Volume 17 - Issue 1 - January, 2005
Why Don’t We Practice Evidence-based Medicine?
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Despite several studies showing an advantage of early treatment with clopidogrel in the patient presenting with acute coronary syndrome, or prior to percutaneous coronary intervention (PCI),1–6 this treatment is frequently not given early enough to achieve maximum benefit. In the United States, PCI is usually applied as an ad hoc procedure at the same time as the cardiac catheterization. Due to concerns regarding increased bleeding risk from clopidogrel at the time of possible coronary artery bypass graft surgery, it is often not administered early, but is witheld until after the
First Clinical Experience with a Rapid Exchange Nitinol Self-expanding Stent in Combination with Balloon-expandable Coronary S
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Case report. An 86-year-old male with coronary artery disease, congestive heart failure and peripheral arterial occlusive disease presented with claudication, weakness and cramping of his left lower extremity. In March 2003, he had undergone a left-sided femoral-popliteal bypass graft following thrombosis of a popliteal artery aneurysm. The patient was without symptoms until six months post-surgery when he presented with rest ischemia involving the same lower extremity. Baseline angiogram performed at that time revealed an occluded graft with distal vessel runoff. The bypass graft wa
Safety and Feasibility of X-Sizer-Facilitated Rescue Percutaneous Coronary Intervention: A Preliminary Experience
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Although primary percutaneous coronary intervention (PCI) has been proven to be superior to thrombolytic therapy for the treatment of acute ST-elevation myocardial infarction (STEMI),1–3 the latter approach is still widely practiced due to reasons such as unavailability of experienced operators or long transport time to a dedicated angioplasty center. Failed reperfusion of the occluded coronary artery after thrombolysis occurs in up to 30% of the patients and is associated with high mortality.4 Failed thrombolysis manifests as unsolved chest pain, persistent ST-segment
Anomalous Origin of the Left Coronary Artery from the Right Coronary Artery: A Rare Case of a Single Coronary Artery Originating
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It is thought that most coronary artery anomalies are congenital in origin, resulting from varied formation during embryonic development. Although a number of different anomalies may occur, the overall incidence of this abnormality has been reported between 0.3–1.3% of the general population undergoing cardiac catheterization.1–4 The incidence may be underestimated, as many of the individuals with these anomalies are commonly asymptomatic, thus many of these anomalies go undetected. It is those individuals who experience signs and symptoms of myocardial ischemia whose anomalies
Impact of Continued Hospitalization in Patients Pre-treated with Clopidogrel Prior to Coronary Angiography and Undergoing Corona
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Clopidogrel is an oral antiplatelet agent which selectively and irreversibly inhibits the platelet adenosine 5'-diphosphate (ADP) receptor. Antiplatelet effect is synergistic when administered with aspirin. Dual antiplatelet therapy with aspirin and clopidogrel is associated with a low incidence of ischemic events in patients undergoing percutaneous coronary intervention (PCI).1 Earlier studies have used a loading dose of 300 mg before PCI,2 but a subsequent registry of 864 patients demonstrated a high loading dose of 600 mg of clopidogrel given within 2–4 hours before
Gender Differences and Predictors of Mortality in Spontaneous Coronary Artery Dissection: A Review of Reported Cases
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Spontaneous coronary artery dissection (SCAD) is a rare but potentially lethal event.1,2 It is a separation between the intimal and medial wall of the coronary vessel. The potential result of the dissection is obstruction of the vessel lumen and subsequent myocardial ischemia. Prior to the widespread use of coronary angiography, diagnosis was made at autopsy.2 From reported cases, some trends have been identified. There are reported associations with female sex,2,3 exercise,4–7 pregnancy and postpartum state,8–12 coronary artery diseas
January 2005
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Dear Readers,
This issue of the Journal of Invasive Cardiology commences our 17th year of publication. The growth of the journal over the last year has been phenomenal. I want to thank the staff at HMP Communications for providing the support that was essential for this growth. None of this would have been possible without our editorial board members who spend countless hours reviewing manuscripts submitted to the journal. And last, but by no means least, I want to thank the authors who continue to contribute high quality material for publication that makes the Journal of I
Early Ambulation Strategies with Contrast Management
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Efficiency in the cardiac catheterization lab is tied directly to patient recovery time in many institutions due to the limited recovery space and expenses inherent in the personnel required. This must always be balanced against the quality of care provided for the patients within the lab. Useful surrogates that may indicate high-quality care within the cardiac catheterization lab can include a low rate of post-procedural complications (especially vascular), high-quality angiographic images that allow for diagnostic accuracy, and a low total contrast volume per case in order to prevent contra
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