Outcome of patients presenting with ST elevation myocardial infarct and cardiogenic shock: a contemporary single center's experience.

Objectives: Acute ST elevation myocardial infarction (STEMI) presenting with cardiogenic shock (CS) is associated with dismal prognosis. In the last years, significant advances have been made in reperfusion techniques and pharmacological treatment. Therefore, we aimed to assess the outcome of these patients during the past decade and identify major factors that impact their prognosis.

The impact of intracoronary thrombus aspiration on STEMI outcomes.

Background: Manual coronary thrombus aspiration was associated with improved outcomes of ST-elevation myocardial infarction (STEMI) patients. We aimed to evaluate the outcome of aspiration in a "real-world" setting of primary percutaneous coronary intervention (PPCI).

Methods And Materials: We analyzed the outcome of STEMI patients who underwent PPCI (initial Thrombolysis in Myocardial Infarction flow grade 0/1), comparing patients who underwent aspiration (ASP) to those who had standard (STD) therapy.

Comparison of late (3-year) registry data outcomes using bare metal versus drug-eluting stents for treating ST-segment elevation acute myocardial infarctions.

Clinical trial data have supported the safety and efficacy of drug-eluting stents (DES) in the treatment of patients with ST-segment elevation myocardial infarctions (STEMIs), but contemporary "real-world" registry data regarding the late safety profiles of DES are limited. This prospective registry-based study included 1,569 consecutive unselected patients with STEMIs who underwent emergency primary percutaneous coronary intervention from January 2001 to December 2009. Of the study cohort, 200 patients (12.

Drug eluting stenting in bifurcation coronary lesions long-term results applying a systematic treatment strategy.

Objectives: To explore the long-term results following implantation of drug-eluting stents (DES) in bifurcation lesions according to contemporary "real world" practice.

Background: Limited information is available on the long-term outcomes of patients with bifurcation lesions who are treated using DES. A systematic approach for bifurcation lesion management was applied, using either a "provisional" single stent technique or a dedicated two stents strategy according to the side-branch diameter and severity of its ostial stenosis.

Characterization and clinical outcomes of drug-eluting in-stent restenosis.

Background: The best therapeutic alternative for patients suffering from in-stent restenosis after drug-eluting stent implantation remains to be elucidated.

Objective: To characterize the pattern, treatment and outcomes of DES-related in-stent restenosis in patients treated at our institution.

Methods: We determined the incidence and major adverse clinical events in 71 consecutive patients with DES failure among 2473 patients who were treated with 2548 drug-eluting stents between 2004 and 2007.

Hematocrit level as a marker of outcome in ST-segment elevation myocardial infarction.

Anemia is a well-known predictor of a poor outcome in patients with ST-segment elevation myocardial infarction (STEMI). In contrast, data relating erythrocytosis to clinical outcomes in patients with STEMI are limited. Because erythrocytosis predisposes to a prothrombotic state, we hypothesized it would be associated with an increased risk of thrombotic complications in patients with STEMI undergoing primary percutaneous coronary intervention.

The risk of cardiac complications following noncardiac surgery in patients with drug eluting stents implanted at least six months before surgery.

Aims: Given the anecdotal reports and case series suggesting that drug-eluting coronary stents [DES] may be still vulnerable to coronary thrombosis after six months, we sought to assess this risk in patients undergoing non-cardiac surgery six months after stenting.

Methods And Results: Linking the Rabin Medical Centre interventional cardiology database with its non-cardiac surgical database, we identified 78 patients who underwent DES placement and subsequently [after six months] had noncardiac surgery [15-vascular, 37- abdominal and genitourinary and 26-others, excluding ophthalmic surgery]. Outcome measures included 30-day rate of postoperative myocardial infarction (MI), DES-related thrombosis, and cardiac mortality.

Major bleeding complicating contemporary primary percutaneous coronary interventions-incidence, predictors, and prognostic implications.

Background: Major bleeding is one of the most frequent procedural-related complications of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infraction (STEMI). We investigated the incidence, predictors, and prognostic impact of peri-procedural bleeding in a cohort of unselected patients undergoing contemporary primary PCI.

