Noninvasive assessment of patients undergoing percutaneous intervention in myocardial infarction.

Background: Restenosis after primary percutaneous coronary intervention (PPCI) remains an important clinical problem, even with stent implantation. The ability of noninvasive testing to diagnose restenosis has had only inconsistent demonstration.

Objective: Our objective was to evaluate the ability of exercise treadmill testing (ETT) and myocardial perfusion imaging (MPI) to diagnose restenosis in patients treated by PPCI within 12 hours of ST-elevation myocardial infarction (STEMI).

Evaluation of plaque composition by intravascular ultrasound "virtual histology": the impact of dense calcium on the measurement of necrotic tissue.

Aims: We aimed to evaluate if the co-localisation of calcium and necrosis in intravascular ultrasound virtual histology (IVUS-VH) is due to artefact, and whether this effect can be mathematically estimated.

Methods And Results: We hypothesised that, in case calcium induces an artefactual coding of necrosis, any addition in calcium content would generate an artificial increment in the necrotic tissue. Stent struts were used to simulate the "added calcium".

Rationale and design for the PAINT randomized trial.

Background: We describe the rationale and design for the 'PercutAneous INTervention with biodegradable-polymer based paclitaxel-eluting or sirolimus-eluting versus bare stents for de novo coronary lesions - PAINT trial'.

Objectives: To evaluate two novel formulations of paclitaxel-eluting stent and the sirolimus-eluting stent against a stent with the same metallic structure but without polymer coating or drug elution.

Methods: The PAINT is a multicenter 3-arm randomized trial, conducted in Brazilian tertiary institutions, which included 275 patients allocated for the InfinniumR paclitaxel-eluting stent, the SupralimusR sirolimus-eluting stent or the Milennium MatrixR bare metal stent in a 2:2:1 ratio.

Randomized evaluation of two drug-eluting stents with identical metallic platform and biodegradable polymer but different agents (paclitaxel or sirolimus) compared against bare stents: 1-year results of the PAINT trial.

Objectives: We tested two novel drug-eluting stents (DES), covered with a biodegradable-polymer carrier and releasing paclitaxel or sirolimus, which were compared against a bare metal stent (primary objective). The DES differed by the drug, but were identical otherwise, allowing to compare the anti-restenosis effects of sirolimus versus paclitaxel (secondary objective).

Background: The efficacy of novel DES with biodegradable polymers should be tested in the context of randomized trials, even when using drugs known to be effective, such as sirolimus and paclitaxel.

The role of invasive therapies in elderly patients with acute myocardial infarction.

Introduction: In elderly patients with acute myocardial infarction, very little is known about the role of surgical myocardial revascularization and percutaneous coronary intervention (invasive therapies--IT), especially in the context of long-term outcomes after hospital discharge.

Methods: We analyzed 1588 patients with MI who had been included prospectively in a databank and followed for up to 7.5 years.

Prognostic heterogeneity among patients with chronic stable coronary disease: determinants of long-term mortality after treatment with percutaneous intervention.

Aims: To evaluate the risk and predictors of death in a large population of patients with stable coronary disease treated with percutaneous intervention.

Methods And Results: The study population comprised 1,276 patients with chronic angina or silent ischaemia who underwent elective coronary angioplasty. Baseline and in-hospital mortality data were prospectively collected for all patients during the index hospitalisation.

A randomized trial of 5 versus 7 French guiding catheters for transfemoral percutaneous coronary stent implantation.

Comparative studies between 5 French guiding catheter and others of larger size using the transfemoral approach to coronary stenting have not been described. Coronary stent implantation was performed in 90 patients in a randomized trial. The primary end-point was to compare the incidence of successful uncomplicated stent implantation per lesion with the 5F and 7F guiding catheters.

Human myocardium preconditioning during successive balloon inflations: irrelevant influence of both collateral recruitment and clinical pre-intervention interference.

Aims: We hypothesised that ischaemic preconditioning (IP) results from complex cellular mechanisms without significant collateral recruitment or clinical pre-intervention interference.

Methods And Results: A total of 58 patients underwent three 2-min balloon inflations separated by 5-min reperfusions. Anginal symptoms were graded according to this scale: 0 = absent, 1 = mild, 2 = moderate and 3 = severe.

Enhanced inflammatory response following coronary stent implantation in stable angina patients.

Background: Percutaneous coronary intervention (PCI) is associated with an increase in inflammatory activity. However, little is known about the association between the inflammatory response post-PCI and plaque morphology. The objective of this study was to characterize the inflammatory response following coronary stent implantation (CSI) of stable atherosclerotic plaques, according to plaque morphology.

Myocardial perfusion scintigraphy to predict outcomes after coronary stenting.

