Long-term outcomes after fractional flow reserve-guided percutaneous coronary intervention in patients with severe coronary stenosis.

Objective: To explore the safety and efficacy of FFR-guided percutaneous coronary intervention (PCI) in vessels with severe diameter stenosis.

Methods & Results: Of 1090 patients undergoing fractional flow reserve (FFR) assessment from 2002 to 2009, we identified 167 patients in whom FFR was measured in at least one 70%-89% stenotic lesion. These patients were subdivided into an FFR-defer group ( = 49) if PCI was deferred (FFR > 0.

Assisted care as a baseline patient risk characteristic affecting the outcome of transcatheter aortic valve insertion.

Background: Objective measures of frailty have not been well defined as risk factors for a poor outcome after transcatheter aortic valve insertion. We hypothesized that assisted care as a baseline patient characteristic was a simple objective measure of frailty. We reviewed our experience to assess for an association between assisted care and outcome of operation.

Clinical Outcomes After Transapical and Transfemoral Transcatheter Aortic Valve Insertion: An Evolving Experience.

Background: Prior publications note increased adverse events after transapical compared with transfemoral access transcatheter aortic valve insertion (TAVI). We reviewed our TAVI experience to understand the differences in baseline patient characteristics and outcomes associated with the two access methods.

Methods: The records were reviewed of 567 patients who underwent transfemoral (n = 351, 61.

Co-registration of angiography and intravascular ultrasound images through image-based device tracking.

Objectives: To determine the feasibility of automated co-registration of angiography and intravascular ultrasound (IVUS) to facilitate integration of these two imaging modalities in a synchronous manner.

Background: IVUS provides cross-sectional imaging of coronary arteries but lacks overview of the vascular territory provided by angiography. Co-registration of angiography and IVUS would increase utility of IVUS in the clinical setting.

The Role of Balloon Aortic Valvuloplasty in Patients With Aortic Valve Stenosis and Society of Thoracic Surgeons Risk of 15% or Higher.

Background: Extreme-risk patients (ie, Society of Thoracic Surgeons [STS] risk 15% or higher) with severe aortic valve stenosis may not obtain mortality benefit from aortic valve replacement (AVR). We reviewed our experience with this group of patients to better understand our triage process and outcomes.

Methods: We performed a retrospective review of 97 patients with severe aortic valve stenosis and STS risk of 15% or higher treated from 2008 through 2013.

Trends and predictors of smoking cessation after percutaneous coronary intervention (from Olmsted County, Minnesota, 1999 to 2010).

Smoke-free ordinance implementation and advances in smoking cessation (SC) treatment have occurred in the past decade; however, little is known about their impact on SC in patients with coronary artery disease. We conducted a retrospective cohort study of 2,306 consecutive patients from Olmsted County, Minnesota, who underwent their first percutaneous coronary intervention (PCI) from 1999 to 2009, and assessed the trends and predictors of SC after PCI. Smoking status was ascertained by structured telephone survey 6 and 12 months after PCI (ending in 2010).

Filter neuroprotection of a single patent internal carotid artery during transapical aortic valve implantation.

The finding of a mobile calcific plaque attached to the aortic valve cusp during transcatheter aortic valve implantation (TAVI/TAVR) necessitated utilization of an embolic protection device, for cerebral protection. We report the urgent but successful deployment of such a filter in a patient with a single patent internal carotid artery. Although stroke rates observed in first-generation TAVI trials were higher than those reported following conventional open aortic valve replacement, adjunctive neuroprotective measures, particularly in patients with a large amount of threatened cerebral territory, may minimize potential neurologic injury.

Sex-related differences in fractional flow reserve-guided treatment.

Background: Sex-specific differences affect the evaluation, treatment, and prognosis of coronary artery disease. We tested the hypothesis that long-term outcomes of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) are different between women and men.

Methods And Results: Consecutive 1090 patients, referred for PCI and undergoing FFR measurements at the Mayo Clinic between October 2002 and December 2009, were included in this registry study.

