Outcome of patients with prior percutaneous revascularization undergoing repeat coronary intervention (from the PRESTO Trial).

Patients with previous percutaneous coronary intervention (PCI) are often excluded from clinical trials. As a result, limited data are available on the long-term outcome of such patients undergoing repeat PCI. In this study, we assessed the impact of previous PCI on outcomes in patients undergoing repeat PCI.

Combination antithrombotic therapy with antiplatelet agents and anticoagulants for patients with atherosclerotic heart disease.

We reviewed the efficacy and safety of combination antithrombotic therapy with aspirin plus warfarin versus aspirin alone in patients with atherosclerotic heart disease. We performed a comprehensive MEDLINE search of English-language reports published between 1966 and 2002 and search of references and relevant papers. Only clinical research studies on primary or secondary prevention of cardiovascular events in patients at high risk for coronary artery disease or patients experiencing unstable angina or myocardial infarction were included.

Right ventricular hemangioma causing right ventricular inflow obstruction and right heart failure.

We report a patient who presented with symptoms of right heart failure. Transesophageal echocardiography revealed a right ventricular mass, causing right ventricular inflow obstruction. Coronary angiography revealed a characteristic tumor blush.

The evolution of thrombolytic therapy and adjunctive antithrombotic regimens in acute ST-segment elevation myocardial infarction.

Acute ST-segment elevation myocardial infarction continues to be associated with substantial mortality rates. Despite much advancement in care, current treatments have also failed to eliminate the significant risk of morbidity, including reinfarction, reocclusion of the infarct-related artery, and thromboembolic stroke. The potential benefit of early thrombolytic therapy in reducing mortality was first established in 1986.

Percutaneous coronary intervention: historical perspectives, current status, and future directions.

In the twenty-six years since Gruntzig introduced a simple balloon angioplasty technique, percutaneous coronary intervention has undergone extraordinary growth and has now surpassed bypass surgery in frequency of performance. Several critical breakthrough technologies account for this remarkable progress: intracoronary stents have increased success rates and reduced restenosis, adjunctive antiplatelet therapy has reduced periprocedural complications, and restenosis after stent placement has been effectively treated with local radiation. Most recently, drug-eluting stents coated with cell-cycle inhibitors have shown great promise for further reducing restenosis, possibly to negligible levels.

Platelets and antiplatelet therapy in patients with diabetes mellitus.

Atherosclerotic heart disease is the leading cause of death in patients with diabetes mellitus. Platelets play a major role in the clinical manifestations of ischemic heart disease. Diabetic patients have hyperreactive platelets with exaggerated adhesion, aggregation and thrombin generation.

Right ventricular foreign body: percutaneous transvenous retrieval of a Greenfield filter from the right ventricle--a case report.

A 55-year-old man suffered head injury during a motor vehicle accident. He underwent a prophylactic inferior vena cava Greenfield filter placement. The filter migrated and lodged in the right ventricle at the level of the tricuspid valve.

Acute myocardial infarction in a patient with von Willebrand disease: pathogenetic dilemmas and therapeutic challenges.

Acute myocardial infarction occurs very rarely in patients with von Willebrand disease, a hereditary bleeding disorder characterized by deficiency of von Willebrand factor. We report a 45-year-old woman with von Willebrand disease who presented with acute anterior myocardial infarction. Percutaneous coronary intervention with adjuvant antiplatelet and antithrombotic therapy was performed without significant bleeding complications.

Unfractionated versus fractionated heparin for percutaneous coronary intervention.

Since the advent of percutaneous coronary intervention (PCI), intravenous unfractionated heparin has been the primary antithrombotic therapy to prevent periprocedural ischemic complications. As compared with unfractionated heparin, low molecular weight heparins (LMWHs) have a greater bioavailability and a more predictable therapeutic response. In several recent studies of patients undergoing PCI, LMWHs have been shown to be as safe and effective as unfractionated heparin; given their better pharmacokinetic profile and the lack of need for coagulation monitoring, they have the potential to replace unfractionated heparin during coronary interventions.