Volume 15 - Issue 12 - December, 2003

Diabetes Mellitus and Preferred Method of Coronary Revascularization — The Debate Continues

James L. Orford, MBChB, MPH and *Peter B. Berger, MD

Diabetes mellitus is a public health problem of increasing importance in both the developed and developing worlds.1 The prevalence of obesity, the metabolic syndrome, and in particular diabetes, continues to increase; the impact on present and future healthcare resources is substantial. Since more than 75% of all diabetic patients die of atherosclerotic coronary heart disease, cardiologists are at the forefront of efforts, along with endocrinologists, to treat patients with established diabetes and coronary heart disease. Efforts to reduce the risk of dying from cardiovascular disease must inc...

PCI for Totally Occluded Site Consisting of Huge Thrombus

Naotsugu Oyama, MD, Kazushi Urasawa, MD, Hidetsugu Sakai, MD, Akira Kitabatake, MD

Case Report. A 53-year-old male was admitted to our hospital complaining of persistent chest pain. He was diagnosed as having acute posterior myocardial infarction based on the clinical findings of ST segment elevation in posterior ECG leads and echocardiographic posterior-lateral wall motion abnormality. Emergency coronary angiography (CAG) revealed total occlusion of the distal left circumflex coronary artery. The culprit lesion was successfully treated with primary implantation of a 4.0 X 13 mm ACS Multi-Link RX Tristar stent (Guidant Corporation, Santa Clara, California). CAG als...

Left Atrial Thrombus Formation on a CardioSeal Septal Occlusion Device in a Patient with Elevated Factor VIII: Resolution with

Michael R. Recto, MD, Walter Sobczyk, MD, *Terence Hadley, MD, †Thomas Yeh Jr., MD, PhD

Transcatheter closure of patent foramen ovale (PFO) has increasingly become accepted therapy for patients with a history of multiple cryptogenic strokes.1–3 As more patients undergo transcatheter closure of PFO, and septal defects (atrial and ventricular septal defects), complications associated with these procedures will continue to be reported in the literature.4–6 One of the more worrisome complications that has previously been reported is thrombus formation on the septal occlusion device.7-10 This particular complication though rare, if present on the left atrial disc of the device, ca...

Pilot Study of Oral Rapamycin to Prevent Restenosis in Patients Undergoing Coronary Stent Therapy: Argentina Single-Center Study

Alfredo E. Rodríguez, MD, PhD, Máximo Rodríguez Alemparte, MD, Cesar F. Vigo, MD, Carlos Fernández Pereira, MD, Claudio Llauradó, BS, Miguel Russo, MD, *Renu Virmani, MD, PhD, †John A. Ambrose, MD

Observational and randomized studies recently showed that sirolimus-coated stents were associated with a lower rate of restenosis than bare stents.1–3 Although the restenosis rate was lower, coated stents have a significantly higher cost than conventional stents and their future use in multivessel disease or in patients with multiple lesions is questionable due to the prohibitive costs of such therapy.
Sirolimus (rapamune), a natural macrocyclic lactone, is a potent immunosuppressive agent that was developed by Wyeth-Ayerst Laboratories and is given orally to renal transplant patients to av...

How Should Diuretic-Refractory, Volume-Overloaded Heart Failure Patients Be Managed?

Jonathan D. Sackner-Bernstein, MD and Rimvida Obeleniene, MD

Clinical problem. Heart failure patients are frequently hospitalized with decompensated heart failure,1 usually with volume overload. Treatment guidelines recommend diuretics to optimize volume status,2 and are most effective administered intravenously. However, the management of patients refractory to diuretic therapy is not addressed in the guidelines of the American Heart Association/American College of Cardiology,3 the European Society of Cardiology4 or the Heart Failure Society of America.5
One problem with defining a treatment strategy in these patients is the lack of a consisten...

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...

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