The importance of bifurcation lesions in patients undergoing percutaneous coronary interventions in ST-segment elevation myocardial infarction.

Background: Bifurcation lesions at the time of emergent PCI for STEMI are relatively common. However, there are little data regarding their significance. The objective of this study is to evaluate the impact of bifurcation lesions in the setting of emergent percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).

Meta-analysis of prospective randomized controlled trials comparing intracoronary versus intravenous abciximab in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Abciximab is a glycoprotein IIb/IIIa receptor inhibitor that has been shown to improve outcomes in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention (pPCI). An earlier study reported better efficacy with intracoronary (IC) compared to intravenous (IV) administration, but this finding has not been duplicated in other studies, thus leaving a great deal of uncertainty as to the most efficacious route of administration. To investigate if IC abciximab compared to IV administration decreases mortality and major adverse cardiac events in patients with ST-segment elevation myocardial infarction who undergo pPCI, a meta-analysis was performed consisting only of prospective randomized controlled trials.

The impact of iso-osmolar contrast use in emergent percutaneous coronary intervention for ST-segment elevation myocardial infarction.

The incidence of contrast-induced nephropathy (CIN) in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) was previously reported to be as high as 19%. Iso-osmolar contrast has frequently been used for populations at high risk for CIN, but a recent meta-analysis did not show a significant benefit of using iso-osmolar contrast in preventing CIN. The aim of our study is to evaluate the impact of iso-osmolar contrast use in patients undergoing emergent PCI.

Transradial cardiac catheterization: a review of access site complications.

Transradial catheterization (TRC) has been associated with a lower incidence of major access site related complications as compared to the transfemoral approach. With the increased adoption of transradial access, it is essential to understand the potential major and minor complications of TRC. The most common complication is asymptomatic radial artery occlusion, which rarely leads to clinical events, owing to the dual collateral perfusion of the hand.

Randomized comparison of transradial coronary angiography via right or left radial artery approaches.

Previous studies have shown that the right radial approach encounters more tortuosity than the left radial approach during transradial coronary angiography. The objective of this study was to compare the procedural difficulty of the right and left radial approaches in the modern era with dedicated transradial catheters. One hundred ninety-three patients scheduled for transradial coronary angiography with normal Allen test results and without histories of coronary artery bypass grafting were randomized to the right or left radial approach.

Long-term outcome of bifurcation stenting with drug-eluting stents.

There are little long-term clinical data regarding the safety and efficacy of using 2 drug-eluting stents (DESs) to treat coronary bifurcation lesions. We obtained clinical follow-up for 124 consecutive patients who underwent bifurcation stenting with 2 DESs. Major adverse cardiac events (MACEs) were defined as cardiac death, acute myocardial infarction (AMI), and target vessel revascularization (TVR).

Relation of race (Asian, African-American, European-American, and Hispanic) to activated clotting time after weight-adjusted bolus of heparin during percutaneous coronary intervention.

A weight-adjusted bolus of heparin (70 to 100 IU/kg) is recommended to achieve adequate anticoagulation during percutaneous coronary intervention (PCI). Proper dosing is mandatory to avoid bleeding and thrombotic complications. We investigated whether sensitivity to heparin is affected by difference in race.

Frequency of severe renal artery stenosis in patients with severe thoracic aortic plaque.

Atherosclerotic renal artery stenosis (RAS) is an underdiagnosed disorder and a treatable etiology of hypertension and renal insufficiency. All patients were referred for a transesophageal echocardiogram for various indications. Abdominal ultrasound was performed in 69 patients, 43 with severe thoracic aortic plaque (> or =4 mm) and 26 controls with no or mild plaque (< or =2 mm).