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Coronary Revascularization

Ravi S Hira, Larry S Dean
Provisional use of rotational atherectomy (RA) is indicated for procedural success in heavily calcified lesions. In the current study, RA use at three high volume percutaneous coronary intervention (PCI) centers between 2005 and 2013 was 1.4%. MACE rate was 17.8% at median follow-up of 22 months. Peripheral vascular disease (PVD), diabetes mellitus (DM), acute coronary syndrome (ACS), and SYNTAX > 23 were found to be independently associated with MACE. With increasing complexity of disease and SYNTAX score, there is usually an increase in severity of calcification and need for atherectomy...
October 2016: Catheterization and Cardiovascular Interventions
Vladimir Dedovic, Goran Stankovic
Despite permanent improvement in success rate and technical developments, chronic total occlusion (CTO) remains undertreated by percutaneous coronary intervention (PCI). Dedicated CTO operators from Japan, Europe and USA perform these procedures with success rate beyond 90%, but there is still huge gap between this group of specialists and broader population of PCI operators. Recently proposed CTO scores can be used for patients' selection according to the CTO operators' experience. Patients with low CTO score values may be suitable for less experienced operators at the beginning of the CTO PCI learning curve, while more complex CTOs (higher CTO score values) should be differed to CTO experts...
October 19, 2016: Panminerva Medica
Razieh Yazdani-Bakhsh, Mehdi Javanbakht, Masoumeh Sadeghi, Atefeh Mashayekhi, Hossein Ghaderi, Katayoun Rabiei
BACKGROUND: Health-related quality of life (HRQOL) evaluation is an important measure of the impact of the disease. As more people with coronary heart disease (CHD) live longer, doctors and researchers want to know how they manage in day to day life. It looked like adults with CHD had a decrease QOL. The aim of this study was to comparison of HRQOL of patients who underwent percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) and to assess its main determinants in the whole sample of coronary artery disease (CAD) patients...
May 2016: ARYA Atherosclerosis
Filiz Kizilirmak, Gultekin Gunhan Demir, Beytullah Cakal, Hüseyin Saffet Bekoz, Fatih Erkam Olgun
Evans syndrome (ES) is a rare hematological disease characterized by autoimmune hemolytic anemia, immune thrombocytopenia, and/or neutropenia, all of which may be seen simultaneously or subsequently. Thrombotic events in ES are uncommon. Furthermore, non-ST segment-elevation myocardial infarction (NSTEMI) during ES is a very rare condition. Here, we describe a case of a 69-year-old female patient presenting with NSTEMI and ES. Revascularization via percutaneous coronary intervention (PCI) was scheduled and performed...
September 2016: Indian Heart Journal
Mohamad Lazkani, Divya Ratan Verma, Michael Morris, Ashish Pershad
Preprocedural planning and advanced imaging is vital to achieve a consistent and high level of success for complex coronary chronic total occlusion (CTO) revascularization. Various practice patterns exist around the world when performing coronary artery CTO revascularization. This case report highlights a fusion of global practices in CTO intervention and integration of advanced imaging to achieve successful revascularization.
September 2016: Indian Heart Journal
Babak Fallahi, Davood Beiki, Yalda Salehi, Alireza Emami-Ardekani, Armaghan Fard-Esfahani, Farahnaz Aghahosseini, Mahdi Haghighatafshar, Mohammad Eftekhari
OBJECTIVE: With respect to the equivocal value of the reverse perfusion pattern (RPP) in technetium-99m (Tc)-sestamibi myocardial perfusion imaging, a study was carried out to evaluate this pattern in association with the presence or absence of coronary artery disease (CAD) and other underlying factors, mainly the time of acquisition and the presence of intense visceral uptake. PATIENTS AND METHODS: We prospectively studied 102 patients with a moderate risk of CAD (41 men and 61 women, mean age: 56...
October 4, 2016: Nuclear Medicine Communications
Seung-Ah Lee, Yeonyee E Yoon, Jung-Eun Kim, Jin Joo Park, Il-Young Oh, Chang-Hwan Yoon, Jung-Won Suh, Jun-Sung Kim, Eun Ju Chun, Young-Suk Cho, Tae-Jin Youn, Cheong Lim, Goo-Young Cho, In-Ho Chae, Kay-Hyun Park, Dong-Ju Choi, Sang Il Choi
The value of late gadolinium-enhanced (LGE) magnetic resonance imaging (MRI) for the prediction of functional recovery after surgical revascularization has been previously established. However, the impact of LGE-MRI on the long-term prognosis after coronary artery bypass grafting (CABG) remains incompletely understood. Therefore, we aimed to evaluate the long-term prognostic value of LGE-MRI, based on the presence or absence of left ventricular (LV) dysfunction, in patients with coronary artery disease undergoing CABG...
