Volume 15 - Issue 12 - December, 2003

Updated Risk Adjustment Mortality Model Using the Complete 1.1 Dataset from the American College of Cardiology National Cardiova

Richard E. Shaw, PhD, H. Vernon Anderson, MD, Ralph G. Brindis, MD, Ronald J. Krone, MD, Lloyd W. Klein, MD, Charles R. McKay, MD, Peter C. Block, MD, Leslee J. Shaw, PhD, Kathleen Hewitt, MS, RN, William S. Weintraub, MD, on behalf of the ACC-NCDR

The use of risk adjustment methodology to account for patient differences in treatment outcomes is imperative to legitimately compare the results of institutions performing cardiovascular intervention. Mortality has been the most widely used indicator to evaluate the quality of cardiac treatment procedures. In prior publications, the initial experience of the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) was described1 and a mortality risk model based on data collected in 100,253 percutaneous coronary interventions (PCI) using version 1.1 data standards of the...

Successful Exclusion of Descending Thoracic Aortic Pseudoaneurysm by Endovascular Stent-Graft Placement

Muhammad Siddique, MD, Anoop K. Gupta, MD, Ranjan K. Thakur, MD

Thoracic aortic aneurysm continues to be a life-threatening problem because of associated comorbid conditions and high morbidity and mortality associated with conventional open repair.1 Despite the remarkable improvements in treatment as a result of technical advances and improved prosthetic grafts, the operative mortality remains high.2 In addition to morbidity related to thoracotomy and cardiopulmonary bypass, open surgical resections and repairs are associated with bleeding, paraplegia, strokes, renal insufficiency and potential need for prolonged ventilatory support in the postoperative pe...

Passive Coating: The Dream Does not Come True

Antonio Colombo, MD, Flavio Airoldi, MD

Stainless steel and small amounts of nickel, chromium molybdenum and other contaminants tends to produce a foreign body reaction when implanted in human coronary arteries. The goal of “passive coatings” is to make the stent as neutral as possible to this recognition. The two most common approaches utilized in the clinical setting are to coat the stent with phosphorylcholine or with carbon ions. Carbon-coated stents are widely used in different clinical settings and several companies have designed and developed stents with different technology to coat the stainless steel. The initial enthus...

Milking-Like Effect Secondary to Systolic Expansion of a Post-Infarction Left Ventricular Aneurysm

Raúl Moreno, MD, FESC, Jesús Perez del Todo, MD, Carlos Macaya, MD, FESC

Systolic compression (milking) of the coronary arteries is almost always due to the existence of myocardial bridging. The prevalence of myocardial bridging ranges from 0.5% to 16% of patients submitted to coronary angiography, and is usually located at the proximal or mid segment of the left anterior descending coronary artery (LAD).1–3
Ocassionally, systolic compression may be caused by a systolic expansion of a left ventricular aneurysm.4 We present a patient with a post-infarction left ventricular aneurysm in whom coronary angiography showed a milking-like effect with systolic compressio...

Editor's Message - October 2003

Richard E. Shaw, PhD, FACC
The Journal of Invasive Cardiology

Dear Readers,

This issue of the Journal of Invasive Cardiology includes original research articles, a special medical informatics update, interesting case reports, and articles from the Journal special sections “Clinical Decision Making” and “Clinical Images”.

In the first original research paper, Dr. Christian Hamm and collaborators from the Department of Cardiology at the Kerckhoff Heart Center in Bad Nauheim, the University Hospital in Frankfurt and the University Hospital Eppendorf in Hamburg, Germany present their study of short-term and 6-month follow-up of a peptide-coat...

Coronary Fistula from Left Main Stem to Main Pulmonary Artery

C.K. Ekonomou, MD, D.P. Papadopoulos, MD, N.V. Dalianis, MD, N.G. Stratigis, MD,
J. Benos, CVT, V.E. Votteas

Congenital coronary arteriovenous fistula (CAF) is a rare anomaly. The incidence of congenital cardiac lesions is only 0.13%.1 Over 90% of these fistulas drain into the systemic venous side of the circulation.2 Drainage of the fistula into the pulmonary trunk has been reported in 17% of cases.2 To the best of our knowledge, a connection between the left main stem and main pulmonary artery has been reported in the literature only once, as a case in India in 1989.3

Case Report. A 51-year-old female with hypertension was admitted to the hospital with her first attack of acute myocard...

