Invasive Cardiology Current Issue

Outcomes of Unselected Recipients of Sirolimus-Eluting Stents: The Cypher® Stent U.S. Post-Marketing Surveillance Registry

admin — Tue, 02 Feb 2010 18:35:19 -0500

ABSTRACT: Objective. To examine the 1-year safety and clinical outcomes associated with the post-marketing early unselected use of sirolimus-eluting stents (SES) in the United States. Background. The safety and effectiveness of SES has been assessed in selected patients enrolled in pivotal randomized trials. This PMS registry was initiated to examine the safety and effectiveness of SES in an unselected population. Methods. Consecutive patients who underwent implantation of ≥1 SES at 38 participating U.S. centers were enrolled in this registry. Results were compared according to “off-” versus “on-label” use of SES. Multivariate regression analyses were carried out in search of predictors of 1-year MACE and stent thrombosis. Results. The mean age of the 2,067 patients (3,367 treated lesions) was 63.7 years. The 12-month follow up was completed by 1,964 patients (95%). SES were implanted for “off-label” indications in 1,173 patients (57%).

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On Registries and Labels

admin — Tue, 02 Feb 2010 19:13:33 -0500

The outcomes that can be expected after Cypher stent implantation have been well publicized and the results from other smaller and larger registries of drug-eluting stent (DES) implantations have been reported and have highlighted the differences in outcomes in “off-label” versus “on-label” usage. For example, the pooled-analysis of RAVEL, SIRIUS, E-SIRIUS and C-SIRIUS¹ and the NEW SIRIUS analysis² (pooled E-SIRIUS and C-SIRIUS) have reported on the 4- and 5-year outcomes of Cypher stents compared to the bare-metal equivalent. With regard to “off-label” versus “on-label” outcomes, in 2007 Beohar et al³ and Win et al⁴ reported worse outcomes in “off-label” use of DES.

Decreasing In-hospital Mortality of Patients Undergoing Percutaneous Coronary Intervention with Persistent (FULL TITLE BELOW)

admin — Wed, 03 Feb 2010 10:05:24 -0500

ABSTRACT: Background. Advances in interventional techniques have been dramatic in the last 10 years. The goal of this study was to evaluate the age-adjusted in-hospital mortality rate in patients undergoing percutaneous coronary intervention (PCI) using a large database. Methods. The Nationwide Inpatient Sample (NIS) database was utilized to calculate the age-adjusted mortality rate for PCI from 1988 to 2004 in patients over the age of 40 retrospectively. Specific ICD-9-CM codes for PCI were used for this study. Demographic data were also analyzed and adjusted for age. Results. The mean age for these patients was 71.56 ± 10.59 years (53.55% male). From 1988 to 1995, the age-adjusted mortality rate was stable. However, after 1995 the age-adjusted mortality rate showed persistent decline to the lowest level in 2004.

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Is PCI Harmful in Women? Insights in a Mixed Literature

admin — Wed, 03 Feb 2010 10:32:23 -0500

New Mechanical Recanalization Devices — The Future in Pediatric Stroke Treatment?

admin — Wed, 03 Feb 2010 10:44:07 -0500

ABSTRACT: Objective. To evaluate the recanalization rate and clinical outcome in children with acute ischemic stroke following treatment with innovative mechanical thrombectomy devices. Patients and Methods. Three subjects aged 7–16 years presenting with acute cerebral vascular occlusions (thrombolysis in myocardial infarction [TIMI] 0) were treated with either the Penumbra System, operating on an aspiration platform, or the Phenox clot retriever device, a flexible wire compound with perpendicularly-oriented polyamid microfilaments. Target vessels were the internal carotid artery, the middle cerebral artery and the basilar artery. Results. Successful recanalization (TIMI 3) was attained in all cases. No device-related complications or intracranial hemorrhage occurred. Follow up was conducted for up to 30 days. A 10- to 26-point improvement in the National Institutes of Health Stroke Scale (NIHSS) score was achieved. Conclusions.