August 30, 2016: American Journal of Cardiology
Chan Joo Lee, Ji-Young Lee, Chi-Yoon Oum, Jong-Chan Youn, Seok-Min Kang, Donghoon Choi, Yangsoo Jang, Sungha Park, Sun Ha Jee, Sang-Hak Lee
BACKGROUND: Data on genetic variants that can predict follow-up cardiovascular events are highly limited, particularly for Asians. The aim of this study was to validate the effects of two variants in FLT1 and 9p21 on long-term cardiovascular outcomes in high-risk Korean patients. METHODS: We examined the prognostic values of the rs9508025 and rs1333049 variants that were found to be associated with coronary artery disease (CAD) risk in a previous Korean genome-wide association study...
2016: PloS One
Nam-Kyong Choi, Daniel H Solomon, Theodore N Tsacogianis, Joan E Landon, Hong Ji Song, Seoyoung C Kim
Limited head-to-head comparative safety and effectiveness data exist between denosumab and zoledronic acid in real-world healthcare. We aimed to examine the safety and effectiveness of denosumab compared to zoledronic acid with regard to risk of serious infection and cardiovascular disease (CVD) and osteoporotic fracture. We conducted a cohort study using claims data (2009-2013) from a US commercial insurance. We included patients aged ≥50 years who newly initiated denosumab or zoledronic acid. The primary outcomes were 1) hospitalization for serious infection, 2) composite CVD endpoint including myocardial infarction, stroke, coronary revascularization, and heart failure and 3) non-vertebral osteoporotic fracture including hip, wrist, forearm and pelvic fracture...
October 13, 2016: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
Alberto Dominguez-Rodriguez, Pedro Abreu-Gonzalez, Jose M de la Torre-Hernandez, Julia Gonzalez-Gonzalez, Tamara Garcia-Camarero, Luciano Consuegra-Sanchez, Maria Del Mar Garcia-Saiz, Ana Aldea-Perona, Tirso Virgos-Aller, Agueda Azpeitia, Russel J Reiter
The MARIA randomized trial evaluated the efficacy and safety of melatonin for the reduction of reperfusion injury in patients undergoing revascularization for ST-elevation myocardial infarction (STEMI). This was a prespecified interim analysis. A total of 146 patients presenting with STEMI within 6 hours of chest pain onset were randomized to receive intravenous and intracoronary melatonin (n=73) or placebo (n=73) during primary pecutaneous coronary intervention (PPCI). Primary endpoint was myocardial infarct size as assessed by magnetic resonance imaging (MRI) at 6±2 days...
October 13, 2016: Journal of Pineal Research
Javier A Valle, Laura Graham, Aerin DeRussy, Kamal Itani, Mary T Hawn, Thomas M Maddox
BACKGROUND: Triple therapy, or the use of anticoagulants with dual antiplatelet therapy (DAPT), is often used to protect against ischemic events in post-percutaneous coronary intervention (PCI) patients with indications for anticoagulation, but is associated with increased bleeding. As both ischemic and bleeding risks increase in the perioperative period, the impact of triple therapy may be especially pronounced in patients undergoing surgery. Outcomes in this population are currently unknown...
October 12, 2016: World Journal of Surgery
Joseph A Ladapo, Udo Hoffmann, Kerry L Lee, Adrian Coles, Megan Huang, Daniel B Mark, Rowena J Dolor, Robert A Pelberg, Matthew Budoff, Gardar Sigurdsson, Harry W Severance, Pamela S Douglas
BACKGROUND: Diagnostic testing in the care of patients newly presenting with symptoms suggestive of coronary artery disease may influence risk factor management, independent of test type or test results. However, little is known about changes in medications and lifestyle after anatomical or functional testing. METHODS AND RESULTS: We examined what factors influenced preventive medical therapy and lifestyle practices at 60 days among 10 003 symptomatic patients (53% women; mean age 61 years) randomly assigned to anatomical testing with coronary computed tomographic angiography or functional testing (NCT01174550)...
October 12, 2016: Journal of the American Heart Association
Ankush Sachdeva, Biswajit Paul
Dobutamine stress echocardiography (DSE) has come a long way as establishing itself as a feasible, safe, effective, relatively cheaper non-invasive technique to detect population suffering from coronary artery disease (CAD) and following up patients post revascuralization. Besides these DSE is commonly used to diagnose low gradient, low flow true severe aortic stenosis (AS); differentiating it from pseudo- AS and to follow up patients with dilated cardiomyopathy (DCMP). Various non-invasive techniques have different sensitivity and specificity to accurately judge a viable myocardium and to accurately detect the improvement in regional wall motion abnormality (RWMA) post-revascularization, leading to an overall increase in left ventricular ejection fraction (LVEF)...
February 2016: Journal of the Association of Physicians of India
Jaskaran S Kang, Maria C Bennell, Feng Qiu, Merril L Knudtson, Peter C Austin, Dennis T Ko, Harindra C Wijeysundera
BACKGROUND: Cardiovascular disease is costly, and annual expenditures are projected to increase. Our objective was to examine the variation in patient-level costs and identify drivers of cost in patients with stable coronary artery disease. METHODS: In this retrospective cohort study using administrative databases in Ontario, Canada, we identified all patients with stable coronary artery disease after index angiography between Oct. 1, 2008, and Sept. 30, 2011. We excluded patients with a myocardial infarction within 90 days before the index, with normal coronaries, or with mild coronary disease...
