Volume 18 - Issue 6 - June, 2006

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...

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...

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
  • Special Projects Editor
    Amanda Wright
Editorial Correspondence

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