Methods: A total of 831 consecutive patients who underwent primary PCI between 1/2001 and 6/2005 were studied.

Effect of previous treatment with statins on outcome of patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

Beyond lipid-lowering effects, statins have favorable effects on platelets, endothelial function, plaque stability, and inflammation. These "pleiotropic" effects could contribute to microvascular function preservation during ischemia. Data are limited about the impact of previous treatment with statins on outcomes of patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).

Beneficial 2-years results of drug-eluting stents in saphenous vein graft lesions.

Aims: There are limited data regarding clinical outcomes of drug-eluting stents (DES) in saphenous vein grafts (SVGs) compared to bare metal stents (BMS). Here we compared outcomes of DES in de novo SVG lesions versus BMS in contemporary percutaneous coronary intervention (PCI).

Methods And Results: We compared in-hospital, 6-month, 1-year and two years outcomes in 68 patients (72 grafts) who underwent PCI of SVG lesions using DES and a control BMS group composed of 43 patients (46 grafts) who underwent angioplasty in de novo SVG lesions.

Comparison of the predictive value of four different risk scores for outcomes of patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention.

Accurate risk stratification has an important role in the management of patients with acute coronary syndromes. Even in patients with ST-elevation acute myocardial infarction (STEMI), for whom early therapeutic options are well defined, risk stratification has an impact on early and late therapeutic decision making. We aimed to compare the prognostic value of 4 risk scores used to evaluate patients with STEMI.

Results of percutaneous coronary interventions in patients > or =90 years of age.

Background: There are few data about percutaneous coronary interventions (PCI) in nonagenarians (patients aged > or =90 years). This study aimed to assess acute and intermediate term clinical outcomes among nonagenarian patients undergoing PCI.

Methods: The study included 65 consecutive patients, age > or =90 years undergoing PCI between January 2001 and August 2006.

Effect of no-reflow during primary percutaneous coronary intervention for acute myocardial infarction on six-month mortality.

No-reflow is a frequent event during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), and it may affect cardiac prognosis. We evaluated the occurrence of no-reflow as a predictor of outcomes in patients who underwent PCI for AMI. We prospectively collected data from 599 consecutive patients who underwent stent-based PCI for ST-elevation AMI by identifying those with no-reflow (Thrombosis In Myocardial Infarction [TIMI] grade <3 flow at completion of the procedure) and analyzing their baseline characteristics and clinical outcomes.

Prognostic importance of right ventricular infarction in an acute myocardial infarction cohort referred for contemporary percutaneous reperfusion therapy.

Background: Right ventricular (RV) involvement during acute inferior myocardial infarction (MI) is associated with increased early morbidity and mortality. With recent improvement in percutaneous coronary intervention (PCI) techniques, it is unclear which factors may improve the outcomes of these patients. We sought to assess the prognostic significance of the presence of right ventricular myocardial infarction (RV-MI) in patients undergoing primary PCI and to explore factors associated with improved outcomes by using a large database representing the "real life" of patients with acute MI (AMI) treated by primary PCI.

The impact of renal insufficiency on patients' outcomes in emergent angioplasty for acute myocardial infarction.

Background: Renal insufficiency (RF) was shown to be associated with a worsened prognosis following acute myocardial infarction (AMI).

Objectives: The authors analyzed the outcomes of AMI patients with impaired renal function tests treated using primary percutaneous coronary intervention (PCI), to determine factors associated with increased mortality risk.

Methods: This study included 558 consecutive AMI patients treated using primary PCI between January 2001 and June 2005.

Drug-eluting stents in bifurcation lesions: to stent one branch or both?

Objectives: The objective of this study was to compare two techniques to treat bifurcation lesions: a single drug-eluting stent (DES) implanted in the main branch combined with balloon dilatation for the side branch vs. stenting of both branches (double stent).

Background: Percutaneous coronary intervention in coronary bifurcation lesions remains challenging.

[Primary angioplasty for acute myocardial infarction in octogenarian patients].