July 2016: CMAJ Open
Muhammad Dzafir Ismail, Wan Azman Wan Ahmad, Matthias Leschke, Matthias Waliszewski, Michael Boxberger, Imran Zainal Abidin, Ahmad Syadi Mahmood Zuhdi
BACKGROUND: Percutaneous coronary interventions (PCI) in coronary artery disease (CAD) with very small vessel diameters remains controversial and challenging. These lesions are usually more diffuse, calcified and tortuous. The usage of thin strut bare metal stents (BMS) with excellent crossing profiles in a very small caliber coronary lesions has increased the likelihood of procedural success. OBJECTIVES: This observational study assessed the 9-month clinical outcomes in an 'all-comers' population with very small caliber CAD after implantation of thin strut cobalt chromium BMS...
2016: SpringerPlus
Francesco Giannini, Andrea Aurelio, Alaide Chieffo
Refractory angina is a chronic condition characterized by the presence of disabling symptoms due to severe obstructive coronary artery disease not improved by either optimal medical therapy and/or percutaneous or surgical revascularization. Mortality rates associated with this condition are quite low in clinically stable patients on optimal medical therapy. However, rehospitalization rates are high. In this subgroup of patients there is thus a clinical need for new therapies targeting an improvement of symptoms but taking into account the potential impact in terms of healthcare and costs...
October 2016: Giornale Italiano di Cardiologia
Gilberto Velho, Ray El Boustany, Guillaume Lefèvre, Kamel Mohammedi, Frédéric Fumeron, Louis Potier, Lise Bankir, Nadine Bouby, Samy Hadjadj, Michel Marre, Ronan Roussel
OBJECTIVE: Plasma copeptin, a surrogate for vasopressin, has been associated with a decline in renal function and albuminuria in population-based studies as well as with progression of diabetic nephropathy in people with type 2 diabetes. We assessed the risk of kidney and coronary events and all-cause mortality associated with plasma copeptin in people with type 1 diabetes. RESEARCH DESIGN AND METHODS: Plasma copeptin was measured in baseline samples of the GENEDIAB (n = 398; 56% male; mean ± SD age 45 ± 12 years and diabetes duration 28 ± 10 years) and GENESIS (n = 588; 52% male; age 42 ± 11 years; diabetes duration 27 ± 9 years) cohorts...
October 11, 2016: Diabetes Care
Shuhei Takahashi, Kazunori Shimada, Katsumi Miyauchi, Tetsuro Miyazaki, Eiryu Sai, Manabu Ogita, Shuta Tsuboi, Hiroshi Tamura, Shinya Okazaki, Tomoyuki Shiozawa, Shohei Ouchi, Tatsuro Aikawa, Tomoyasu Kadoguchi, Hamad Al Shahi, Takuma Yoshihara, Makoto Hiki, Kikuo Isoda, Hiroyuki Daida
BACKGROUND: Postprandial hyperglycemia plays an important role in the pathogenesis of coronary artery disease and cardiovascular events. Serum 1,5-anhydroglucitol (1,5-AG) levels are known to be a clinical marker of postprandial hyperglycemia. However, the impact of 1,5-AG level on cardiovascular events has not been fully investigated. METHODS: We enrolled 240 consecutive patients who had undergone first-time elective percutaneous coronary intervention (PCI) with follow-up angiography within 1 year...
October 11, 2016: Cardiovascular Diabetology
Xiao-Fang Tang, Ya-Ling Han, Jia-Hui Zhang, Jing Wang, Yi Yao, Chen He, Bo Xu, Zhan Gao, Shu-Bin Qiao, Jue Chen, Yuan Wu, Ji-Lin Chen, Run-Lin Gao, Yue-Jin Yang, Jin-Qing Yuan
INTRODUCTION: Both CYP2C19 genotyping and platelet function testing are used to predict major adverse cardiac events (MACEs) in Chinese patients treated with clopidogrel and undergoing stent implantation, but the most accurate prognostic technique is still debated. Here, we combine both techniques, to determine if a more accurate prognosis is possible. METHODS: Patients undergoing stent implantation (1104) were genotyped and assessed for platelet reactivity, with a 12-month follow-up...
October 7, 2016: Thrombosis Research
Samir B Pancholy, Gaurav Patel, Sukrut P Nanavaty, Maitri S Pancholy
Cardiogenic shock (CS) following ST-elevation myocardial infarction (STEMI) is a devastating complication and continues to have a high mortality rate. Coronary revascularization with percutaneous coronary intervention (PCI) is the cornerstone in the management of CS; however, PCI-related access-site bleeding has been observed to be more prevalent in CS patients. Historically, PCI by transfemoral access (TFA) has been the preferred approach over transradial access (TRA) in CS patients due to weak radial pulse, operators' inexperience with TRA, and the use of TFA for concomitant mechanical cardiovascular support...
October 11, 2016: Minerva Cardioangiologica
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