascularization, a new
meta-analysis suggests, although only a randomized controlled trial will resolve
the issue.
Subgroup
interactions in the Heart and Estrogen/Progestin Replacement Study: lessons
learned
Furberg CD, et al.
Circulation 2002;105:917-22.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11864918
http://www.circulationaha.org/cgi/content/full/105/8/917
http://www.circulationaha.org/cgi/content/abstract/105/8/917
The Heart and Estrogen/Progestin Replacement Study (HERS) showed no overall
benefit of postmenopausal hormone treatment in women with coronary heart disease
(CHD). Extensive post hoc analyses did not identify any subgroup of HERS
participants in which postmenopausal hormone treatment was clearly beneficial or
harmful, but several possibilities emerged for testing in future trials
Relation
of homocysteine, vitamin B(12), and folate to coronary in- stent restenosis
Genser D, et al.
Am J Cardiol 2002;89:495-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11867030
Univariate and multivariate analyses revealed no significant differences
between patients with or without restenosis with regard to total homocysteine (median
[interquartile range]: 12.9 [11.2 to 14.8] and 12.4 [10.3 to 15.4] micromol/L,
respectively), folate (16.1 [12.4 to 20.5] and 15.4 [12.5 to 19.5] nmol/L,
respectively), or vitamin B(12) (239.0 [182.5 to 322.1] and 258.4 [205.8 to
330.5] pmol/L, respectively). These results suggest that homocysteine, folate,
and vitamin B(12) are not related to the angiographically determined rate of
coronary in-stent restenosis after 6 months.
Clinical
outcome following percutaneous coronary interventions in patients with chronic
renal failure
Gruberg L, et al.
Catheter Cardiovasc Interv
2002;55:66-72.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11793497&dopt=Abstract
By multivariate analysis, high left ventricular ejection fraction and creatinine
clearance were associated with decreased late mortality (OR = 0.84 and 0.95; P
< 0.0001), whereas end-stage renal disease (OR = 3.65; P = 0.0002),
non-Q-wave myocardial infarction (OR = 2.21; P < 0.0001), diabetes mellitus
(OR = 1.99; P < 0.0001), and chronic renal failure (OR = 1.74; P = 0.003)
were independent correlates of increased late mortality. Therefore, PCI in
patients with impaired renal function, whether on dialysis or not, is associated
with poor in-hospital and 1-year survival.
The
impact of obesity on the short-term and long-term outcomes after percutaneous
coronary intervention: the obesity paradox?
Gruberg L, et al.
J Am Coll Cardiol
2002;39:578-84.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11849854
In patients with known CAD who undergo PCI, very lean patients (BMI
<18.5) and those with BMI within the normal range are at the highest risk for
in-hospital complications and cardiac death and for increased one-year mortality
Withdrawal
of statins increases event rates in patients with acute coronary syndromes
Heeschen C, et al.
Circulation
2002;105:1446-52.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11914253
http://www.circulationaha.org/cgi/content/full/105/12/1446
http://www.circulationaha.org/cgi/content/abstract/105/12/1446
Statin pretreatment in patients with acute coronary syndromes is associated
with improved clinical outcome. However, discontinuation of statins after onset
of symptoms completely abrogates this beneficial effect.
Visualization
of coronary atherosclerotic plaques in patients using optical coherence
tomography
(OCT): comparison with intravascular ultrasound
Jang IK, et al.
J Am Coll Cardiol
2002;39:604-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11849858
The aim of this study was to evaluate the feasibility and the ability of
intravascular optical coherence tomography (OCT) to visualize the components of
coronary plaques in living patients. OCT appears to be feasible and safe.
Optical coherence tomography identified most architectural features detected by
IVUS and may provide additional detailed structural information.
Comparison
of efficacy and safety of atorvastatin and simvastatin in patients with
dyslipidemia with and without coronary heart disease
Karalis DG, et al.
Am J Cardiol 2002;89:667-71.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11897207
In both comparator groups a higher proportion of atorvastatin-treated
patients reached their NCEP LDL cholesterol goal compared with simvastatin.