Comparison of Stainless-Steel Stents Coated with Turbostratic Carbon and Uncoated Stents for Percutaneous Coronary Interventions

Jürgen Haase, MD, PhD, Hans Störger, MD, Manfred Hofmann, MD, Claus-Eberhard Schwarz, MD, Harald Reinemer, MD, Franz Schwarz, MD, PhD

Implantation of stainless-steel stents has improved the results of percutaneous coronary revascularization.1,2 However, in various subsets of lesions, especially in the presence of complex lesion morphology, in-stent restenosis due to late neointimal hyperplasia occurs in up to 50% of cases3–5 requiring repeated coronary interventions including intravascular brachytherapy.6,7 Various passive stent coatings have been proposed to reduce thrombus formation and intimal hyperplasia following stent implantation.8–10 However, none of these stent coatings have proven to prevent in-stent restenosis...

Peptide-Treated Stent Graft for the Treatment of Saphenous Vein Graft Lesions: First Clinical Results

Christian W. Hamm, MD, FESC, *Volker Schächinger, MD, †Thomas Münzel, MD, Christian Maikowski, MD, **Tassilo Bonzel, MD, †Ralf Köster, MD, Matthias Rau, MD, *Andreas M. Zeiher, MD

Percutaneous interventions of degenerated saphenous vein grafts (SVGs) are associated with high rates of distal embolic events and in-stent restenosis.1 Recent experience with covered stents suggests that these types of devices may be a promising alternative to bare stents or repeat bypass surgery in the treatment of diseased saphenous vein grafts.2–4 A new, ePTFE stent graft (Figure 1) has been developed, which incorporates a synthetic, cell-adhesion peptide (P-15) surface treatment.5 Pre-clinical studies of this device in the porcine model have demonstrated a rapid and complete regeneratio...

Catheter-Based Revascularization of the Hepatic Artery to Treat Coronary Steal from a Gastroepiploic Artery Bypass Graft

David E. Kandzari, MD

For patients treated with coronary bypass surgery, atherosclerotic peripheral arterial disease may compromise blood flow to more distally located arterial bypass grafts. In most instances, proximal subclavian artery stenosis limits flow to the left internal mammary artery (LIMA) graft, resulting in myocardial ischemia. Although percutaneous revascularization of the subclavian artery to relieve ischemia related to the LIMA graft has been described,1–3 catheter-based revascularization of other peripheral arteries to treat steal phenomena from additional arterial conduits is not well characteri...

The Influence of Diabetes Mellitus on the Practice and Outcomes of Percutaneous Coronary Intervention in the Community: A Report

Aaron D. Kugelmass, MD, •David J. Cohen, MD, MSc, †Frank Houser, MD, ••Michael Mack, MD, ††April W. Simon, RN, MSN, †Salvatore L. Battaglia, BS, †Lynn G. Tarkington, RN, •••Edmund R. Becker, PhD, •••Steven D. Culler, PhD

Diabetic patients with coronary artery disease (CAD) have poorer long-term prognosis with more revascularization procedures than non-diabetic patients regardless of the initial treatment strategy.1,2 The role of percutaneous versus surgical revascularization as the initial treatment strategy for diabetic patients remains controversial. The Bypass Angioplasty Revascularization Investigation (BARI) trial found that diabetic patients with Multivessel coronary artery disease randomized to an initial strategy of PCTA versus CABG surgery had significantly higher mortality rates (34.7% versus 19.1%) ...

Editorial Staff
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    Laurie Gustafson
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    Elizabeth Vasil
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    Jeff Benson
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    Carson McGarrity
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    Amanda Wright
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