Volume 20 - Issue 11 - November, 2008
Microvascular Dysfunction following Primary Percutaneous Coronary Intervention
- Tue, 11/4/08 - 11:38am
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In the Setting of ST-Elevation Myocardial Infarction
ABSTRACT: Primary percutaneous coronary intervention (PCI) is an established reperfusion strategy in the treatment of acute myocardial infarction with ST-segment elevation (STEMI). Nevertheless, myocardial damage is not terminated immediately, even with successful primary PCI, which eliminates the epicardial occlusion. Despite the success of contemporary reperfusion therapy and effective restoration of epicardial coronary flow, many patients have suboptimal flow at the tissue level within the myocardium. Studies indicate that the
Use of Anticoagulants in ST-Elevation Myocardial Infarction Patients undergoing Percutaneous Coronary Intervention
- Tue, 11/4/08 - 11:49am
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A Potential Role for Enoxaparin
ABSTRACT: Unfractionated heparin (UFH) is currently given as the standard anticoagulant therapy in ST-elevation myocardial infarction (STEMI) patients, including those undergoing percutaneous coronary intervention (PCI). Recent data, however, have shown lower rates of death or recurrent myocardial infarction (MI) with the low-molecular-weight heparin (LMWH) enoxaparin compared with UFH in STEMI patients treated with thrombolytics, offsetting an increase in major bleeding. This review compares the use of enoxaparin with UFH in STEMI patients undergoin
ECG-Guided Immediate Intervention at the Time of Primary PCI
- Tue, 11/4/08 - 11:55am
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To Reduce Door-to-Balloon Time in ST-Elevation Myocardial Infarction Patients
ABSTRACT: Background. In ST-segment elevation acute myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), all efforts must be made to improve door-to-balloon (DTB) times. This study was designed to assess the impact of electrocardiographic-guided immediate intervention (EGII) without performing a complete coronary evaluation on DTB times and clinical outcomes of STEMI patients treated with primary PCI. Methods. Consecutive STEMI patients undergoing primary PCI
Cardiac Mass Presenting as ST-Elevation Myocardial Infarction: Case Report and Review of the Literature
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ABSTRACT: We discuss the case of a 71-year-old female patient who presented with findings suggestive of an acute myocardial infarction. Subsequent evaluation revealed an extrinsic cardiac mass encasing the left circumflex and right coronary arteries (RCA) which caused compression and spasticity of the RCA. Biopsy findings were consistent with a hematologic malignancy. Reports of extrinsic compression of epicardial coronary arteries are uncommon. Neoplasms, either primary cardiac tumors or metastatic disease, are a rare cause of extrinsic compression of coronary arteries.
J INVASIVE CARDIOL
Editor’s Message
- Tue, 11/4/08 - 12:28pm
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Dear Readers,
This issue of the Journal of Invasive Cardiology continues our series of special focus sections to provide a more in-depth examination of important topics in cardiovascular medicine. The special section for this issue includes articles focusing on treatment of patients who present with ST-elevation myocardial infarction (STEMI). The guest editor for this section is Dr. Samin Sharma from Mount Sinai Medical Center in New York. Dr. Sharma has provided an introduction to the section and a short discussion about the articles that are featured this month. In addition to the foc
Do Things that Make Sense to Further Improve STEMI Treatment
- Tue, 11/4/08 - 12:32pm
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Director, Cath Lab and Intervention
Cardiovascular Institute
Mount Sinai Medical Center, New York, New York
E-mail: Samin.Sharma@mountsinai.org
Primary percutaneous coronary intervention (PCI) using stents (bare-metal or drug-eluting) has become the gold standard of treatment of ST-segment elevation myocardial infarction (STEMI). Numerous studies have established the importance of shortening the door-to-balloon time to < 90 minutes when performing STEMI interventions (ACC/AHA guidelines 2007 focused update). At the same time, preservation of the microvasculature along with epicardial re
Intractable Prinzmetal’s Angina Three Months after Implantation of Sirolimus-Eluting Stent
- Tue, 11/4/08 - 12:53pm
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ABSTRACT: Sirolimus-eluting stents (SES) prevent neointimal proliferation and have been widely used to treat stenotic lesions in coronary arteries because of a significant reduction of restenosis in comparison with bare-metal stents. Sirolimus, however, may cause endothelial dysfunction by damage to vascular endothelium or impairing vascular repair. Recent studies report the occurrence of exercise- or acetylcholine-induced coronary vasoconstriction in the vessel segments adjacent to the SES. We report here a clinical case of intractable Prinzmetal’s angina 3 months after SES implantation and
A Variant of Takotsubo Cardiomyopathy: A Rare Complication in the Electrophysiology Lab
- Tue, 11/4/08 - 1:01pm
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ABSTRACT: Catecholamine-induced cardiomyopathy has been recognized for decades. We present the case of a 21-year-old female referred for an electrophysiologic (EP) study who underwent an infusion of isoproterenol and epinephrine in an attempt to unmask an ectopic atrial tachycardia. Prior to leaving the study suite, the patient started complaining of chest pain and shortness of breath. Bedside echocardiography revealed a severely depressed left ventricular ejection fraction (EF) of 25–30% with basal-mid left ventricular cavity hypokinesis, but normal apical wall motion. Her coronary angiogra
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