Drug-eluting stents: a study of international practice.

Objective: We aimed to analyze trends in drug-eluting stents (DES) use in four international health care and regulatory settings.

Background: Accounts suggest a differential approach to DES internationally and recent reductions in use following reports of late stent thrombosis. Current studies of clinical practice are limited in their scope.

Obesity paradox in a cohort of 4880 consecutive patients undergoing percutaneous coronary intervention.

Aims: We sought to investigate the impact of body mass index (BMI) on long-term all-cause mortality in patients following first-time elective percutaneous coronary intervention (PCI).

Methods And Results: We used the Scottish Coronary Revascularisation Register to undertake a cohort study of all patients undergoing elective PCI in Scotland between April 1997 and March 2006 inclusive. We excluded patients who had previously undergone revascularization.

Effect of clopidogrel discontinuation at 1 year after drug eluting stent placement on soluble CD40L, P-selectin and C-reactive protein levels: DECADES (Discontinuation Effect of Clopidogrel After Drug Eluting Stent): a multicenter, open-label study.

Antiplatelet therapy with clopidogrel has been shown to reduce major adverse cardiac events in acute coronary syndromes and after percutaneous interventions. This effect is not only due to its anti-platelet effect but also possibly due to an anti-inflammatory effect. The effect of clopidogrel cessation after one year of therapy on markers of inflammation has been investigated in diabetics and showed an increase in platelet aggregation as well as hsCRP and surface P-selectin levels.

Radial versus femoral approach for high-speed rotational atherectomy.

Objective: The aim of this study was to compare in-hospital outcomes for patients undergoing high-speed rotational atherectomy (HSRA) via the radial and femoral route.

Background: Transradial access is often avoided for HSRA because of concern over limitations on guide catheter size. No studies have compared a radial and femoral approach for HSRA.

Successful reintroduction of previously failed ACE inhibitor therapy following stenting of atherosclerotic renovascular disease.

Background: Angiotensin Converting Enzyme (ACE) inhibitors improve outcomes in patients with coronary artery disease irrespective of the status of the left ventricle. In the presence of functionally significant renovascular disease, ACE inhibitors often cause deterioration of renal function leading to their withdrawal.

Design: Observational study with 6 months prospective follow-up.

Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.

Background: In patients with multivessel coronary artery disease who are undergoing percutaneous coronary intervention (PCI), coronary angiography is the standard method for guiding the placement of the stent. It is unclear whether routine measurement of fractional flow reserve (FFR; the ratio of maximal blood flow in a stenotic artery to normal maximal flow), in addition to angiography, improves outcomes.

Methods: In 20 medical centers in the United States and Europe, we randomly assigned 1005 patients with multivessel coronary artery disease to undergo PCI with implantation of drug-eluting stents guided by angiography alone or guided by FFR measurements in addition to angiography.

Smoke-free legislation and hospitalizations for acute coronary syndrome.

Background: Previous studies have suggested a reduction in the total number of hospital admissions for acute coronary syndrome after the enactment of legislation banning smoking in public places. However, it is unknown whether the reduction in admissions involved nonsmokers, smokers, or both.

Methods: Since the end of March 2006, smoking has been prohibited by law in all enclosed public places throughout Scotland.

Drug-eluting stents versus bare-metal stents for off-label indications: a propensity score-matched outcome study.

Background: The US Food and Drug Administration recently concluded that data on off-label drug-eluting stent (DES) safety are limited. However, in actual clinical practice, DES are often used for off-label indications, and observational studies demonstrate that complications are higher when compared with on-label use. We aimed to determine whether clinical outcomes differ after DES and bare-metal stent implantation in a patient cohort defined by DES off-label indications.

Validity of self-reported smoking status: Comparison of patients admitted to hospital with acute coronary syndrome and the general population.

Many studies rely on self-reported smoking status. We hypothesized that patients with acute coronary syndrome (ACS), a smoking-related condition, would be more prone to misclassify themselves as ex-smokers, because of pressure to quit. We compared patients admitted with ACS with a general population survey conducted in the same country at a similar time.

Pharmacological options for inducing maximal hyperaemia during studies of coronary physiology.