This study aimed to evaluate clinical outcomes in octogenarian patients with acute myocardial infarction (AMI) treated by primary angioplasty. We used our clinical database consisting of all patients treated using primary angioplasty (< or = 12 hours) for acute ST elevation myocardial infarction excluding patients with cardiogenic shock. The clinical and angiographic results of non-shock patients, distinguished according to age < 80 years and > or = 80 years, was characterized by higher 30-day mortality among the elderly compared to younger patients (12% versus 3.

The impact of circadian variation on outcomes in emergency acute anterior myocardial infarction percutaneous coronary intervention.

Objectives: We investigated the impact of primary coronary angioplasty performed during night and compared to the impact of that performed during day-time on outcomes of patients with acute ST elevation anterior wall myocardial infarction (AMI).

Methods: We prospectively followed 273 consecutive patients of whom 160 (58.6%) were treated during day time (8:00 a.

Characteristics and clinical outcomes of patients with cardiogenic shock complicating acute myocardial infarction treated by emergent coronary angioplasty.

Background: Cardiogenic shock (CS) is a dreadful complication of acute myocardial infarction (AMI) associated with a poor prognosis. Percutaneous coronary intervention (PCI) is widely recommended by current treatment guidelines.

Aim: To evaluate the in-hospital and 30-day mortality rate and to determine independent predictors of mortality in a cohort of unselected consecutive patients with CS.

The ACIST power injection system reduces the amount of contrast media delivered to the patient, as well as fluoroscopy time, during diagnostic and interventional cardiac procedures.

The ACIST injection system is an automatic power injection device that allows for online control of injection rate and volume of contrast. Limited data is available whether this technology allows reducing use of contrast and fluoroscopy time. Accordingly, we compared the use of this system to manual injection among 450 consecutive patients who underwent diagnostic coronary angiography and/or angioplasty who were randomly assigned to either manual contrast injection (control; n=198) or to the ACIST system (study group; n=252).

Acute and intermediate-term results of percutaneus left main coronary artery interventions.

Background: Left main coronary artery disease is considered a surgical indication in most centers. However, in some cases prohibited from surgery or in patients with prior bypass grafting, there is a need for percutaneous coronary intervention in LMCA disease scenarios.

Objectives: To assess the clinical outcomes among patients undergoing stent-based LMCA angioplasty.

Coronary bifurcation lesions: to stent one branch or both?

Objective: The purpose of this study was to evaluate two different stent placement techniques for bifurcation lesions: 1) stenting of the main branch and balloon dilatation of the sidebranch versus 2) stenting of both branches.

Background: Percutaneous coronary intervention (PCI) of coronary bifurcation lesions remains challenging, and limited information is available regarding whether stent placement is necessary in both branches of the bifurcation using bare-metal stents. Methods.

Clinical experiences using the FilterWire EX for distal embolic protection during complex percutaneous coronary interventions.

Background: Distal embolization during coronary angioplasty may result in vessel occlusion, no reflow and myonecrosis. This study tested the authors' clinical experiences using a guidewire system designed to preserve distal flow during angioplasty.

Methods And Results: The FilterWire EX trade mark (Boston Scientific, Natick, MA, USA) consists of a 0.

Acute and intermediate-term results of percutaneous coronary stenting in octogenarian patients.

Background: Percutaneous coronary intervention (PCI) in octogenarian patients has been associated with increased cardiovascular morbidity and mortality. This study aimed to assess acute and intermediate-term clinical outcomes among octogenarians undergoing PCI.

Methods: The authors identified 97 consecutive patients aged > or =80 years who underwent PCI using stents between November 2000 and February 2002 at their institution.

Safety and efficacy of a 6 French perclose arterial suturing device following percutaneous coronary interventions: a pilot evaluation.

Background: Arterial access site management after percutaneous coronary intervention (PCI) is a matter of increasing importance in this era of potent antiplatelet pharmacotherapy. We evaluated the safety and efficacy of a 6 French (Fr) Perclose suturing device in achieving rapid hemostasis of the access site after PCI and thus improving patient comfort.

Methods: The 6 Fr Perclose (Prostar) device consists of a suture-based closure device delivered via introducer sheath designed for suturing of the arteriotomy puncture site.