Measurement of cardiac output with first-pass determination during rubidium-82 PET myocardial perfusion imaging.

In addition to providing useful clinical information, cardiac output determined during rubidium-82 positron emission tomographic (PET) myocardial perfusion studies can be used in the measurement of absolute regional myocardial blood flow using Sapirstein's method. This investigation was conducted to compare cardiac output values obtained by post-processing data acquired in a list mode PET myocardial perfusion study with those obtained using a technetium-99m-labeled red blood cell method on the same patients. Results from 14 patients showed that cardiac output can be accurately measured simultaneously in a 82Rb PET myocardial study, allowing determination of multiple perfusion and functional parameters of the heart, thus improving the cost-effectiveness of the 82Rb PET study.

Low molecular weight heparin in prevention of restenosis after angioplasty. Results of Enoxaparin Restenosis (ERA) Trial.

Background: Heparin, an anticoagulant, possesses antiproliferative effects and has been shown to reduce neointimal proliferation and restenosis following vascular injury in experimental studies.

Methods And Results: The primary aim of this double-blind multicenter study was to determine if 40 mg Enoxaparin, a low molecular weight heparin, administered subcutaneously once daily for 1 month after successful angioplasty would reduce the incidence of restenosis. Four hundred fifty-eight patients were randomized at nine clinical centers (231 to placebo and 227 to Enoxaparin).

Angioplasty of the proximal left anterior descending coronary artery: initial success and long-term follow-up.

From 1984 to 1987, 537 consecutive patients (mean age 58 years; range 34 to 79) underwent angioplasty for proximal left anterior descending coronary artery disease. The procedure was clinically successful in 516 (96.1%).

Percutaneous transluminal angioplasty involving internal mammary artery grafts.

With the increasing use of the internal mammary artery as the conduit of choice in coronary bypass surgery, it is anticipated that an expanding patient population will have stenosis, usually at the site of internal mammary-to-coronary artery anastomosis. In our series 31 patients underwent dilatation at either the site of anastomosis (24), the native coronary artery beyond the anastomosis (4), or both (3) with no mortality, myocardial infarction, or need for emergency coronary artery bypass surgery. Angiographic and clinical success was achieved in 28 patients (90%).

Percutaneous transluminal coronary angioplasty of native coronary arteries via saphenous vein grafts.

We analyzed the immediate and long-term outcome of percutaneous transluminal angioplasty (PTCA) of native coronary arteries via saphenous vein grafts (SVG) in 30 patients. The mean age of the grafts was 69 months. Angioplasty was successful in 27 (90%) patients.

Evaluation of coexistent carotid and coronary disease by combined angiography.

We studied 247 patients who underwent combined coronary and carotid angiography to determine (a) the frequency of angiographic carotid stenosis (> 50%) in patients with coronary artery disease (CAD) and (b) the technical quality and safety of the combined procedure. All patients were evaluated primarily for CAD. Combined carotid angiography was performed for asymptomatic carotid bruits (115 patients, 47%), transient ischemic attacks (TIA) or stroke (66 patients, 26.

Risk factors for in-hospital mortality associated with coronary angioplasty.

The clinical, angiographic, and procedural findings in 40 in-hospital deaths among 5,000 consecutive percutaneous transluminal coronary angioplasties were reviewed. Compared to the total group, the mortality group had a higher proportion of women, older age, and more extensive coronary disease. Angioplasty was performed as an emergency procedure in 21 of the 40 patients who died.

Percutaneous transluminal coronary angioplasty in silent ischemia.

The short- and long-term outcome of percutaneous transluminal coronary angioplasty were analyzed in 34 patients who had documented coronary artery disease without symptoms. Of the 34 patients, 33 had abnormal stress tests before angioplasty. Angioplasty was successful in 31 patients (91%).

Long-term outcome of unsuccessful percutaneous transluminal coronary angioplasty.

We analyzed the long-term outcome of 198 patients after unsuccessful percutaneous transluminal coronary angioplasty. Forty-nine percent underwent emergency coronary artery bypass grafting surgery, 17% had elective bypass surgery, and 34% were treated medically. The in-hospital mortality rate was 4%, and myocardial infarction occurred in 36% of patients.

Percutaneous transluminal coronary angioplasty in the young adult.

A total of 33 patients age 35 years or younger underwent percutaneous transluminal coronary angioplasty (PTCA) at The Cleveland Clinic Foundation between January 1981 and October 1987. Arteriography showed one-, two-, and three-vessel disease in 16, 12, and 5 patients, respectively. Twenty-four patients (73%) had functional Class 3 or 4 angina and 17 (52%) had unstable angina.

Changing patterns in percutaneous transluminal coronary angioplasty.

We analyzed the impact of evolving technology on percutaneous transluminal coronary angioplasty in 2677 patients. There were 168 patients in period 1 when fixed-wire catheters were used, 1117 patients in period 2 when steerable catheters were available, and 1392 patients in period 3 when low-profile systems were utilized. The age of patients (55 to 57 to 59 years) and the proportion of patients with severe angina increased over the three periods (25% to 36% to 54%).

Determinants of primary success in elective percutaneous transluminal coronary angioplasty for significant narrowing of a single major coronary artery.

Clinical and angiographic characteristics, procedural details and outcome were analyzed in 2,677 consecutive patients who underwent elective single-artery, single-lesion percutaneous transluminal coronary angioplasty (PTCA) between December 1980 and May 1987. Primary success was achieved in 2,479 (93%) patients. The primary success rate was significantly lower during the first period, when nonsteerable systems were used (73%), than in later periods (94%) (p less than 0.

Clinical and angiographic features of coronary artery disease after chest irradiation.

Coronary artery disease (CAD) developed in 15 patients at a mean of 16 years (range 3 to 29) after chest irradiation. The mean dose of radiation was 42 +/- 7 grays; irradiation was performed for Hodgkin's disease in 9 patients, lymphoma in 2, breast carcinoma in 3 and cystic hygroma in 1 patient. Mean age was 48 years (range 26 to 63) at diagnosis of CAD; 4 patients were younger than 35 years.

Comparative safety and efficacy of percutaneous transluminal coronary angioplasty in men and in women.

In early reports of percutaneous transluminal coronary angioplasty (PTCA) in women, the complication rate was higher and the success rate lower than in men. From December, 1980, to December, 1986, 969 women aged 61 (32-84) years and 2,727 men aged 57 (27-84) years underwent PTCA, at our institution. At the time of PTCA 26% of the women had functional class IV angina pectoris compared to 16% of the men (P less than 0.