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The Role of Cardiovascular Computed Tomographic Angiography for Coronary Sinus Mitral Annuloplasty

admin — Wed, 03 Feb 2010 10:58:22 -0500

ABSTRACT: Background. The coronary sinus (CS) travels in close proximity to the left circumflex (LCX) artery. Percutaneously placed CS devices used to treat mitral regurgitation (MR) therefore have the potential to impinge upon the LCX arterial distribution and compromise coronary flow. Objectives. In this study, we sought to analyze the anatomic relationship between the CS, LCX and mitral annulus (MA) in patients with right dominant (RCD), left dominant (LCD) and codominant (CCD) arterial systems using a novel systematic approach. Methods. We retrospectively studied 102 normal patients (46 females) and 27 consecutive patients (5 females) with ischemic severe MR. All patients underwent cardiovascular computed tomographic (CCT) angiography with a 64 multidetector scanner for clinical indications. Images were analyzed using a GE Advantage workstation, version 4.4, capable of advanced image processing and manipulation. Results.

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Cardiac CT and Percutaneous Mitral Annuloplasty: A Vision of the Future?

admin — Wed, 03 Feb 2010 11:18:36 -0500

Mitral regurgitation (MR), a common valvular disorder, is a heterogeneous condition that can be broadly categorized into primary (affecting the valve apparatus) or secondary (functional) etiologies. For appropriately selected patients, surgical mitral valve repair, when possible, is the preferred strategy over mitral valve replacement.¹ The evidence for device/surgical treatment of functional mitral regurgitation is less well established for patients with severe heart failure and conveys increased operative risk.² Several investigational percutaneous devices are being developed that make use of the close anatomic relationship between the coronary sinus (CS) and the mitral valve annulus (MA) in an effort to alter the geometric alignment of the mitral valve and improve functional mitral regurgitation.³

Outcomes of Overlapping Bare-Metal Stents with Sirolimus-Eluting Stents for Long Lesions in Small Coronary Vessels

admin — Wed, 03 Feb 2010 11:26:36 -0500

ABSTRACT: Objectives. Compare outcomes of hybrid bare-metal stent (BMS)/sirolimus-eluting stent (SES) to BMS alone for the treatment of stenoses in small coronary arteries. Background. One approach to potentially reduce the risk of restenosis in long lesions with smaller distal reference diameters is to use a small (2.0–2.5mm) “BMS cap” (BMC) distally, telescoped in tandem with a SES(s) proximally, matched to a proximal segment where the diameter is ≥ 2.5 mm (creating a BMC/SES hybrid stent). Results from previous reports using “hybrid” drug-eluting stents and BMS are mixed. Methods. We performed a retrospective analysis of BMC/SES cases in small vessels at our institution and compared the outcomes with a control group (BMS) consisting of patients treated with at least one 2.0–2.5 mm BMS. Results. During the years 2003–2006, 41 BMC/SES and 62 BMS cases were identified and follow up was available in 33 and 49 patients, respectively.

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Efficacy of Modified Dual Antiplatelet Therapy Combined with Warfarin Following Percutaneous (FULL TITLE BELOW)

admin — Wed, 03 Feb 2010 11:43:53 -0500

ABSTRACT: Background. The optimal combination of anticoagulant and antiplatelet therapy following percutaneous coronary intervention with stenting (PCI-S) among patients requiring oral anticoagulation (OAC) is unknown. Objectives. We sought to compare the efficacy of a modified dual-antiplatelet regimen (daily aspirin and every other day clopidogrel) to conventional treatment (daily aspirin and daily clopidogrel) following percutaneous coronary intervention (PCI) with drug-eluting stents (DES) among patients who are also discharged on warfarin. Methods. We performed a single-center, retrospective analysis of consecutive patients (n = 454) who underwent PCI-S with DES and were discharged on warfarin and either a conventional (n = 170) or modified (n = 284) antiplatelet regimen between March 2003 and May 2007. In-hospital and 1-year events were compared between the two groups. Results.

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Virtual Histology Imaging in Acute Coronary Syndromes: Useful or Just a Research Tool?

admin — Wed, 03 Feb 2010 11:56:41 -0500

ABSTRACT: Acute coronary syndromes (ACS) frequently cause considerable morbidity and mortality with a high risk of further events within the following year, despite the use of percutaneous coronary intervention (PCI). Numerous studies have described the concept of acute, partial or complete thrombotic occlusion of the coronary artery, which occurs at the site of a friable atherosclerotic plaque with a lipid-rich necrotic core and a ruptured overlying thin fibrous cap (“culprit lesion”). Moreover, this process appears independent of the severity of the underlying stenosis. Most of our knowledge about the morphological characteristics of culprit lesions has been obtained from necropsy studies of lesions at the extreme end of the ACS spectrum.

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