Primary Percutaneous Coronary Intervention and Application of the Pharmacoinvasive Approach Within ST-Elevation Myocardial Infarction Care Networks.

The management of acute ST-elevation myocardial infarction (STEMI) has transitioned from observation and reactive treatment of hemodynamic and arrhythmic complications to accelerated reperfusion and application of evidence-based treatment to minimize morbidity and mortality. International research established the importance of timely reperfusion therapy and the application of fibrinolysis, primary percutaneous coronary intervention (PCI), and subsequent development of the pharmacoinvasive approach. Clinician thought leaders developed and investigated comprehensive systems of care to optimize the outcomes of patients with STEMI, with a key focus in Canada being the integration of prehospital paramedics in diagnosis, triage, and treatment.

Risk Prediction Models for Contrast-Induced Acute Kidney Injury Accompanying Cardiac Catheterization: Systematic Review and Meta-analysis.

Background: Identification of patients at risk of contrast-induced acute kidney injury (CI-AKI) is valuable for targeted prevention strategies accompanying cardiac catheterization.

Methods: We searched MedLine and EMBASE for articles that developed or validated a clinical prediction model for CI-AKI or dialysis after angiography or percutaneous coronary intervention. Random effects meta-analysis was used to pool c-statistics of models.

Cirrhotic cardiomyopathy: Implications for liver transplantation.

The majority of patients on a waiting list for liver transplantation have end-stage liver disease. Because of the marked peripheral vasodilatation of end-stage cirrhosis that masks a latent myocardial dysfunction, cardiac abnormalities in the resting state are usually subclinical and escape the attention of physicians. However, when challenged, the systolic and diastolic contractile responses are attenuated.

Structural Heart Disease Intervention: The Canadian Landscape.

Cardiovascular disease encompasses coronary artery disease and valvular heart disease, and the prevalence of both increases with age. Over the past decade, the landscape of interventional cardiology has evolved to encompass a new set of percutaneous procedures outside the coronary tree, including transcatheter aortic valve implantation, transcatheter mitral valve repair, and left atrial appendage occlusion. These interventions have sparked a new discipline within interventional cardiology referred to as structural heart disease (SHD) intervention.

Ischemic postconditioning does not improve peripheral endothelial function in ST-segment elevation myocardial infarction patients.

The purpose of this study was to determine whether ischemic postconditioning (IPC) could improve peripheral endothelial function in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Of 102 patients randomly assigned to an IPC or standard protocol to study infarct size utilizing cardiovascular magnetic resonance imaging, 84 patients had peripheral endothelial function assessed with brachial ultrasound measures and peripheral arterial tonometry (PAT) during reactive hyperemia 3 days after PCI. Overall IPC was not associated with a smaller infarct size compared to controls, though there was a trend towards greater myocardial salvage with IPC.

No cardioprotective benefit of ischemic postconditioning in patients with ST-segment elevation myocardial infarction.

Background: Postconditioning is a potential cardioprotective strategy that has demonstrated conflicting and variable reductions in infarct size in human trials.

Objectives: To determine whether postconditioning could increase the extent of myocardial salvage in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PPCI).

Methods: One hundred two patients (aged 57 ± 11 years; 88% male) were randomly assigned to a postconditioning or standard protocol.

Canadian Cardiovascular Society position statement on radiation exposure from cardiac imaging and interventional procedures.

Exposure to ionizing radiation is a consequence of many diagnostic and interventional cardiac procedures. Radiation exposure can result in detrimental health effects because of deterministic (eg, skin reaction) and stochastic effects (eg, cancer). However, with the levels experienced during cardiac procedures these risks can be difficult to quantify.

Temporal associations of early patient transfers and mortality with the implementation of a regional myocardial infarction care model.

Background: In order to reduce the delays encountered through patient transfer, regional care models have been developed that directly transport subsets of acute myocardial infarction (AMI) patients to hospitals with percutaneous coronary intervention (PCI) facilities. Calgary is a Canadian city that implemented this type of model in 2004.

Methods: The study population included 9768 AMI patients admitted to Calgary hospitals between 1997 and 2007.

