Volume 18 - Issue 6 - June, 2006

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...

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...

Impact of Functional Testing Results on Prescription Patterns of Anti-Anginal Medication after Coronary Artery Bypass Graft Surg

Karen Wou, Hiep Nguyen, MD, Robert Duerr, MD, Michael Del Core, MD, Dominique Fourchy, MD, Thao Huynh, MD, Ellis Lader, MD, Felix J. Rogers, DO, Rashid Chaudhry, MD, Louise Pilote, MD, MPH, PhD, Mark J. Eisenberg, MD, MPH...

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...

Impact of Functional Testing Results on Prescription Patterns of Anti-Anginal Medication after Coronary Artery Bypass Graft Surg

Karen Wou, Hiep Nguyen, MD, Robert Duerr, MD, Michael Del Core, MD, Dominique Fourchy, MD, Thao Huynh, MD, Ellis Lader, MD, Felix J. Rogers, DO, Rashid Chaudhry, MD, Louise Pilote, MD, MPH, PhD, Mark J. Eisenberg, MD, MPH

Coronary artery bypass graft surgery (CABG) relieves anginal symptoms and decreases morbidity and mortality in patients suffering from coronary artery disease (CAD).1,2 Unless comorbid diseases are present, guidelines do not recommend the routine use of anti-anginal medication post-CABG.3,4 However, previous studies suggest that anti-anginal medication is not significantly reduced following CABG. It is also unclear whether functional testing results have an impact on post-CABG prescription patterns. Functional testing is often used to identify graft occlusion, native coro...

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...

Immediate- and Short-Term Outcome following Recanalization of Long Chronic Total Occlusions (> 50 mm) of Native Coronary Arteri

aAkil Loli, MD, aRex Liu, MD, bAshish Pershad, MD

Chronic total occlusion (CTO) is present in approximately 30% of diagnostic angiograms. Data suggest that 10-year survival of patients with CTO is improved if the CTO is successfully recanalized.1 Percutaneous coronary intervention (PCI) of a CTO now accounts for approximately 10% of patients undergoing PCI.2–4 However, the success of recanalization with conventional wires is about 50–60%,5–7 and the impact of the new technology on recanalization is unknown. We are presenting a single-center experience with one device, the Frontrunner™ catheter (LuMe...

Late In-Stent Thrombosis in a Patient with Systemic Lupus Erythematosus and Hyperhomocysteinemia while on Clopidogrel and Aspiri

Andre C. Olivier, MD and Jay L. Hollman, MD

Recent case reports of late stent thrombosis following the discontinuation of aspirin have raised the concern that drug-eluting stents might be more prone to this complication. McFadden et al reported on 4 patients, 2 who received a paclitaxel-eluting stent, and 2 who received a sirolimus-eluting stent. The time from stent implantation to stent thrombosis was 335 to 442 days. All patients had finished dual antiplatelet drugs and were being maintained on aspirin. The aspirin was discontinued for elective surgery 4 days to 2 weeks prior to stent thrombosis. Two patients received bare metal stent...

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