Transcatheter aortic valve insertion catastrophe in inoperable patients: should aortic valve replacement be denied?

This paper reports the outcomes of patients initially deemed inoperable for standard aortic valve replacement who received transcatheter aortic valve insertion. Each patient experienced a transcatheter valve insertion complication and was then subsequently reconsidered for urgent standard valve replacement. We review the outcomes of these inoperable patients and discuss recommendations for managing this complication.

Endovascular abdominal aortic aneurysm repair to facilitate access for transcatheter aortic valve implantation.

Transcatheter aortic valve insertion is an accepted treatment for select patients at high-risk for standard aortic valve insertion. Constraints imposed by the Food and Drug Administration, Centers for Medicare and Medicaid Services, and the PARTNER Trial Executive Committee require a transfemoral approach in certain patients. The presence of aortoiliac aneurysms, occlusive disease, and excessive vessel tortuosity may create difficulties for safe transfemoral access.

Long-term outcomes of fractional flow reserve-guided vs. angiography-guided percutaneous coronary intervention in contemporary practice.

Aims: Fractional flow reserve (FFR) is the reference standard for the assessment of the functional significance of coronary artery stenoses, but is underutilized in daily clinical practice. We aimed to study long-term outcomes of FFR-guided percutaneous coronary intervention (PCI) in the general clinical practice.

Methods And Results: In this retrospective study, consecutive patients (n = 7358), referred for PCI at the Mayo Clinic between October 2002 and December 2009, were divided in two groups: those undergoing PCI without (PCI-only, n = 6268) or with FFR measurements (FFR-guided, n = 1090).

High sensitivity C-reactive protein and outcomes following percutaneous coronary intervention in contemporary practice.

Background: High sensitivity C-reactive protein (hsCRP) has been identified as a predictor of adverse cardiovascular outcomes. Whether hsCRP is a useful biomarker for risk stratification in contemporary percutaneous coronary intervention remains unknown.

Methods And Results: We conducted a prospective study among 513 patients undergoing non-emergency percutaneous coronary intervention and examined the relationship between pre- and postprocedural hsCRP levels and outcomes.

Predictors of an optimal clinical outcome with alcohol septal ablation for obstructive hypertrophic cardiomyopathy.

Background: Alcohol septal ablation has emerged as a therapy for patients with obstructive hypertrophic cardiomyopathy (HCM). However, there are limited data on the predictors of success with the procedure.

Methods: We examined patient characteristics and cardiac morphology as well as procedural data on 166 HCM patients (mean age, 63 years; 43% men), who underwent ablation at Mayo Clinic.

Clinical and economic outcomes after introduction of drug-eluting stents.

Background: In clinical trials, drug-eluting stents (DES) improve clinical outcomes but are more expensive than bare-metal stents (BMS).

Objective: To assess clinical and economic outcomes of all percutaneous coronary intervention (PCI) procedures in a general interventional cardiology practice before and after DES introduction in 2003.

Methods: We identified all patients undergoing PCI in 2000-2002 (early cohort, pre-DES era) and from 2004 through April 31, 2006 (late cohort, DES era) in a large PCI registry.

Protected carotid stenting in high-risk patients: results of the SpideRX arm of the carotid revascularization with ev3 arterial technology evolution trial.

Purpose: A prospective nonrandomized multicenter registry of 160 patients with severe carotid stenosis and high-risk features for carotid endarterectomy was conducted during the 3-month period from March to May 2005.

Methods: Carotid artery stenting (CAS) was performed with the SpideRX™ Embolic Protection System (ev3, Inc., Plymouth, MN, USA) as part of an investigational device exemption from the Food and Drug Administration.

Comparison of drug-eluting and bare-metal stents for stable coronary artery disease.

Objectives: The current study was designed to determine whether drug-eluting stents (DES) are superior to bare-metal stents (BMS) in patients with stable angina.

