Stent-Only Versus Adjunctive Balloon Angioplasty Approach for Saphenous Vein Graft Percutaneous Coronary Intervention: Insights From DIVA Trial.

Background: Direct stenting without pre-dilation or post-dilation has been advocated for saphenous vein graft percutaneous coronary intervention to decrease the incidence of distal embolization, periprocedural myocardial infarction, and target lesion revascularization.

Methods: We performed a post hoc analysis of patients enrolled in the DIVA (Drug-Eluting Stents Versus Bare Metal Stents in Saphenous Vein Graft Angioplasty; NCT01121224) prospective, double-blind, randomized controlled trial. Patients were stratified into stent-only and balloon-stent groups.

Comparative Quantification of Arterial Lipid by Intravascular Photoacoustic-Ultrasound Imaging and Near-Infrared Spectroscopy-Intravascular Ultrasound.

Intravascular photoacoustic-ultrasound (IVPA-US) imaging and near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) are two hybrid modalities that detect arterial lipid, with comparison necessary to understand the relative advantages of each. We performed in vivo and ex vivo IVPA-US imaging of the iliac arteries of Ossabaw swine with metabolic syndrome (MetS) and lean swine to investigate sensitivity for early-stage atherosclerosis. We repeated imaging ex vivo with NIRS-IVUS for comparison to IVPA-US and histology.

Poor agreement between pulmonary capillary wedge pressure and left ventricular end-diastolic pressure in a veteran population.

Background: Accurate determination of left ventricular filling pressure is essential for differentiation of pre-capillary pulmonary hypertension (PH) from pulmonary venous hypertension (PVH). Previous data suggest only a poor correlation between left ventricular end-diastolic pressure (LVEDP) and its commonly used surrogate, the pulmonary capillary wedge pressure (PCWP). However, no data exist on the diagnostic accuracy of PCWP in veterans.

C-reactive protein and fibrin clot strength measured by thrombelastography after coronary stenting.

Inflammation is implicated in the progression of coronary artery disease and the molecular processes of inflammation and thrombosis are closely intertwined. Elevated levels of C-reactive protein (CRP) have been associated with an elevated risk of adverse ischaemic events after coronary stenting and hypercoagulability. Heightened whole blood clot strength measured by thrombelastography (TEG) has been associated with adverse ischaemic events after stenting.

Protease activated receptor-1 (PAR-1) mediated platelet aggregation is dependent on clopidogrel response.

Introduction: Clopidogrel inhibits ADP mediated platelet aggregation through inhibition of the P2Y12 receptor by its active metabolite. Thrombin induces platelet aggregation by binding to protease activated receptor-1 (PAR-1), and inhibition of PAR-1 has been evaluated in patients treated with clopidogrel to reduce ischemic events after acute coronary syndromes. Residual PAR-1 mediated platelet aggregation may be dependent on extent of clopidogrel response.

Cardiac events after non-cardiac surgery in patients with previous coronary intervention in the drug-eluting stent era.

The peri-operative risk for patients with coronary drug-eluting stents (DES) who subsequently have non-cardiac surgery (NCS) is unclear. We performed this retrospective study of all patients in our institution who had coronary intervention and subsequent NCS from 2003 through December 2008 to evaluate the incidence of major adverse cardiac events (MACE) in patients who received DES compared to those who received bare-metal stents (BMS) or had percutaneous transluminal coronary angioplasty (PTCA) during the same time period. The main outcome measures were 30-day post-operative myocardial infarction, stent thrombosis, target vessel revascularization (TVR) and cardiac death.

Spontaneous closure of an iatrogenic circumflex coronary artery-to-coronary vein fistula.

Coronary artery fistulae are rare and usually discovered as incidentally during coronary angiography. They may be congenital or acquired secondary to trauma or cardiac intervention, and usually involve the left anterior descending or right coronary artery, with the circumflex artery much less often affected. They have been reported in transplanted hearts, usually as a secondary complication to right ventricular biopsies, and typically drain into the right ventricle.

Endothelial dysfunction: its role in hypertensive coronary disease.

Purpose Of Review: Coronary artery disease is the major cause of death worldwide. Hypertension is a major risk factor for developing coronary disease. It is now recognized that endothelial dysfunction is an early marker of coronary artery disease before structural changes to the vessel wall are apparent on angiography or intravascular ultrasound and that it has a prognostic value in predicting cardiovascular events in hypertensive patients.

Have all the ICD primary prevention trials excluded an important group of patients?

Primary prevention trials of implantable cardioverter defibrillator (ICD) therapy have generally excluded patients early after revascularization. Clinicians are commonly faced with patients who have ventricular dysfunction and nonsustained ventricular tachyarrhythmia developing shortly after revascularization. Since there are no evidence-based guidelines, management is currently at the discretion of the treating clinician.

Percutaneous treatment of superior vena cava obstruction following transvenous device implantation.

The aim of this study is to assess the feasibility and safety of percutaneous treatment of superior vena cava (SVC) obstruction following transvenous device implantation. SVC obstruction is an uncommon but serious complication that can occur following permanent pacemaker or cardioverter defibrillator implantation utilizing transvenous endocardial leads. The treatment has traditionally been surgical but with the advent of stents, percutaneous approach is becoming popular.

Effectiveness of early implantation of cardioverter defibrillator for postoperative ventricular tachyarrhythmia.

The effectiveness of implantable cardioverter defibrillators (ICDs) implanted in the early postoperative period after cardiac surgery for ventricular tachyarrhythmias is unknown, because all of the major trials excluded this patient population. Thus, a 10-year retrospective study was conducted of patients who had ICDs implanted for de novo postoperative ventricular tachyarrhythmias during the index admission for cardiac surgery. There was a high rate of early recurrence of ventricular tachyarrhythmia treated by defibrillators, and this finding questions the exclusion of this important patient population from large trials.

Use of proteomics to discover novel markers of cardiac allograft rejection.

Endomyocardial biopsy remains the most reliable method of detecting rejection following cardiac transplantation. Despite numerous attempts to detect rejection using a blood assay, none have proved reliable enough to replace the biopsy. Here, we have investigated the hypothesis that proteomics has the potential to reveal many molecules which are upregulated in the heart during rejection, some of which may serve as novel blood markers of rejection.