Dear Readers,

This issue of the Journal of Invasive Cardiology includes original research articles, case reports, case reports with reviews of the literature, editorials, and articles from the some of the journal’s special sections.

In the first research article, Dr. Jiro Aoki and colleagues from the Erasmus Medical Center in Rotterdam, present their evaluation of the in-hospital and late outcomes of diabetic patients who received sirolimus-eluting stents versus an historical control group of diabetic patients who had been treated with bare metal stents. They found no difference between the groups in relation to the occurrence of late death or MI, but did find that patients receiving the drug-eluting stent had a significantly reduced rate of need for repeat revascularization. Dr. Kimberly A. Skelding, of the Mayo Clinic in Rochester, Minnesota, and Dr. John J. Young, of the Lindner Center for Research & Education and The Ohio Heart & Vascular Center, Cincinnati, Ohio, have provided a very insightful commentary on the paper from Aoki, et al. They further discuss some of the methodologic issues involved in this study and provide an important overview of the state of our understanding about treating coronary disease in the diabetic patient.

The second original article submitted by Dr. Hubertus von Korn and collaborators from the Klinik fur Kardiologie in Bad Berka, Germany, assesses the safety and efficacy of a new filter-based protection system for use in aorto-coronary bypass grafts. The authors found that the device offered a high rate of success and resulted in an excellent final TIMI flow and no macroembolism.

Next, Dr. Nicolas Shammas and colleagues from institutions participating in the APPROVE Registry (Angiomax Peripheral Procedure Registry of Vascular Events), present the predictors of in-hospital and 30-day complications of peripheral vascular interventions using bivalirudin as the primary anticoagulant therapy. Their analysis demonstrated that exchanges to larger sheath sizes was a strong predictor of bleeding events, and female gender and low weight contributed to major bleeding.

The next research study describes the results from the ESPRIT trial on the bailout use of platelet glycoprotein IIb/IIIa inhibition during coronary stent implantation presented by Dr. Warren Cantor and the ESPRIT collaborators. Although they were able to identify that a stenosis ? 90%, visible thrombus, and absence of aspirin treatment were associated with a higher rate of bailout therapy, the overall multivariate model was weak, suggesting that it is difficult to predict the need for glycoprotein IIb/IIIa inhibitor bailout therapy using baseline characteristics.

In the last research article, Dr. Jose de la Torre Hernandez and associates from the Unidad de Hemodinamica, Hospital Marques de Valdecilla in Santander, Spain, compare the sensitivity and specificity for coronary calcium detection using a standard fluoroscopic system and a flat panel digital detector system. Comparing both modalities to IVUS as the standard, they found that the newer flat panel digital detector system had increased sensitivity for detecting calcium without a significant loss in specificity.

In our Case Report with Brief Review section, Drs. Rigattieri, Hamon and Grollier from the Centre Hospitalier Universitaire in Caen, France, report their results in treating three different patient presentations using the buddy wire technique in transradial stenting of complex, calcified lesions. They demonstrated its usefulness in situations following predilatation, need for multiple coronary stents, and bailout for dissection. In the second case report with literature review, Dr. Woong Chol Kang and colleagues from the Gil Medical Center, Gachon Medical School in Incheon, Korea, report on a patient who presented with acute myocardial infarction caused by late sent thrombosis after deployment of a paclitaxel-eluting stent. They show that this was related to the discontinuation of clopidogrel and discuss the need for continued use of this drug with drug-eluting stents.

In our Case Report section, Drs. Tassanawiwat, Iakovou and Colombo from the St. Raffaele Hospital and EMO Centro Cuore Columbus in Milan, Italy, describe their use of a custom-made polytetrafluoroethylene-covered stent system in the successful treatment of a challenging coronary aneurysm involving a bifurcation. In the next case report, Robert Applegate and colleagues from Wake Forest University School of Medicine in North Carolina, present a case of a drug-eluting stent that was hand-crimped onto two monorail balloons offering an alternative to the “crush” technique and providing optimal treatment of the proximal vessel. The last report, submitted by Drs. Oliveira, Meireles and Pimenta from the Hospital do Servidor Publico Estadual in Sao Paulo, Brazil, demonstrates that coronary stent implantation is possible in patients with thrombocytopenia, provided that prophylactic platelet transfusion is performed.

In our special section Clinical Images, Drs. Ito, Itoh and Suzuki from the Nagoya City Moriyama Municipal Hospital, the Nagoya City University School of Graduate School and Medical Sciences and Toyohashi Heart Center in Japan, show dramatic images of a new technology called optical coherence tomography, which provides visualization of the vascular microstructure that is not usually seen by other techniques. They provide images showing a patient after cutting balloon therapy for in-stent restenosis.

In the Adjunctive Therapy section, Drs. Walter Coats and Joel Gorfinkel from the Ohio University College of Osteopathic Medicine and the Ohio State University School of Medicine in Columbus, Ohio, describe bivalirudin therapy in a patient who experienced acute myocardial infarction following total knee arthroplasty. They provide a review of studies that support this treatment approach.

In the Interventions in Peripheral Vascular Disease section, Drs. Friedel, Khalil, and Lasorda from the Allegheny General Hospital in Pittsburgh, Pennsylvania, present a complicated case in which an iatrogenic renal artery perforation was treated with a covered stent, but thrombus distal to the stent required use of rheolytic thrombectomy.

This month we have part one of a comprehensive review on percutaneous dilation of mitral stenosis from Dr. Guérios and colleagues from the Hospital Evangelico de Curitiba and the Hospital São Vicente de Paulo, Guarapuava, Brazil. They address the traditional techniques, technical innovations, the most significant case loads worldwide, an analysis of the procedure, as well as immediate and late outcomes.

It is my hope that all of the articles in this issue provide healthcare professionals with valuable information that is useful in the daily care of patients with cardiovascular disease.

Sincerely,

Richard E. Shaw, PhD, FACC
Editor-in-Chief