Left ventricular contraction patterns in patients with suspected acute coronary syndrome and normal coronary angiograms: a new look at the takotsubo syndrome.

Background: Original descriptions of the takotsubo syndrome (TS) included a characteristic left ventricular (LV) contraction pattern, "apical ballooning." Recently, several reports have associated contraction patterns not strictly conforming to the original description with TS. The specifics of the contraction pattern seem to set TS apart from the much larger population of patients with acute coronary syndrome (ACS) but no obstructive coronary artery disease (OCAD).

The use of excimer laser for complex coronary artery lesions.

Excimer laser coronary atherectomy (ELCA) has been used for coronary intervention for more than 20 years. Advances in delivery systems for laser energy using the xenon-chlorine pulsed laser catheter deliver higher energy density with lower heat production. The Spectranetics CVX-300 (Spectranetics, Colorado Springs, CO, USA) excimer laser catheter system has been used for the treatment of complex coronary lesions.

Platelet reactivity in diabetic patients subjected to acute exercise stress test.

Background: Previous studies have reported ambiguous results regarding the effect of acute exercise on platelet reactivity in healthy and cardiac patients.

Objectives: We aimed to assess platelet reactivity among diabetic patients before and immediately after an acute exercise stress test.

Methods: Patients (controls: mean age 53.

Optical coherence tomography: a new imaging modality for plaque characterization and stent implantation.

Optical coherence tomography (OCT) is a novel, catheter-based, invasive imaging system based on near-infrared light with high image resolution (15-20 μm). The system allows for unparalleled imaging of the coronary artery lumen, plaque characterization, assessment of coronary stent strut apposition, neointimal coverage, vascular proliferative response, complications such as focal dissection or thrombus formation, and insight into the time course of stent endothelization. This review will describe the currently available developments in OCT technology and its application in both the clinical and research arenas.

Effect of insurance type on adverse cardiac events after percutaneous coronary intervention.

Previous studies have documented disparities in both access to invasive cardiovascular procedures and outcomes in patients with Medicaid, Medicare, or no insurance. Outcomes by insurance have yet not been examined in a percutaneous coronary intervention (PCI) population. Data from patients undergoing PCI from June 2000 to June 2009 were retrospectively analyzed.

Complications and outcome of balloon aortic valvuloplasty in high-risk or inoperable patients.

Objectives: This study aimed to determine the success, complications, and survival of patients after balloon aortic valvuloplasty (BAV).

Background: The introduction of transcatheter aortic valve implantation (TAVI) BAV has led to a revival in the treatment of patients with severe aortic stenosis.

Methods: A cohort of 262 patients with severe aortic stenosis underwent 301 BAV procedures.

Outcomes of patients with acute myocardial infarction from a saphenous vein graft culprit undergoing percutaneous coronary intervention.

Objectives: We sought to describe characteristics of patients presenting with an acute MI from a SVG culprit, compared with a native culprit.

Background: Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) results in worse outcomes than native vessel PCI, but outcomes of such patients with acute myocardial infarction (MI) setting are not well-described.

Methods: Patients presenting with ST-elevation or non-ST-elevation MI undergoing PCI from 2000 to 2010 were retrospectively analyzed to identify the culprit as a SVG vs.

Pathogenesis of the Takotsubo syndrome: a unifying hypothesis.

The takotsubo syndrome (TS) is defined by a constellation of clinical observations in a subgroup of patients with acute coronary syndromes. Separating patients with TS from the general population with acute ischemic events are 2 important findings: obstructive coronary artery disease is missing, but the sine qua non is a distinctive pattern of abnormal left ventricular contraction. As with many newly recognized clinical syndromes, TS seems not to conform to accepted pathogenetic mechanisms.

Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery.

Background: Many patients with severe aortic stenosis and coexisting conditions are not candidates for surgical replacement of the aortic valve. Recently, transcatheter aortic-valve implantation (TAVI) has been suggested as a less invasive treatment for high-risk patients with aortic stenosis.

Methods: We randomly assigned patients with severe aortic stenosis, whom surgeons considered not to be suitable candidates for surgery, to standard therapy (including balloon aortic valvuloplasty) or transfemoral transcatheter implantation of a balloon-expandable bovine pericardial valve.

Lack of association between the Trp719Arg polymorphism in kinesin-like protein-6 and coronary artery disease in 19 case-control studies.

Objectives: We sought to replicate the association between the kinesin-like protein 6 (KIF6) Trp719Arg polymorphism (rs20455), and clinical coronary artery disease (CAD).

Background: Recent prospective studies suggest that carriers of the 719Arg allele in KIF6 are at increased risk of clinical CAD compared with noncarriers.

Methods: The KIF6 Trp719Arg polymorphism (rs20455) was genotyped in 19 case-control studies of nonfatal CAD either as part of a genome-wide association study or in a formal attempt to replicate the initial positive reports.

Correlates and consequences of gastrointestinal bleeding complicating percutaneous coronary intervention.

Gastrointestinal bleeding (GIB) complicating percutaneous coronary intervention (PCI) results in high mortality, but clinical factors associated with and long-term outcomes of GIB are poorly understood. We sought to examine clinical and procedural factors associated with GIB complicating PCI. We also examined the impact of GIB on 30-day mortality and 1-year major adverse cardiac events (MACEs).

Does on- versus off-hours presentation impact in-hospital outcomes of ST-segment elevation myocardial infarction patients transferred to a tertiary care center?

Objectives: To determine whether in-hospital outcome differs for transferred patients with ST-segment elevation myocardial infarction (STEMI) presenting during business (ON) hours vs. after (OFF) hours.

