In-hospital prognosis in non-ST-segment elevation acute coronary syndrome derived using a new risk score based on electrocardiographic parameters obtained at admission.

Several electrocardiographic variables are of prognostic value in non-ST-segment elevation acute coronary syndrome (NSTEACS). From observations in 427 patients, we developed a new risk score (the ECG-RS) based on admission ECG findings that can be used to determine the likelihood of death or recurrent ischemia during hospitalization, which occurred in 36% of patients. Logistic regression analysis, which considered seven electrocardiographic variables and variables from the Thrombolysis in Myocardial Infarction (TIMI) risk score, identified the following significant predictors: corrected QT interval (QTc) > or =450 ms (odds ratio 4.

Management of residual shunts after initial percutaneous patent foramen ovale closure: a single center experience with immediate and long-term follow-up.

Background: Moderate-to-large residual shunts following percutaneous patent foramen ovale (PFO) closure are clinically important and associated with recurrent neuroembolic events. However, their management has not been clearly established in clinical practice. We report our experience in patients of these patients with a prior history of cryptogenic stroke and/or transient ischemic attack (TIA).

Left atrial appendage exclusion: state-of-the-art.

It is postulated that the source of thromboembolism in 90% of patients with non-valvular atrial fibrillation (AF) arises from the left atrial appendage (LAA). Anticoagulation with warfarin is the standard medical therapy for stroke prevention in patients with AF. However, chronic warfarin therapy is contraindicated in 14 to 44% of patients with AF who are at risk for stroke.

Hyperglycemia on admission predicts larger infarct size in patients undergoing percutaneous coronary intervention for acute ST-segment elevation myocardial infarction.

Aims: To determine if hyperglycemia on admission correlates to infarct size measured by single-photon emission computed tomography (SPECT) in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).

Methods: We evaluated 347 STEMI patients who underwent primary PCI. Infarct size was determined by SPECT on Day 5.

ST-elevation myocardial infarction mortality in a major academic center "on-" versus "off-" hours.

Background: A higher mortality rate for weekend myocardial infarction (MI) admissions has been reported and attributed to the lower availability of primary percutaneous coronary intervention (PCI) during off-hours. However, the data are conflicting and, furthermore, inapplicable to hospitals where primary PCI is invariably performed.

Methods: This study was conducted in a tertiary hospital where primary PCI is routinely performed in all patients with ST-elevation myocardial infarction (STEMI).

Impact of pre- and postprocedural mitral regurgitation on outcomes after percutaneous mitral valvuloplasty for mitral stenosis.

Percutaneous mitral valvuloplasty (PMV) is an effective therapy in patients with significant mitral stenosis. Few studies have examined the effect of mitral regurgitation (MR), a frequent periprocedural finding, on PMV outcomes. We examined the effects of pre- and postprocedural MR after PMV.

Clinical manifestation and current management of patent foramen ovale.

There is increasing interest in the evaluation and treatment of patent foramen ovale, which has been associated with various pathologic conditions, such as cryptogenic stroke, platypnea-orthodeoxia syndrome and migraine. However, optimal treatment of patients with patent foramen ovale has not been established. This article aims to review the clinical manifestation and current therapeutic options for patent foramen ovale.

Association between -T786C NOS3 polymorphism and resistant hypertension: a prospective cohort study.

Background: It is estimated that 5% of the hypertensive patients are resistant to conventional antihypertensive therapy. Polymorphisms in the endothelial nitric oxide synthase (NOS3) gene have been associated with high blood pressure levels, but not with resistant hypertension. The aim of the present study was to investigate if the -786T>C and G894T (Glu298Asp) polymorphisms of the NOS3 gene were associated with resistant hypertension.

Endovascular therapy for left main compression syndrome. Case report and literature review.

Extrinsic compression of the left main coronary artery (LMCA) can occur in patients with severe pulmonary hypertension and enlarged pulmonary artery trunk. It has been usually described in the setting of congenital defects such as atrial septal defect, ventricular septal defect, and, more rarely, isolated persistent ductus arteriosus. Functional and structural evaluation of such patients can currently be performed noninvasively with the use of cardiac CT scanning and/or MRI.

