Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials.

Aims: The aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs).

Methods And Results: Data from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis.

Long term prognostic value of subclinical carotid and femoral arterial wall lesions in patients with ST-elevation-myocardial infarction having percutaneous coronary intervention.

The presence of clinical peripheral arterial disease (PAD) is associated with an increased risk for adverse cardiovascular outcomes in patients with coronary artery disease. However, there are few data regarding the impact of the presence and degree of the subclinical PAD on outcomes in patients with coronary artery disease. The aim of this study was to assess prospectively the grade of subclinical PAD in the setting of patients who underwent primary percutaneous coronary intervention for the prediction of intermediate- and long-term clinical outcomes.

Long-term outcome of percutaneous exclusion of huge saphenous vein graft aneurysms using peripheral covered-stents as alternative to surgical repair.

Giant vein graft aneurysms occur infrequently after coronary artery bypass graft surgery and are most often detected incidentally during coronary angiography for suspected angina or as a mediastinal mass on chest radiographs. Hereby, we describe the percutaneous treatment of a huge right coronary artery saphenous vein bypass graft aneurysm by using peripheral stent-graft. Twelve months after the procedure, the aneurysm was completely sealed at computed tomographic angiography with a good distal run-off in the bypass graft.

Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study.

Objectives: The purpose of this study was to assess whether transradial access for ST-segment elevation acute coronary syndrome undergoing early invasive treatment is associated with better outcome compared with conventional transfemoral access.

Background: In patients with acute coronary syndrome, bleeding is a significant predictor of worse outcome. Access site complications represent a significant source of bleeding for those patients undergoing revascularization, especially when femoral access is used.

First results of the DEB-AMI (drug eluting balloon in acute ST-segment elevation myocardial infarction) trial: a multicenter randomized comparison of drug-eluting balloon plus bare-metal stent versus bare-metal stent versus drug-eluting stent in primary percutaneous coronary intervention with 6-month angiographic, intravascular, functional, and clinical outcomes.

Objectives: The goal of this study was to compare angiographic, intravascular imaging, and functional parameters, as well as the clinical outcomes of patients treated with drug-eluting balloon (DEB) plus bare-metal stent (BMS) versus BMS versus drug-eluting stent (DES) for ST-segment elevated acute myocardial infarction (STEMI).

Background: Concerns remain regarding the long-term safety of DES in STEMI. DEB could provide an attractive alternative in order to achieve potentially similar effectiveness but limiting the long-term hazards related to late-acquired stent malapposition and thus stent thrombosis.

Retrograde popliteal access as bail-out strategy for challenging occlusions of the superficial femoral artery: a multicenter registry.

Background: The concomitant use of femoral and popliteal accesses has been recommended for challenging superficial femoral artery (SFA) occlusions, but no comprehensive comparison of this approach to a strategy of femoral access only is available. We thus aimed to appraise the risk-benefit balance of retrograde popliteal access as bail-out strategy for SFA occlusions.

Methods: Consecutive patients with symptomatic SFA occlusion and undergoing percutaneous revascularization were enrolled.

Reduction of scatter radiation during transradial percutaneous coronary angiography: a randomized trial using a lead-free radiation shield.

Background: Occupational radiation exposure is a growing problem due to the increasing number and complexity of interventional procedures performed. Radial artery access has reduced the number of complications at the price of longer procedure duration. Radpad® scatter protection is a sterile, disposable bismuth-barium radiation shield drape that should be able to decrease the dose of operator radiation during diagnostic and interventional procedures.

Huge coronary perforation during percutaneous intervention sealed by injection of polyvinyl alcohol microspheres.

During percutaneous coronary intervention, coronary perforation is one of the most feared life-threatening complications, as it may cause cardiac tamponade or acute myocardial infarction. The incidence of this serious complication in recent years has increased from 0.2 to 0.

Stent-triggered 'electric shock' during leg bending 2 years after emergency iliac artery percutaneous revascularization.

We report a case of a 41-year-old woman who underwent surgical removal of an uterine leiomyoma, complicated by accidental injury of the left external iliac artery, treated by suturing. A few days after the intervention the patient was treated with emergency percutaneous stent implantation for acute thrombotic occlusion of the external iliac artery. Two years later, the patient began to complain of pain in the left leg, as an 'electric shock' sensation in the leg during squatting and leg adduction on the trunk.

Acute myocardial infarction with occlusion of all three main epicardial coronary arteries: when Mother Nature takes care more than physicians.

Double-arterial coronary stent thrombosis in acute myocardial infarction (AMI) is an infrequent but severe complication, especially when the third main coronary artery is chronically occluded. The conus artery (CA) can serve as a major source of collateral when the left anterior descendent coronary artery (LAD) becomes obstructed. We report a case of a 48-year-old man presenting with AMI due to a very late double-arterial stent thrombosis (ST) following drug-eluting stent implantation and a chronic occlusion of LAD collateralized by a large anomalous CA, which provided for the entire vascularization of the coronary tree.

Mehran contrast-induced nephropathy risk score predicts short- and long-term clinical outcomes in patients with ST-elevation-myocardial infarction.

Background: The Mehran Risk Score (MRS) has been demonstrated to be clinically useful for prediction of contrast-induced nephropathy (CIN) after nonurgent percutaneous coronary intervention. We aim to validate the MRS in the setting of Primary percutaneous coronary intervention for prediction of both CIN and short- and long-term clinical outcomes.

