Volume 15 - Issue 11 - November, 2003

Pharmacoinvasive Management of Acute Coronary Syndrome in the Setting of Percutaneous Coronary Intervention: Evidence-Based, Sit

1Dean J. Kereiakes, MD, 2James Tcheng, MD, 3Edward T.A. Fry, MD, 4Deepak L. Bhatt, MD, 5Gideon Bosker, MD,
6Jose G. Diez, MD, 7James J. Ferguson, III, MD, 8Glenn N. Levine, MD, 9Gary L. Schaer, MD, 10James Zidar, MD

The CATH (Cardiac Catheterization and Antithrombotic Therapy in the Hospital) Clinical Consensus Panel Report

A total of 5,225 patients were enrolled in the PARAGON B trial. Among these patients, the type of heparin used was known in 5,200 (99.5%). The median duration of therapy was 72.8 hours for UFH and 79.7 hours for LMWH. LMWH was used in about one-fifth of the study cohort. Of the 389 sites that participated, approximately 61% of the sites used UFH only, 10% used LMWH only, and 28% used either UFH or LMWH (at the discretion of the attending physician). Enoxaparin was used in 91% of the patients treated with LMWH.36 In the PARAGON B trial, use of the LMWH enoxaparin in conjunction with a GP IIb/II...

Preservation of Myocardial Microcirculation During Mechanical Reperfusion for Myocardial Ischemia with Either Abciximab or Eptif

George Stoupakis, James Orlando, Harmit Kalia, Joan Skurnick, Muhamed Saric, Rohit Arora

Although rapid restoration of coronary flow in an infarct related artery is associated with improved survival, it is becoming increasingly evident that myocardial perfusion, and not just epicardial flow, is vital to myocardial salvage and viability. For example, patients with TIMI 2 flow are found to have a higher mortality than those with TIMI 3 flow, possibly as a result of impaired microcirculation.1 Myocardial blush grade (MBG) is an angiographic method of assessing myocardial microcirculation and provides independent risk stratification among patients with normal epicardial TIMI 3 flow. ...

Pulmonary Arteriovenous Fistula Discovered After Percutaneous Patent Foramen Ovale Closure in a 27-Year-Old Woman

Jeffrey M. Schussler, MD, Sabrina D. Phillips, MD, Azam Anwar, MD

Patent foramen ovale (PFO) is a common condition with an incidence as high as 25% in the general population.1 In some studies, young patients who present with neurological events show a higher prevalence of PFO and an association with a significant increase in recurrent events.2–4
Over the last few years, there has been a great deal of interest in the percutaneous management of PFO. Recent studies have demonstrated that percutaneous closure is both safe and successful in the treatment of PFO, as well as other intracardiac communications.5–10
Sporadic pulmonary arteriovenous malformation ...

Microcirculatory Effects of Abciximab and Eptifibatide: A Critical Appraisal

Dean J. Kereiakes, MD

The coronary microcirculation is critically important in the maintenance of myocardial nutritive blood flow. Even in situations where measures of epicardial blood flow appear normal, abnormalities in microcirculatory integrity secondary to microvascular occlusion may precipitate myocardial infarction and regional myocardial dysfunction. Atherothrombotic embolization of the distal microcirculation may occur spontaneously following plaque rupture during acute coronary syndromes or may occur secondary to percutaneous coronary intervention (PCI) induced plaque disruption. The debris produced by co...

Multiple Ulcerations in Plaque Behind Stent Struts Resulting in Late Stent Malapposition After Gamma Brachytherapy for In-Stent

Makoto Hirose, MD, Yoshio Kobayashi, MD, Jeffrey W. Moses, MD

Intracoronary stents reduce restenosis compared with conventional balloon angioplasty.1,2 However, in-stent restenosis remains an important clinical problem.3,4 Recently, randomized trials have demonstrated that intracoronary vascular brachytherapy (VBT) reduces recurrence after the treatment of in-stent restenosis.5–7 On the other hand, undesired effects of VBT such as late thrombosis and edge effect are also reported.6–8 Late stent malapposition is one of undesired effects of VBT. This case report describes multiple late stent malappositions after gamma VBT.