Differential
influence of diabetes mellitus on increased jeopardized myocardium after initial
angioplasty or bypass surgery: bypass angioplasty revascularization
investigation
Kip KE, et al.
Circulation
2002;105:1914-20.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11997277
http://www.circulationaha.org/cgi/content/full/105/16/1914
http://www.circulationaha.org/cgi/content/abstract/105/16/1914
Presence of diabetes differentially influences worsening of jeopardized
myocardium after initial PTCA compared with CABG. This differential effect
occurs irrespective of whether follow-up angiography is undertaken for clinical
or nonclinical purposes.
Chelation
therapy for ischemic heart disease: a randomized controlled trial
Knudtson ML, et al.
Jama 2002;287:481-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11798370
Chelation therapy using EDTA is an unproven but widely used alternative
therapy for ischemic heart disease. Based on exercise time to ischemia, exercise
capacity, and quality of life measurements, there is no evidence to support a
beneficial effect of chelation therapy in patients with ischemic heart disease,
stable angina, and a positive treadmill test for ischemia.
Effects
of simvastatin (40 and 80 mg) on highly sensitive C-reactive protein in patients
with combined hyperlipidemia
Miller M, et al.
Am J Cardiol 2002;89:468-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11835933
Which
patients benefit from percutaneous mitral balloon valvuloplasty?
Prevalvuloplasty and postvalvuloplasty variables that predict long-term outcome
Palacios IF, et al.
Circulation
2002;105:1465-71.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11914256
http://www.circulationaha.org/cgi/content/full/105/12/1465
http://www.circulationaha.org/cgi/content/abstract/105/12/1465
Percutaneous mitral balloon valvuloplasty (PMV) results in good immediate
results, particularly in patients with echocardiographic scores (Echo-Sc) <
or =8. However, which variables relate to long-term outcome is unclear. Cox
regression analysis identified post-PMV mitral regurgitation > or =3+,
Echo-Sc >8, age, prior surgical commissurotomy, NYHA functional class IV,
pre-PMV mitral regurgitation > or =2+, and higher post-PMV pulmonary artery
pressure as independent predictors of combined events at long-term follow-up.
Therefore, the use of the Echo-Sc in conjunction with other clinical and
morphological predictors of PMV outcome allows identification of patients who
will obtain the best outcome from PMV.
Effect
of azithromycin treatment on endothelial function in patients with coronary
artery disease and evidence of Chlamydia pneumoniae infection
Parchure N, et al.
Circulation
2002;105:1298-303.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11901039
http://www.circulationaha.org/cgi/content/full/105/11/1298
http://www.circulationaha.org/cgi/content/abstract/105/11/1298
Our findings indicate that treatment with azithromycin has a favorable
effect on endothelial function in patients with documented coronary artery
disease and evidence of Chlamydia pneumoniae(CPn) infection irrespective of
antibody titer levels. Whether these favorable actions of antibiotic treatment
will translate into a beneficial effect on atherogenesis and cardiac events
needs further investigation.
Serological
markers of Chlamydia pneumoniae infection in men and women and subsequent
coronary events; the Scottish Heart Health Study Cohort
Tavendale R, et al.
Eur Heart J 2002;23:301-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11812066
Prior infection with C. pneumoniae, as estimated by these markers, does not
appear to be a risk factor for subsequent coronary heart disease.
Presentation
Is
the Concept of Infection as a Cause of Atherosclerosis Dead?
by Dr. Stephen E. Epstein
Proteinuria,
serum creatinine, and outcome of percutaneous coronary intervention in patients
with diabetes mellitus
Reeder GS, et al.
Am J Cardiol 2002;89:760-4.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11897221
Incidence
and prognostic importance of acute renal failure (ARF)
after percutaneous coronary
intervention
Rihal CS, et al.
Circulation
2002;105:2259-64.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12010907
http://www.circulationaha.org/cgi/content/full/105/19/2259
http://www.circulationaha.org/cgi/content/abstract/105/19/2259
The overall incidence of ARF after PCI is low. Diabetic patients with
baseline Cr values <2.0 mg/dL are at higher risk than nondiabetic patients,
whereas all patients with a serum Cr >2.0 are at high risk for ARF. ARF was
highly correlated with death during the index hospitalization and after
dismissal.