The coronary pressure wire is used for physiological assessment of the coronary vasculature increasingly frequently in clinical practice. Fractional flow reserve (FFR) can now be used to assess lesion severity in a variety of anatomical situations. Increasingly, the coronary pressure wire is being used to interrogate the coronary microvasculature.

Hospital and operator variations in drug-eluting stent use: a multi-level analysis of 5967 consecutive patients in Scotland.

Objective: To determine whether drug-eluting stent (DES) use varies among Scottish hospitals, and the extent to which any variations are explained by differences between operators, patients and lesions.

Methods: Multi-level analysis of consecutive patients treated with percutaneous coronary intervention (PCI) between April 2005 and March 2006 in Scotland, using the Scottish Coronary Revascularization Registry.

Results: A total of 38 operators performed 5967 PCI procedures on 8489 lesions.

Pro-healing drug-eluting stents: a role for antioxidants?

Current strategies to lower the incidence of ISR (in-stent restenosis) following PCI (percutaneous coronary intervention) are aimed at modifying arterial healing after stent injury. This can impair endothelial recovery and render the vessel prone to acute thrombosis. As early restoration of endothelial integrity inhibits neointimal growth and thrombosis, alternative approaches which encourage this process may provide a more effective long-term result after PCI.

The clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimus-eluting stent: insights from the Arterial Revascularization Therapies Study part II (ARTS II).

Aims: Little is known about the impact of treating bifurcations on the overall outcome of multivessel coronary artery disease treated with stenting. This analysis was made to investigate the 1 year clinical outcome of the treatment of bifurcation lesions using sirolimus-eluting stents (SES) in patients with multivessel disease.

Methods And Results: Among a total of 607 patients (2160 lesions) in the Arterial Revascularization Therapies Study part II (ARTS II), there were 324 patients in whom at least one bifurcation lesion was treated (465 lesions).

Importance of collateral circulation in coronary heart disease.

Aims: Collateral arteries are a common but inconsistent finding in coronary heart disease (CHD). We endeavoured to review the methods for coronary artery collateral assessment, the predictors and clinical importance of collateral blood flow, and the potential for therapeutic augmentation of collateral anastomoses.

Methods And Results: While many methods have been used to assess collateral blood flow only a few have been formally validated.

Improvement in left ventricular function following successful rescue percutaneous coronary intervention is independent of time-to-reperfusion.

Objective: To study the influence of clinical and angiographic factors on global and regional left ventricular (LV) function after rescue percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI).

Methods: We performed repeat cardiac catheterization in 102 patients who underwent rescue PCI at our centre. Eighty-two patients had suitable baseline and follow-up ventriculograms, which were analyzed offline by an automated edge detection technique.

Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction.

Background: The appropriate treatment for patients in whom reperfusion fails to occur after thrombolytic therapy for acute myocardial infarction remains unclear. There are few data comparing emergency percutaneous coronary intervention (rescue PCI) with conservative care in such patients, and none comparing rescue PCI with repeated thrombolysis.

Methods: We conducted a multicenter trial in the United Kingdom involving 427 patients with ST-segment elevation myocardial infarction in whom reperfusion failed to occur (less than 50 percent ST-segment resolution) within 90 minutes after thrombolytic treatment.

Randomized comparison of balloon angioplasty versus silicon carbon-coated stent implantation for de novo lesions in small coronary arteries.

The objectives of this study were to compare the short- and long-term clinical and angiographic outcomes of conventional balloon angioplasty versus elective silicon carbide-coated stent implantation in de novo lesions in small coronary arteries (<3.0 mm). Angioplasty of small coronary arteries is associated with high restenosis rates.

Validation of coronary flow reserve measurements by thermodilution in clinical practice.

Background: Coronary flow reserve (CFR) and fractional flow reserve (FFR) provide complementary information on the coronary circulation. Using a pressure wire, it is possible to calculate CFR by thermodilution (CFR(thermo)), so that FFR and CFR can be measured with a single guide wire. The present multicentric study was performed to compare the feasibility of CFR(thermo)obtained with an improved algorithm and a standardized injection technique and its agreement with Doppler-derived CFR (CFR(Doppler)).