Case Report. A ...

Short- and Intermediate-Term Follow-up Results of Percutaneous Transluminal Balloon Valvuloplasty in Adolescents and Young Adu

Saleem Sharieff, MBBS, FCPS, Khan Shah-e-Zaman, MBBS, MRCP, FRCP, Prof. Azhar Masood A. Faruqui, MBBS, FRCPC, FAHA

PVS, usually due to dome-shaped valve apparatus, resulting from commissural fusion, comprises approximately 10% of all congenital heart diseases1–3 including 10–15% dysplastic valves,4–6 which are due to markedly thickened immobile cusps with variably reduced mobility. In moderate-to-severe valvular pulmonary stenosis (PS), subvalvular hypertrophy can cause infundibular narrowing and obstructive hemodynamics, which regresses after correction of valvular stenosis.7–9 Similarly, cyanosis can occur with right-to-left atrial shunting through a patent foramen ovale due to severe PS and decr...

Editor's Message (Sept 2003)

Richard E. Shaw, PhD, FACC

Dear Readers,

This issue of the Journal of Invasive Cardiology, which coincides with the annual Transcatheter Therapeutics meeting, includes original research articles, case reports, reviews, articles from the Journal special sections “Clinical Decision Making”, “The Electrophysiology Corner” and “Clinical Images”, and a Continuing Medical Education offering.

The first research study, submitted by Dr. George Stoupakis and colleagues from the UMDNJ-New Jersey Medical School in Newark, New Jersey, presents their evaluation of preservation of myocardial microcirculation measur...

Collateral Formation in Patients After Percutaneous Myocardial Revascularization: A Mechanism for Improvement?

Chi Hang Lee, MRCP, Pieter C. Smits, MD, Kengo Tanabe, MD, Ron T. van Domburg, PhD, Muzaffer Degertekin, MD, Wim van der Giessen, MD, Patrick W. Serruys, MD

Percutaneous myocardial revascularization (PMR) has emerged as a less invasive alternative to the transmyocardial revascularization (TMR), which requires thoracotomy. Initial results of PMR are encouraging with a significant proportion of patients that experience an increase in exercise capacity, reduction in angina frequency and improvement in quality of life.1,2 Although a recent double-blinded randomized clinical trial has cast doubt on the efficacy of PMR,3 the substantial improvements seen in other clinical trials are factual. The underlying mechanism accounting for the improvement seen a...

Metabolically Controlled Reperfusion in Acute Myocardial Infarction: Should the Polarizing Solution be Given Subselectively?

Paolo Angelini, MD, P. Clay Haas, DO, †Chiara Bucciarelli Ducci, MS, *Steven Adams, PhD, †Judy Ober, BS, †Joyce Bigley, BS, CCP, †Fred J. Clubb, DVM, PhD, †O.H. Frazier, MD

Acute myocardial infarction (AMI) is characterized by a progressive, irreversible loss of myocardium that results from sustained critical ischemia. Treatment involves recanalizing the occluded culprit coronary artery to restore blood flow, originally by means of systemic fibrinolysis2 and more recently with a catheter device.3 Unfortunately, reperfusion of the ischemic myocardium with blood can, itself, cause arrhythmias and further tissue injury.4 However, substantial laboratory and clinical evidence indicates that ischemic injury may be lessened by the systemic administration of glucose, ins...

Endocardial Electromechanical Mapping in a Porcine Acute Infarct and Reperfusion Model Evaluating the Extent of Myocardial Ische

Jacob Odenstedt, MD, Chrichan Månsson, Lab. Asst., Sven-Olof Jansson, MD, Lars Grip, MD, PhD

Catheter-based, left ventricular, electromechanical mapping (EMM) has evolved as a diagnostic tool to characterize ischemic and injured myocardium, and has the potential for direct myocardial interventions.1–15 It is difficult to identify the myocardium at risk and irreversible infarcted areas in the setting of acute myocardial infarction (AMI). Mapping has the potential of improving accuracy since preserved electrical myocardial activity indicates viable myocardium and reduced mechanical activity either can represent infarcted or ischemic myocardium.6 However, the criteria for diagnosis by ...

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