Predicting success and long-term outcomes of percutaneous mitral valvuloplasty: a multifactorial score.

Background: Percutaneous mitral valvuloplasty (PMV) success depends on appropriate patient selection. A multifactorial score derived from clinical, anatomic/echocardiographic, and hemodynamic variables would predict procedural success and clinical outcome.

Methods: Demographic data, echocardiographic parameters (including echocardiographic score), and procedure-related variables were recorded in 1085 consecutive PMVs.

Coronary artery perforations in the contemporary interventional era.

Background: Coronary perforations represent a serious complication of percutaneous coronary intervention (PCI).

Methods: We performed a retrospective analysis of documented coronary perforations at Massachusetts General Hospital from 2000 to 2008. Medical records review and detailed angiographic analysis were performed in all patients.

Retrograde versus antegrade percutaneous aortic balloon valvuloplasty: immediate, short- and long-term outcome at 2 years.

Background: The short- and long-term vascular risks and hemodynamic benefits of antegrade versus retrograde percutaneous aortic balloon valvuloplasty (PAV) have not been clearly established. With the advent of percutaneous aortic valve replacement strategies, more valvuloplasties are being performed. The antegrade approach may reduce vascular complications, particularly in patients with peripheral vascular disease (PVD).

Non-invasive assessment of myocardial ischaemia by using low amplitude oscillations of the conventional ECG signals (ECG dispersion mapping) during percutaneous coronary intervention.

Objective: The HeartVue 6S System is a recently developed novel technology that may provide non-invasive assessment of myocardial ischaemia by analysing low amplitude oscillations of the conventional ECG signals (ECG dispersion mapping). The available data to validate this new technology is limited. Therefore we performed a prospective study to assess the HeartVue 6S System for the detection of myocardial ischaemia during coronary occlusion in patients undergoing percutaneous coronary intervention (PCI).

An association between resistant hypertension and the null GSTM1 genotype.

Reduction in expression levels of glutathione S-transferase (GST) mu type 1 (GSTM1) in stroke-prone spontaneously hypertensive rats has recently been reported. GSTM1 genotype was evaluated in 49 patients with resistant hypertension and compared with selected patients with controlled hypertension (n=232) and healthy participants (n=110). Null GSTM1 genotype occurred more frequent in patients with resistant hypertension than those with controlled hypertension (57.

Anticoagulation with the direct thrombin inhibitor argatroban in patients presenting with acute coronary syndromes.

Objectives: This study examined the efficacy and safety of the direct thrombin inhibitor argatroban in patients presenting with acute coronary syndromes undergoing cardiac catheterization.

Background: Argatroban is a direct-thrombin inhibitor approved for use in percutaneous coronary intervention in patients with heparin-induced thrombocytopenia. Few studies have examined its use in patients undergoing cardiac catheterization for acute coronary syndromes.

Diabetic patients treated for unprotected left main coronary artery disease with drug eluting stents: a 3-year clinical outcome study. The diabetes and drug eluting stent for LeFT main registry (D-DELFT).

Aims: Diabetes mellitus (DM) plays an important role in the development of coronary artery disease. Although previous studies have associated drug-eluting stent (DES) implantation in diabetic patients with favourable clinical and angiographic outcomes, the very long-term efficacy of these devices in diabetic patients undergoing PCI for significant unprotected left main coronary artery (ULMCA) disease has not been established yet.

Methods And Results: Consecutive diabetic patients (n=100), who underwent elective PCI with DES for de novo lesions in an ULMCA between April 2002 and April 2004 in seven tertiary health care centres, were identified retrospectively and analysed.

Impact of concomitant aortic regurgitation on percutaneous mitral valvuloplasty: Immediate results, short-term, and long-term outcome.