The value of myocardial perfusion scintigraphy (MPS) in predicting the occurrence of restenosis or new coronary lesions after stent implantation is debatable. A total of 47 patients treated with successful bare stent implantation underwent stress gated SPECT MPS at three time-points: pre-procedure, early pos-procedure, and 6-month follow-up. Follow-up angiographic re-study was obtained at 6 months.

Coronary revascularization (surgical or percutaneous) decreases mortality after the first year in diabetic subjects but not in nondiabetic subjects with multivessel disease: an analysis from the Medicine, Angioplasty, or Surgery Study (MASS II).

Background: It is currently unknown whether revascularization procedures are associated with an improvement in mortality among diabetic subjects, as compared with a more conservative medical treatment.

Methods And Results: In MASS II, a total of 611 patients with stable multivessel coronary disease were randomly assigned to medical treatment, surgery, or angioplasty. From these, 190 patients had diabetes (medical, 75 patients; angioplasty, 56 patients; surgery, 59 patients) and comprised the present study population.

Angiographic segment size in patients referred for coronary intervention is influenced by constitutional, anatomical, and clinical features.

Background: Factors influencing the size of target vessels of patients referred for coronary intervention are poorly defined. We aimed to investigate in a large series of patients undergoing percutaneous intervention the relation of constitutional, anatomical, and clinical features with the reference diameter of coronary vessels treated with stenting.

Methods: A total of 4,850 de novo coronary lesions, non-ostial and non-bifurcational, located in native vessels were analyzed.

Early ambulation and variability in anticoagulation during elective coronary stenting with a single intravenous bolus of low-dose, low-molecular weight heparin enoxaparin.

Background: The best anticoagulation strategy for patients undergoing percutaneous coronary intervention (PCI) remains controversial. The primary objective of this study was to assess the feasibility of immediate sheath removal post-PCI in patients given a single low-dose intravenous (IV) bolus of enoxaparin as the sole anticoagulant.

Methods: In 53 patients with stable coronary disease undergoing elective PCI, a single IV bolus of 0.

Noninvasive evaluation of left circumflex coronary aneurysm by real-time three-dimensional echocardiography.

The diagnosis of coronary aneurysms has already been described using transthoracic and transesophageal echocardiography. In the present report we demonstrated the use of real-time three-dimensional echocardiography for the diagnosis of a large left circumflex coronary aneurysm. The improved spatial resolution of this new imaging technique provided valuable information for anatomic characterization of the coronary aneurysm, allowing for distinction between the lumen and lining thrombus.

Late coronary artery recanalization effects on left ventricular remodelling and contractility by magnetic resonance imaging.

Aims: To assess the recanalization effects of post-myocardial infarction (MI) on left ventricular (LV) remodelling and contractility in relation to conservative therapy.

Methods And Results: Thirty-six patients with occluded infarct-related artery between 12 h and 14 days post-anterior MI were randomized to percutaneous coronary intervention (PCI group) or conservative therapy (no-PCI group). Magnetic resonance imaging was performed at enrollment and after 6 months.

Angiographic aspects of ruptured plaque in patients with acute myocardial infarction: correlation with clinical and laboratory variables.

In patients with acute myocardial infarction (AMI), little is known about the correlation between prognostic variables and aspects of ruptured plaque at the coronary angiography. Five hundred patients with acute myocardial infarction were studied in a consecutive and prospective manner; of these, 264 patients were excluded mainly because of the presence of an occluded culprit coronary artery. The remaining 236 patients were divided according to the presence (113, 52%) or absence (126, 48%) of angiographic aspects suggestive of ruptured plaque, and correlated with 49 clinical, electrocardiographic, in-hospital complications, procedures, and other angiographic prognostic variables.

Luminal recovery from six to twelve months after implantation of "thicker strut" coronary stents.

A group of 50 patients with 51 de novo lesions treated with thicker strut stents (strut thickness >100 microm) was angiographically evaluated at baseline, after stenting, and at 6 and 12 months. Minimal luminal diameter (MLD) significantly increased from 6 to 12 months (6 months: 1.72 +/- 0.

A new paradigm for plaque stabilization.

The concept of plaque stabilization was developed to explain how lipid lowering could decrease adverse coronary events without a substantial reduction in the regression of atherosclerosis. Plaques were stabilized by reducing serum cholesterol leading to several favorable pathobiological changes in the vessel wall of lipid-rich plaques responsible for a majority of acute coronary events. However, this concept is limited for several reasons including that it does not incorporate strategies directed against either plaques that have already destabilized or non-lipid-rich plaques, which are the substrate for at least one third of major coronary thrombi and may or may not be stabilized by lipid lowering.

Stenting vs. balloon angioplasty with provisional stenting for the treatment of vessels with small reference diameter.

A consecutive series of interventions in vessels with reference diameter < or = 2.75 mm was retrospectively analyzed according to preprocedure strategy: balloon angioplasty with provisional stenting (PTCA group, 73 patients) and primary stenting (PS group, 122 patients). In the PS group, there were more patients with single-vessel disease (54.