Background: Percutaneous coronary intervention has been shown to decrease symptoms of angina; its use for stable angina has not been shown to reduce myocardial infarction or mortality.

Methods: We conducted a retrospective, cross-sectional analysis of prospective data comparing the use of BMS versus DES in patients who met criteria used by the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) study investigators.

Survival benefit with concomitant clopidogrel and glycoprotein IIb/IIIa inhibitor therapy at ad hoc percutaneous coronary intervention.

Objective: To study clinical outcomes in patients given glycoprotein (GP) IIb/IIIa inhibitors with concomitant clopidogrel at the time of ad hoc percutaneous coronary interventions (PCI).

Patients And Methods: We studied 30-day and long-term outcomes of patients undergoing elective or urgent PCI from March 1, 1998, to December 31, 2006, stratified by administration of GP IIb/IIIa inhibitors with concomitant clopidogrel treatment at the time of ad hoc PCI.

Results: The mean+/-SD age was 66.

Safety and efficacy of drug-eluting stent for ST-segment elevation myocardial infarction in an unselected consecutive cohort.

Objective: The objective of this study is to investigate the clinical outcome of a large cohort of patients with ST-segment elevation myocardial infarction (STEMI) treated with drug-eluting stents (DES) compared to bare metal stents (BMS).

Background: Several randomized controlled trials have demonstrated that PCI with the routine use of DES is safe and effective in patients with STEMI. However as randomized trials have strict inclusion criteria, further studies in unselected patient populations are needed.

Drug-eluting stents in octogenarians: early and intermediate outcome.

Background: Large randomized controlled trials have demonstrated that percutaneous coronary intervention with the routine use of drug-eluting stents is safe and effective. However, octogenarians are usually excluded from these trials.

Methods: We analyzed 2453 consecutive patients who underwent DES implantation at the Mayo Clinic (Rochester, MN).

Outcomes of stent thrombosis and restenosis during extended follow-up of patients treated with bare-metal coronary stents.

Background: Concern regarding risk of late thrombosis after "off-label" treatment with drug-eluting stents has prompted increased use of bare-metal stents (BMS) in current practice. The sequelae of late BMS failures, however, have been poorly characterized.

Methods And Results: We performed a retrospective study of 4503 consecutive patients treated with at least 1 BMS and dual antiplatelet therapy between 1994 and 2000.

Regional systems of care to optimize timeliness of reperfusion therapy for ST-elevation myocardial infarction: the Mayo Clinic STEMI Protocol.

Background: Quality improvement efforts have focused on strategies to improve the timeliness of reperfusion therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize the timeliness of reperfusion therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states.

Methods And Results: The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006.

Frequency, etiology, treatment, and outcomes of drug-eluting stent thrombosis during one year of follow-up.

Drug-eluting stents (DESs) exhibit delayed endothelialization compared with bare metal stents. Adverse late vessel wall remodeling and inflammation have also been attributed to the drug/polymer coating. Recent registry data suggesting increased risk of DES thrombosis in routine clinical practice compared with previous clinical trial experience has led to concerns regarding long-term safety of these devices.

Initial experience with the Cardiva Boomerang vascular closure device in diagnostic catheterization.

Objectives: The authors studied the safety and efficacy of the Cardiva Boomerang vascular closure device in patients undergoing diagnostic cardiac catheterization.

Background: Conventional vascular closure devices (sutures, collagen plugs, or metal clips) have been associated with catastrophic complications including arterial occlusion and foreign body infections; furthermore, they cannot be utilized in patients with peripheral vascular disease or vascular access site in a vessel other than the common femoral artery. The Cardiva Boomerang device facilitates vascular hemostasis without leaving any foreign body behind at the access site, can be used in peripheral vascular disease, and can be used in vessels other than the common femoral artery

Methods: A total of 96 patients undergoing transfemoral diagnostic cardiac catheterization were included in this study, including 25 (26%) patients with contraindications to conventional closure devices.