The
contribution of genetic factors to thrombotic and bleeding outcomes in coronary
patients randomised to IIb/IIIa antagonists
Shields DC, et al.
Pharmacogenomics J
2002;2:182-90
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12082590
Population: 924 Caucasians with acute coronary syndromes participating in
the OPUS-TIMI16 trial of the GPIIb/IIIa antagonist orbofiban. There was a
significant interaction of the polymorphisms with orbofiban treatment
influencing bleeding outcomes (P = 0.004). Thus, genetic polymorphisms may be
associated with subsequent myocardial infarction, and may also be associated
with treatment-associated bleeding among coronary patients.
Effects
of pravastatin on mortality in patients with and without coronary heart disease
across a broad range of cholesterol levels. The Prospective Pravastatin Pooling
project
Simes J, et al.
Eur Heart J 2002;23:207-15.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11792135
Treatment with pravastatin over 5 years reduces all-cause mortality and
coronary mortality in patients with and those without a history of coronary
heart disease. The size of the benefit was related principally to the baseline
risk.
Relationship
between lipid levels and clinical outcomes in the Long- term Intervention with
Pravastatin in Ischemic Disease (LIPID) Trial: to what extent is the reduction
in coronary events with pravastatin explained by on-study lipid levels?
Simes RJ, et al.
Circulation 2002;105:1162-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11889008
http://www.circulationaha.org/cgi/content/full/105/10/1162
http://www.circulationaha.org/cgi/content/abstract/105/10/1162
Changes in lipid levels can explain all or most of the observed benefit of
pravastatin. Some treatment effect may also be mediated through nonlipid changes.
Tolerability
of statin-fibrate and statin-niacin combination therapy in dyslipidemic patients
at high risk for cardiovascular events
Taher TH, et al.
Am J Cardiol 2002;89:390-4.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11835917
The results of this study demonstrate that combination statin-fibrate and
statin-niacin regimens are safe and effective in managing dyslipidemias in most
patients at risk for cardiovascular events who are inadequately treated with one
of these agents alone.
Limited
role of coronary angioplasty and stenting in coronary spastic angina (CSA)
with
organic stenosis
Tanabe Y, et al.
J Am Coll Cardiol
2002;39:1120-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11923034
Spasm was frequently induced at a site different from the initial stenosis,
even in the absence of restenosis after PCI. Calcium antagonists should be
continued in most patients with CSA who show no restenosis after PCI.
Late
coronary stent thrombosis: early vs. late stent thrombosis in the stent era
Wang F, et al.
Catheter Cardiovasc Interv
2002;55:142-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11835636
There were no clinical or angiographic features at the time of the initial
procedure that were associated with stent thrombosis as an entire group compared
with control group, but early (acute and subacute) stent thrombosis patients had
a smaller final stent minimal lumen diameter and longer stent length compared
with patients who had late stent thrombosis or controls. Late stent thrombosis
occurs in nonbrachytherapy patients and is almost as frequent as early stent
thrombosis. Further studies are required to determine whether longer-term
poststent pharmacological treatment may decrease or prevent this complication
C-reactive
protein and angiographic coronary artery disease: independent and additive
predictors of risk in subjects with angina
Zebrack JS, et al.
J Am Coll Cardiol
2002;39:632-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11849862
C-reactive protein correlates with extent of CAD, but the degree of
correlation is low. Severity/extent of CAD and CRP are independent and additive
predictors of risk. Therapy should target CRP-associated risk as well as
angiographically evident stenosis.
Rescue
percutaneous transluminal coronary angioplasty in a patient with a single
coronary artery arising from the right Sinus Valsalvae: previously unreported
scenario and review of literature
Zweiker R, et al.
J Intern Med 2002;252:84-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12074743
This is the first description of treatment with coronary stenting of a
patient with a single coronary artery originating from the right Sinus Valsalvae
and suffering from acute inferior myocardial infarction.