An early cardiac access clinic significantly improves cardiac rehabilitation participation and completion rates in low-risk ST-elevation myocardial infarction patients.

Background: Survivors of an acute ST-elevation myocardial infarction (STEMI) remain at high risk for future cardiac events. Cardiac rehabilitation (CR) participation significantly reduces coronary artery disease (CAD) morbidity and mortality risk. Regrettably, poor utilization of CR services post STEMI is common, accentuating a critical action gap in the trajectory of CAD management.

Outcomes of after-hours versus regular working hours primary percutaneous coronary intervention for acute myocardial infarction.

Background: Primary percutaneous coronary intervention (PCI) is a proven therapy for acute ST-segment elevation myocardial infarction. However, outcomes associated with primary PCI may differ depending on time of day.

Methods And Results: Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease, a clinical data-collection initiative capturing all cardiac catheterisation patients in Alberta, Canada, the authors described and compared crude and risk-adjusted survival for ST-segment elevation myocardial infarction patients undergoing primary PCI after-hours versus regular working hours.

Long-term outcomes of patients receiving drug-eluting stents.

Background: We sought to establish the long-term safety of drug-eluting stents compared with bare-metal stents in a usual care setting.

Methods: Using data from a prospective multicentre registry, we compared rates of death and of death or repeat revascularization during 3 years of follow-up of 6440 consecutive patients who underwent angioplasty with either drug-eluting or bare-metal stents between Apr. 1, 2003, and Mar.

Coronary dominance and prognosis of patients with acute coronary syndrome.

Background: A number of studies have identified the number of diseased vessels to be an important determinant of survival in patients with acute coronary syndrome (ACS). It is unknown if coronary dominance has an impact on prognosis of these patients. We hypothesized that the prognosis of patients with ACS with left dominance (LD) would be worse than that of patients with right or mixed dominance.

Prognostic implication of hyperglycemia in myocardial infarction and primary angioplasty.

Purpose: The study assessed the relationship of admission blood glucose level to in-hospital mortality in patients presenting with an ST-segment elevation myocardial infarction and treated with primary angioplasty.

Methods: A total of 980 patients presenting with an ST-segment elevation myocardial infarction and treated exclusively with primary angioplasty were evaluated. Patients were divided into quartiles based on their admission blood glucose level: group 1 (< or =6.

Expedited transfer for primary percutaneous coronary intervention: a program evaluation.

Background: A shorter time from symptom onset to reperfusion is associated with improved outcomes for patients with ST-segment elevation myocardial infarction (MI). Primary percutaneous coronary intervention is a favourable method of reperfusion if performed effectively and expeditiously. We sought to evaluate the impact of an expedited pre-hospital diagnosis and transfer pathway developed by a multidisciplinary team on the door-to-balloon time in a large urban community.

Registry data evaluating the effectiveness of drug-eluting stents for the treatment of symptomatic in-stent restenosis.

Background: In this new-era of drug-eluting stents (DES) the impact of symptomatic in-stent restenosis (ISR) is diminishing. However, world wide bare-metal stents remain widely used and therefore, it is imperative to establish a simple and effective form of treatment. The objective of this registry database was to evaluate the 'real-world' effectiveness of DES for the treatment of symptomatic bare-metal stent ISR.

Effect of percutaneous coronary intervention of nonacute total coronary artery occlusions on QT dispersion.

Background: Myocardial ischemia is one of several potential causes of increased QT dispersion (QTd) in patients with nonacute total coronary artery occlusions (TCOs). We sought to assess the effect of percutaneous revascularization (PCI) of TCO on QTd and the relationship between QTd and long-term vessel patency.

Methods: Seventy patients enrolled in the TOSCA were analyzed.

The Canadian study of the sirolimus-eluting stent in the treatment of patients with long de novo lesions in small native coronary arteries (C-SIRIUS).

Objectives: We assessed the safety and effectiveness of the sirolimus-eluting stent (SES) in treating single de novo long lesions in small native coronary arteries compared to an identical bare metal stent (BMS).

Background: The SES was previously demonstrated to reduce restenosis significantly. However, patients with long lesions in small vessels have not been well studied and may define a group at very high risk.