Volume 15 - Issue 3 - March, 2003

Early and Late Reactions Following the Use of Iopamidol 340, Iomeprol 350 and Iodixanol 320 in Cardiac Catheterization

A.G.C. Sutton, *P. Finn,  P.G. Campbell, D.J.A. Price, J.A. Hall,  M.J. Stewart,  A. Davies, N.J. Linker, A.A. Harcombe, M.A. de Belder

ABSTRACT: Goal. To investigate the incidence of early (< 24 hours) and late (> 24 hours to 7 days) reactions to 3 contrast agents commonly used in cardiac catheterization. Methods and Results. A total of 2,108 patients undergoing cardiac catheterization in a Regional Cardiothoracic Unit were randomly assigned to receive 1 of 3 commonly used contrast agents in a prospective, double-blind study.

 ...

Intracardiac Echocardiography and Transcranial Doppler Ultrasound to Guide Closure of Patent Foramen Ovale

Mario Zanchetta, MD, Gianluca Rigatelli, MD, *Eustaquio Onorato, MD

Patent foramen ovale (PFO) is increasingly recognized as a mediator of Patent foramen ovale (PFO) is increasingly recognized as a mediator of paradoxical embolism,1,2 refractory hypoxemia3,4 and platypnea-orthodeoxia syndrome.5–7 Many specialists are involved in PFO patient care, such as vascular surgeons, neurologists, respiratory physicians, and cardiologists; an interdisciplinary working group assumes special importance in the management of this disease.
For a long time, transthoracic (TTE) and transesophageal (TEE) echocardiography were considered the main imaging tools for diagnosing P...

Platelet Glycoprotein IIb/IIIa Inhibition in Unstable Angina and Non-ST Segment Elevation Myocardial Infarction: Application of

John J. Young, MD, Joseph K. Choo, MD, Dean J. Kereiakes, MD

Introduction. Over the past decade, appreciable reductions in mortality, reinfarction and length of hospital stay have been reported in large-scale trials of patients with acute coronary syndromes (ACS). Every year, approximately 1.5 million patients are admitted to hospitals in the United States with unstable angina (UA) and non-ST segment elevation myocardial infarction (NSTEMI). In the last few years, there have been many advances in the evaluation and management of this patient population, including effective medical treatments such as antiplatelet, anticoagulant and cholesterol-low...

February 2003

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

Dear Readers,

This issue of the Journal of Invasive Cardiology includes original research articles, case reports, a CME offering, articles from the Journal special sections “Acute Coronary Syndromes” and “Interventional Pediatric Cardiology”, as well as Part VIII of the discussion series from the International Andreas Gruentzig Society 7th Biennial Meeting held in February of 2002.

In the first original research article, Dr. Lee A. MacDonald and colleagues from the Divisions of Cardiology and Hematology in the Department of Medicine at Northwestern University Medical Scho...

Post-Cardiac Catheterization Access Site Complications and Low-Molecular-Weight Heparin Following Cardiac Catheterization

Lee A. MacDonald, MD, Sheridan Meyers, MD, Charles L. Bennett, MD, PhD, Dan Fintel, MD, Neal Grosshans, MS, RPh, Raffy Syegco, RN, Charles J. Davidson, MD

No consensus has emerged on the periprocedural anticoagulation regimen of patients receiving long-term oral anticoagulation.1 Enoxaparin, a low molecular weight heparin (LMWH), is often used following percutaneous invasive procedures in patients on long-term anticoagulation who undergo temporary periprocedural discontinuation of warfarin. From 1993 through 1998, the Food and Drug Administration (FDA) received reports of 43 patients who developed spinal or epidural hematomas following the use of enoxaparin in the setting of neuraxial blockade.2 Many of these patients developed severe neurologic...

Long-Term Warfarin and Percutaneous Intervention

Sanjeev Vaderah, MD and John Webb, MD

Despite improvements in interventional procedural techniques and equipment, vascular and bleeding complications remain a too frequent complication of percutaneous coronary intervention (PCI). In the National Cardiovascular Network database of over 100,000 patients undergoing cardiac catheterization the transfusion rate was 4% and the vascular complication rate was 3.5%.1 Contemporary PCI trials report rates of major bleeding of 1 to 2% and minor bleeding rates of 3–6%.2,3
The optimal peri-procedural strategy for patients requiring ongoing anticoagulation with warfarin is unclear. In the cu...

Successful Aspiration of Occlusive Coronary Thrombus with Intracoronary Aspiration Using the Export™ Catheter

Srinivas Koneru, MD, Anthony Pucillo, MD, Melvin B. Weiss, MD, Craig Monsen, MD

Percutaneous transluminal coronary angioplasty (PTCA) for unstable angina relieves symptoms and reduces the likelihood of subsequent acute myocardial infarction. However, initial procedural success rates in patients with unstable angina are lower than in those with stable angina. This is postulated to mainly be due to the higher complication rates associated with PTCA procedures in this setting.1 Procedure-related mortality has been reported to range from 0–5.4%, periprocedural myocardial infarction rates range from 0–12% and the need for emergency surgery ranges from 3–13%.2–8 Complic...

A Comparison of Arterial Closure Devices to Manual Compression in Liver Transplantation Candidates Undergoing Coronary Angiograp

Lee A. MacDonald, MD, Nirat Beohar, MD, Norman C. Wang, MD, Lisa Nee, MD, Raj Chandwaney, MD, Mark J. Ricciardi, MD, Keith H. Benzuly, MD, Sheridan N. Meyers, MD, Mihai Gheorghiada, MD, Charles J. Davidson, MD

Coronary artery disease is common in adult patients with end-stage liver disease who are candidates for orthotopic liver transplantation.1 Patients with end-stage liver disease are predisposed to spontaneous bleeding complications due to thrombocytopenia, reduced synthesis of coagulation factors and increased fibrinolytic activity.2–4 The impaired immunity has been shown to lead to a higher frequency of bacteremia and subsequent increased mortality.5,6 Vascular access site hematomas and infections are well known complications of cardiac catheterization.7 Several trials have reported similar ...

Contemporary View of the Acute Coronary Syndromes (Part I of II)

Ali Moustapha, MD and *H. Vernon Anderson, MD

Acute coronary syndromes (ACS) represent a clinical spectrum that extends all the way from unstable angina presenting with worsening episodes of chest pain, to non-ST segment elevation myocardial infarction (NSTEMI) with more prolonged chest pain and biochemical evidence of myocardial injury, to ST-segment elevation myocardial infarction (STEMI) with more extensive myocardial damage and usually the formation of Q-waves on the surface electrocardiogram, and finally to sudden cardiac death. Pathophysiologic correlations in ACS include minor plaque ulceration and transient thrombus formation in u...

Contemporary View of the Acute Coronary Syndromes (Part II of II)

Ali Moustapha, MD and *H. Vernon Anderson, MD

The dilemma of invasive versus conservative strategies. After patients with unstable angina and NSTEMI have been stabilized with medical therapy, a decision must be made regarding risk stratification. Several randomized trials have compared outcomes with early conservative versus early invasive management in ACS. Results of these trials were conflicting and most antedated the use of platelet GP IIb/IIIa receptor inhibitors and coronary stenting (Table 3). These include TIMI-IIIB,60 VANQWISH,61,62 MATE,63 FRISC II,64,65 and TACTICS-TIMI 18.66
The TIMI-IIIB trial60 used a 2 x 2 factorial...

Editorial Staff
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    Amanda Wright
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