Invasive evaluation of plaque morphology of symptomatic superficial femoral artery stenoses using combined near-infrared spectroscopy and intravascular ultrasound.

The purpose of this study is to characterize the plaque morphology of severe stenoses in the superficial femoral artery (SFA) employing combined near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS). Atherosclerosis is the most common cause of symptomatic peripheral arterial disease. Plaque composition of SFA stenoses has been characterized as primarily fibrous or fibrocalcific by non-invasive and autopsy studies.

Incidence of myocardial infarction with shifts to and from daylight savings time.

Modulators of normal bodily functions such as the duration and quality of sleep might transiently influence cardiovascular risk. The transition to daylight savings time (DST) has been associated with a short-term increased incidence ratio (IR) of acute myocardial infarction (AMI). The present retrospective study examined the IR of AMIs that presented to our hospitals the week after DST and after the autumn switch to standard time, October 2006 to April 2012, with specific reference to the AMI type.

Analysis of target lesion length before coronary artery stenting using angiography and near-infrared spectroscopy versus angiography alone.

Lipid core plaque (LCP) can extend beyond the angiographic margins of a target lesion, potentially resulting in incomplete lesion coverage. We sought to compare the target lesion length using near-infrared spectroscopy (NIRS) combined with conventional coronary angiography versus angiography alone. NIRS was performed in 69 patients (75 lesions) undergoing native vessel percutaneous coronary intervention (LipiScan Coronary Imaging System).

Malignant ventricular arrhythmias in patients with acute right ventricular infarction undergoing mechanical reperfusion.

Patients with acute right ventricular (RV) infarctions are prone to ventricular arrhythmias, but little is known regarding the temporal patterns of these arrhythmias, their impact on outcomes, or their relation to the severity of RV impairment. The aim of this study was to examine the impact of malignant ventricular arrhythmias (MVAs) complicating acute RV infarction. A further aim was to determine whether the degree of RV impairment was a predisposing factor to MVAs.

Normal coronary arteries are rare in young patients with acute myocardial infarction.

Objective: To delineate the angiographic extent of coronary atherosclerosis in young patients (<45 years) with acute myocardial infarction (MI).

Background: Prior studies suggest 20% of young patients with acute MI have normal coronary arteries. However, most such studies defined "normal" as absence of stenoses >50% luminal diameter, ignoring the presence of nonflow limiting disease that may harbor culprit plaques.

Patterns of coronary compromise leading to bradyarrhythmias and hypotension in inferior myocardial infarction.

Background: Occlusion and reperfusion of the acutely occluded right coronary artery may result in abrupt bradycardia and hypotension, attributed to Bezold-Jarisch cardio-inhibitory reflexes arising from the ischemic left ventricle. Given that right ventricular infarction, a result of proximal right coronary artery occlusion, predisposes to bradycardia and hypotension, we hypothesized that proximal right coronary occlusions would be more likely to result in bradycardia-hypotension compared to more distal occlusions.

Methods: In 216 patients with acute inferior myocardial infarction undergoing primary angioplasty of the right coronary artery, we retrospectively analyzed the incidence of bradyarrhythmias and hypotension during occlusion and with reperfusion.

Right ventricular performance at rest and during stress with chronic proximal occlusion of the right coronary artery.

Acute proximal right coronary artery (RCA) occlusion results in profound right ventricular (RV) ischemic dysfunction; however, chronic RV dysfunction at rest from persistent RCA occlusion is rare. We studied the responses of the right ventricle to exercise in patients with chronic proximal RCA occlusion, demonstrating preserved RV free wall motion and appropriate augmentation of ejection fraction in nearly all cases.

Resolution of refractory no-reflow with intracoronary epinephrine.

Refractory no-reflow is associated with adverse outcomes in patients undergoing percutaneous coronary intervention. Charts were reviewed to identify 29 consecutive patients in whom intracoronary epinephrine was administered for refractory no-reflow. The effects of intracoronary epinephrine on coronary flow (TIMI grade), cardiac rhythm, and systolic blood pressure in the cardiac catheterization laboratory were assessed.

Patterns of coronary compromise resulting in acute right ventricular ischemic dysfunction.

Background: Although proximal right coronary artery (RCA) occlusion is the culprit commonly responsible for acute right ventricular (RV) infarction (RVI), the severity of RV dysfunction ranges broadly. This study was designed to delineate the patterns of coronary compromise that determine the magnitude of RV ischemic dysfunction.

Methods And Results: In 125 patients with acute inferior myocardial infarction undergoing emergency angiography, the culprit infarct lesion was identified, RV branch flow assessed (TIMI flows and frame counts), and individual patient RV perfusion indices calculated by separately averaging the branch flows and frame counts, which were correlated with RV wall motion by ultrasound.

Primary percutaneous interventions for acute myocardial infarction in octogenarians: a single-center experience.

Background: The majority of cardiovascular deaths occur in the elderly. The safety and results of primary infarct intervention in octogenarians is not well characterized.

Hypothesis: The purpose of this study was to compare the results of primary infarct intervention in octogenarians with those in younger patients during 1997-1998 and to compare these results to those obtained in octogenarians treated in 1991-1994.