Methods And Results: We assigned 891 consecutive patients with ST-elevation-myocardial infarction undergoing primary percutaneous coronary intervention to 4 groups of risk of CIN (RC) according to MRS (low, medium, high, and very high risk).

Randomized clinical trial on short-time compression with Kaolin-filled pad: a new strategy to avoid early bleeding and subacute radial artery occlusion after percutaneous coronary intervention.

Background: Despite the increasing use of transradial techniques for cardiac percutaneous procedures, none of the strategies commonly utilized for hemostasis has been able to reduce the occurrence of radial artery occlusion (RAO). The aim of this study was to evaluate the occurrence of 24-hour RAO and the rate of bleeding of a novel hemostatic device for radial closure after percutaneous interventions, in adjunct to short-time compression.

Methods: Once the radial access was obtained, patients were randomized to 3 different strategies of radial closure: a short compression with the QuikClot® Interventional™ pad (Z-Medica Corporation, Wallingford, CT, USA) (15 minutes, group 1), a short compression (15 minutes, group 2), and a conventional prolonged compression (2 hours, group 3) both without QuikClot® utilization.

Modified mother-child technique for selective cannulation of complex take-off left coronary artery.

An 85-year-old male patient, with long-standing hypertension, was admitted to our hospital for a late inferior myocardial infarction. An elective coronary angiogram was performed, but due to severe iliac artery tortuosity, thoracic aortic dilatation, high left coronary artery take-off, and separated origin of the left descending coronary artery and circumflex, selective cannulation with different catheter shapes was not possible. Thus, we decided to utilize a modified mother-child technique by cutting the first 10 cm from the hub of a conventional 7 F Judkins left 4 guiding catheter and inserting it into a 7 F valved sheath.

Rationale and study design of the OISTER trial: optical coherence tomography evaluation of stent struts re-endothelialization in patients with non-ST-elevation acute coronary syndromes--a comparison of the intrEpide tRapidil eluting stent vs. taxus drug-eluting stent implantation.

Background: Drug-eluting stents (DES) have been designed to prevent restenosis, but long-term clinical outcome may be offset by an increased risk of stent thrombosis, which is associated with suboptimal stent implantation or delayed re-endothelialization. DES implantation has also been associated with local persistent endothelial dysfunction. Conversely, Trapidil is a potent anti-inflammatory, vasodilatator and antiproliferative drug and several studies have shown anti-restenotic effects, suggesting substantial clinical benefits through the use of Trapidil-eluting DES.

A multicenter randomized study to evaluate intracoronary abciximab with the ClearWay catheter to improve outcomes with Lysis (IC ClearLy): trial study design and rationale.

Background: Percutaneous coronary intervention (PCI) is a highly effective therapy for acute ST-elevation myocardial infarction. Adjunctive therapy with platelet glycoprotein (GP) IIb/IIIa inhibitor can result in increased vessel patency and improved outcomes in ST-elevation myocardial infarction patients undergoing PCI. The investigation of novel dosing and delivery strategies of this therapy may help to further improve outcomes.

A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up.

Background: Few reports described outcomes of complete compared with infarct-related artery (IRA)-only revascularisation in patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD). Moreover, no studies have compared the simultaneous treatment of non-IRA with the IRA treatment followed by an elective procedure for the other lesions (staged revascularisation).

Methods: The outcomes of 263 [corrected] consecutive patients with STEMI and multivessel CAD undergoing primary angioplasty were studied.

Maximum persisting single lead ST elevation after primary angioplasty: a good predictor of left ventricular dilatation assessed by magnetic resonance imaging.

Aims: To determine the frequency and predictors of left ventricular dilatation assessed by magnetic resonance imaging among patients with a first acute myocardial infarction treated with successful primary angioplasty and stent.

Methods And Results: Cine magnetic resonance imaging and late enhancement imaging were prospectively performed in 42 patients 1 month and more than 1 year after successful early reperfusion of a first acute ST elevation myocardial infarction (age 61 +/- 13 years, 76% men, 55% anterior myocardial infarction, and mean symptom-to-balloon time 199 +/- 130 min). Both at the 1-month and at the 15-month magnetic resonance imaging examinations, 57% of patients had left ventricular dilatation (end-systolic volume indexed > 36 ml/m2, values above the upper 95th percentile based on magnetic resonance imaging reference values for left ventricular size in normal participants).

Echocardiographic diastolic dysfunction and magnetic resonance infarct size in healed myocardial infarction treated with primary angioplasty.

Background: After acute myocardial infarction (MI) the severity of diastolic dysfunction by echocardiography represents an independent prognostic marker. However, the mechanisms whereby diastolic dysfunction portends an increased risk after MI are not fully understood. We investigated the relationship between echocardiographic diastolic dysfunction severity and infarct size quantitatively measured by contrast-enhanced magnetic resonance (ce-MR).

Vascular surgery patients: perioperative and long-term risk according to the ACC/AHA guidelines, the additive role of post-operative troponin elevation.

Aims: The objectives of this study are to evaluate the prognostic role of pre-operative stratification in patients undergoing elective major vascular surgery, the timing of adverse outcomes, and the predictive role of troponin (cTn).

Methods And Results: Consecutive vascular surgery candidates (n=391) were prospectively stratified and treated according to the ACC/AHA guidelines. The patients were categorized into three groups: (1) with coronary revascularization in the past 5 years, (2) with intermediate clinical risk predictors, and (3) with minor or no clinical risk predictors.