Volume 20 - Issue 11 - November, 2008

Use of Anticoagulants in ST-Elevation Myocardial Infarction Patients undergoing Percutaneous Coronary Intervention

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

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

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

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

Director, Cath Lab and Intervention
Cardiovascular Institute
Mount Sinai Medical Center, New York, New York
E-mail: [email protected]

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

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

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



Suitability of Saphenous Vein Graft Lesions for the Use of Distal Embolic Protection Devices

ABSTRACT: The use of distal embolic protection devices (EPD) in saphenous vein graft percutaneous interventions (SVG-PCI) has been associated with a decrease in adverse events. Currently, there are limited data regarding the percentage of SVG lesions that are suitable for EPD deployment. We retrospectively reviewed 131 SVG-PCI procedures occurring over 18 months for suitability for EPD deployment, utilizing previously published suitability criteria. We found that 49% of cases were suitable for EPD use, which is similar to results from other studies. Given the data supporting the use of EPD use



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