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Volume 18 - Issue 6 - June, 2006

Acute Left Main Coronary Artery Occlusion: A Catastrophic Problem with Poor Prognosis

Mouhammed A. Joumaa, MD, Thomas Davis, MD, Howard Rosman, MD

Left main coronary artery occlusion is a rare occurrence that is often fatal. It usually manifests as an acute myocardial infarction with cardiogenic shock and/or fatal arrhythmias. This circumstance is rarely observed, as most patients affected die before seeking medical attention.

Case Report. A 47-year-old male with no known coronary artery disease presented to our hospital one hour after sudden-onset chest pain and dyspnea. The pain occurred while the patient was working on a construction site. The patient’s past medical history included poorly-controlled hypertension, diabe...

Has THIS Target Stopped Moving?

Ronald J. Krone, MD

In this issue of the Journal, Hays, Lujan, and Chilton describe techniques to accurately measure aortic valve gradient during cardiac catheterization.1 While noninvasive cardiologists may consider this whole discussion a waste of time — “old cardiology” — there are times when an accurate gradient is important.
The gold standard of accuracy is measuring the pressure in the ascending aorta and simultaneously in the left ventricle using catheters with excellent frequency response.2 The most precise way of doing this is to place two catheters simultaneously i...

Cold Leg in Patient with High Coated Platelets: Possible Association with the Use of Rofecoxib

Abdul Rashid, MD, George Dale, MD, Thomas Hennebry, MD

Diagnostic coronary angiography in the current era is a remarkably safe procedure, yet major complications do occur. Many of these complications are related to vascular access. Although discomfort at the site of access is frequent and minor hematomas are common, one of the most potentially devastating complications is acute limb ischemia. This can relate to pre-existing atherosclerosis, prothrombotic state, catheter-induced dissection, local thrombus formation, or a combination of these factors. Prolonged use of external compression devices may also increase this risk. A new concern is whether...

Percutaneous Coronary Intervention for Cardiac Arrest Secondary to ST-Elevation Acute Myocardial Infarction. Influence of Immedi

Benigno Quintero-Moran, MD, Raul Moreno, MD, Sergio Villarreal, MD, Maria-José Perez-Vizcayno, MD, Rosana Hernandez, MD, César Conde, MD, Paul Vazquez, MD, Fernando Alfonso, MD,Camino Bañuelos, MD, Javier Escaned, MD, Antonio Fernandez-Ortiz, MD, Luis Azcona, MD, Carlos Macaya, MD

Primary percutaneous coronary intervention (PCI) is the best reperfusion strategy in patients with ST-elevation acute myocardial infarction (AMI).1 This is mainly because it achieves a very high rate of successful recanalization of the infarct-related artery in a wide variety of clinical and angiographic situations,2 but also because it virtually eliminates the risk of intracranial bleeding and reduces the incidence of mechanical complications.3
Half of the patients who die from AMI do so early, before reaching a hospital, and in most cases because of a fatal ...

Pronto™ Catheter Thrombectomy in Acute ST-Segment Myocardial Infarction: A Case Series

Ashish Pershad, MD, David Hoelzinger, MD, *Shirish Patel, MD

The aim in the treatment of patients with myocardial infarction is the early restoration of TIMI 3 blood flow in the infarct related artery.1 Primary angioplasty during an acute myocardial infarction achieves this objective but is associated with increased procedural risk because of the probability of dealing with a high thrombus burden.2 Although TIMI 3 flow is achieved in > 90% of patients with primary angioplasty/stenting in acute myocardial infarction, up to 15–20% of patients continue to have impaired myocardial perfusion. This is evident angiographically as the ...

Clinical Outcomes after Percutaneous Coronary Intervention with Drug-Eluting Stents in Dialysis Patients

Salah-Eddine Hassani, MD, William W. Chu, MD, PhD, Roswitha M. Wolfram, MD,
Pramod K. Kuchulakanti, MD, Zhenyi Xue, MS, Natalie Gevorkian, MD, William O. Suddath, MD, Lowell F. Satler, MD, Kenneth M. Kent, MD, PhD, Augusto D. Pichard, MD, Neil J. Weissman, MD, Ron Waksman, MD

The major cause of mortality in dialysis patients is attributable to cardiovascular diseases.1,2 The higher prevalence of coronary artery disease in this population is thought to be related to a higher risk factor distribution, platelet thrombogenicity and premature coronary calcification, when compared with nondialysis subjects. Treatment of ischemic heart disease with percutaneous revascularization techniques has remained controversial because of consistent exclusion of dialysis patients from major clinical trials. To our knowledge, the literature has been composed of retrospectiv...

Cardiogenic Shock due to Complete Thrombotic Occlusion of the Left Main Coronary Ostium in a Young Female

Angel Sanchez-Recalde, MD, Luis Calvo Orbe, MD, Guillermo Galeote, MD

Cardiogenic shock complicating acute myocardial infarction is associated with high mortality.1,2 Early recognition and coronary revascularization are crucial to improve its poor prognosis. Successful early reperfusion of the infarct-related coronary artery, while maintaining integrity of the downstream microvasculature, limits ongoing necrosis, salvages myocardium, and may prevent the development of cardiogenic shock.3
In this report we present an unusual case of a patient with acute thrombosis of the left main artery who reached the hospital in cardiogenic shock and u...

Percutaneous Coronary Intervention in the Elderly Patient (Part I of II)

Lloyd W. Klein, MD

The elderly patient with coronary artery disease (CAD) poses unique challenges in clinical management. The basic problem is that there are insufficient data from dedicated clinical trials to provide a framework for decision making. Clinical decisions in elderly patients are thus mainly empiric. The proportion of elderly patients who are included in randomized revascularization trials is much lower than the actual percentage in the CAD population as a whole.1 Elderly patients in registries and large series exhibit the greatest benefit from interventional procedures when compared to p...

June 2006

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

Dear Readers,

The first of our feature articles in the June issue is from Pierfrancesco Agostoni and colleagues of the University Verona and AZ Middelheim in Antwerp, Belgium and assesses the safety of percutaneous left heart catheterization directly performed by cardiology fellows. They concluded that, under supervision, cardiology fellows could perform direct cardiac catheterizations without an increase in local access site or major complications.
Our next research article is from Dr. Rasih Ener and colleagues from Temple, Drexel and Hahnemann Universities in Philadelphia. They examin...

Percutaneous Coronary Intervention in the Elderly Patient (Part II of II)

Lloyd W. Klein, MD

Continued (Part II of II)

Cardiogenic Shock
Although several registries suggest that elderly patients who present with cardiogenic shock have a significant improvement in survival with PCI, neither the SHOCK trial nor the Northern New England Shock Study showed much benefit, and may have shown worse outcomes. These studies demonstrated 34% and 12% absolute differences, respectively in early mortality between elderly patients and younger patients with shock treated with PCI.
Elderly patients with cardiogenic shock was one subject of the very complex SHOCK trial65 and registry.66...

Editorial Staff
  • Executive Officer
    Laurie Gustafson
  • Production
    Elizabeth Vasil
  • National Account Manager
    Jeff Benson
  • Senior Account Director
    Carson McGarrity
  • Special Projects Editor
    Amanda Wright
Editorial Correspondence
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