Background: The aim of the study is to examine the effect of concomitant aortic regurgitation (AR) on percutaneous mitral valvuloplasty (PMV) procedural success, short-term, and long-term clinical outcome. No large-scale study has explored the impact of coexistent AR on PMV procedural success and outcome.

Methods: Demographic, echocardiographic, and procedure-related variables were recorded in 644 consecutive patients undergoing 676 PMV at a single center.

What is the optimal anticoagulation level with argatroban during percutaneous coronary intervention?

Argatroban is increasingly used in patients with heparin-induced thrombocytopenia. Although the recommended activated clotting time during percutaneous coronary intervention is 300-450 s, this recommendation is based on the limited data. This single-center, retrospective study evaluated the efficacy (composite of death, myocardial infarction, or urgent revascularization) and safety (evaluated by thrombolysis in myocardial infarction major bleeding) of argatroban during percutaneous coronary intervention according to activated clotting time levels.

[Patent foramen ovale: current state of the art].

Patent foramen ovale is a congenital cardiac lesion that persists into adulthood and which is present in over 25% of the adult population. Its diagnosis, evaluation and treatment have attracted increasing interest as it has been suggested that it may be associated with various pathologic conditions, such as cryptogenic stroke, platypnea-orthodeoxia syndrome, decompression sickness and migraine. However, data on these associations are contradictory.

Efficacy and safety of argatroban in patients with heparin induced thrombocytopenia undergoing endovascular intervention for peripheral arterial disease.

Objectives: This study aimed to evaluate the efficacy and safety of argatroban during percutaneous interventions for peripheral arterial disease (PAD).

Background: Endovascular interventions are commonly used in patients with peripheral arterial disease. Heparin is routinely administered during these procedures, but cannot be used in patients with a history of heparin-induced thrombocytopenia (HIT).

Identification of serum endoglin as a novel prognostic marker after acute myocardial infarction.

Endoglin is a proliferation-associated and hypoxia-inducible protein expressed in endothelial cells. The levels of soluble circulating endoglin and their prognostic significance in patients with acute myocardial infarction (AMI) are not known. In this observational prospective study serum endoglin levels were measured by ELISA in 183 AMI patients upon admission to hospital and 48 hrs later and in 72 healthy controls.

Pharmacological and cellular therapies to prevent restenosis after percutaneous transluminal angioplasty and stenting.

Angioplasty and stenting have become routine practice for the treatment of significant obstructive atherosclerotic vascular disease. This method of revascularization has a longer history concerning coronary artery disease but is becoming an increasingly used modality of revascularization in the peripheral circulation. Neointimal formation is the pathological basis for restenosis after revascularization procedures such as angioplasty, stenting, and bypass grafting.

Left atrial appendage exclusion using an Amplatzer device.

Patients with atrial fibrillation are at an increased risk of having a cardioembolic stroke. Most of the thrombi responsible for these ischemic events originate in the left atrial appendage (LAA). Several surgical and percutaneous endovascular techniques have been explored to occlude the LAA.

[Heparin-induced thrombocytopenia].

Hemorrhage is the most common and best-recognized complication of heparin treatment. However, a potentially more dangerous complication is the development of heparin-induced thrombocytopenia (HIT). All patients exposed to heparin, irrespective of the dose and route of administration, are at risk of developing HIT.

Efficacy and safety of argatroban with or without glycoprotein IIb/IIIa inhibitor in patients with heparin induced thrombocytopenia undergoing percutaneous coronary intervention for acute coronary syndrome.

Background: There is limited experience with the use of argatroban in combination with glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitor in acute coronary syndrome (ACS) patients with heparin-induced thrombocytopenia (HIT) undergoing percutaneous coronary intervention (PCI).

Materials And Methods: This single-center, retrospective study evaluated the efficacy (composite of death, myocardial infarction, or urgent revascularization) and safety (evaluated by TIMI major bleeding) of the argatroban with or without a GPIIb/IIIa inhibitor during PCI. Among 102 consecutive ACS patients (71.