Background: Door-to-device (DTD) time is a prognostic factor in patients with STEMI and is longer during OFF hours.

Correlates and causes of death in patients with severe symptomatic aortic stenosis who are not eligible to participate in a clinical trial of transcatheter aortic valve implantation.

Background: Transcatheter aortic valve implantation is currently being evaluated in patients with severe aortic stenosis who are considered high-risk surgical candidates. This study aimed to detect incidences, causes, and correlates of mortality in patients ineligible to participate in transcatheter aortic valve implantation studies.

Methods And Results: From April 2007 to July 2009, a cohort of 362 patients with severe aortic stenosis were screened and did not meet the inclusion/exclusion criteria necessary to participate in a transcatheter aortic valve implantation trial.

Does black ethnicity influence the development of stent thrombosis in the drug-eluting stent era?

Background: It has been suggested that black race predicts stent thrombosis (ST) after drug-eluting stent implantation. Whether socioeconomic status or comorbid conditions confound the contribution of black race to the development of ST is unclear.

Methods And Results: We compared 1594 black patients who underwent drug-eluting stent implantation with 5642 nonblack patients.

A novel percutaneous coronary intervention risk score to predict one-year mortality.

Clinical and angiographic risk factors associated with adverse outcomes after percutaneous coronary intervention (PCI) have been included in previous validated risk scores. Complications after PCI are known to increase mortality and morbidity but have not been included in any model. Records of 6,932 consecutive patients who underwent PCI from 2000 to 2005 were reviewed.

Three-year outcomes following sirolimus- versus paclitaxel-eluting stent implantation in an unselected population with coronary artery disease (from the REWARDS Registry).

The Registry Experience at the Washington Hospital Center with Drug-Eluting Stents (REWARDS) study includes unselected patients with coronary artery disease treated with sirolimus-eluting stents (SESs; n = 2,392) or paclitaxel-eluting stents (PES; n = 1,119). This study aimed to examine the long-term safety profile of the 2 stents in a "real-world" population, especially in relation to stent thrombosis, and to compare differences in the diabetic cohort. Patients were followed for 3 years with regard to major adverse cardiac events (MACEs), including death, Q-wave myocardial infarction, and target lesion revascularization.

Insurance type influences the use of drug-eluting stents.

Objectives: We sought to examine the effect of insurance type upon the likelihood of receiving a drug-eluting stent (DES).

Background: Recent guidelines suggest that consideration of a patient's resources should play a role in decisions to use DES. Previous studies have also documented disparities in both access to care and cardiovascular outcomes according to race, insurance, and socioeconomic status.

Impact of chronic obstructive pulmonary disease on acute-phase outcome of myocardial infarction.

Several reports have alluded to the adverse effect of chronic obstructive pulmonary disease (COPD) on long-term prognosis of patients with myocardial infarction (MI). Little information is available, however, regarding the effects of a decrease in cardiopulmonary reserve imposed by COPD on in-hospital outcome of acute MI. This study aimed to evaluate the impact of COPD on acute-phase outcome of patients with acute MI.

Safety and efficacy of bivalirudin for percutaneous coronary intervention with rotational atherectomy.

Background: Although bivalirudin use in percutaneous coronary intervention (PCI) results in less bleeding compared to unfractionated heparin (UFH) use, its safety in patients undergoing rotational atherectomy (RA) is unknown.

Methods: A cohort of 503 patients who underwent PCI with RA from 2000 to 2009 was studied. Patients receiving bivalirudin (n = 322) were compared to those (n = 181) treated with UFH +/- glycoprotein IIb/IIIa inhibitor (GPI) as PCI anticoagulation.

Body mass index and bleeding complications after percutaneous coronary intervention: does bivalirudin make a difference?

Background: The association between obesity and bleeding after percutaneous coronary intervention (PCI) is not well defined. We investigated the impact of body mass index (BMI) on PCI-related bleeding, and whether bivalirudin, compared to heparin, used as PCI anticoagulant modifies this relationship.

Methods: From 2000 to 2009, 16,783 patients who underwent PCI were grouped according to 6 BMI groups: underweight (<18.

Is there still a role for intravascular ultrasound in the current practice era?

Although coronary angiogram is considered the gold standard for coronary assessment, it consistently underestimates vessel size/lesion severity, and usually misses heavy calcified plaques. Intravascular ultrasound (IVUS) technology accurately determines vessel size/lesion severity and allows a detailed plaque composition evaluation. The role of IVUS guidance after bare metal stent implantation has been explored in various trials; however, no study has tested how the pre-procedural use of IVUS might impact intervention strategy and clinical outcome.

A first-in-man, randomized, placebo-controlled study to evaluate the safety and feasibility of autologous delipidated high-density lipoprotein plasma infusions in patients with acute coronary syndrome.

Objectives: This study aimed to determine whether serial autologous infusions of selective high-density lipoprotein (HDL) delipidated plasma are feasible and well tolerated in patients with acute coronary syndrome (ACS).

Background: Low HDL is associated with increased risk of cardiovascular disease. Plasma selective delipidation converts alphaHDL to prebeta-like HDL, the most effective form of HDL for lipid removal from arterial plaques.

Prognosis of asymptomatic coronary artery disease after percutaneous coronary intervention.

The appropriate treatment for asymptomatic patients with obstructive coronary stenoses is controversial. The effect of percutaneous coronary intervention (PCI) on the prognosis of such patients is unknown. The present study compared the 1-year outcomes of patients with stable coronary artery disease (CAD) with regard to the presence or absence of symptoms after elective PCI.

Sirolimus-eluting stents versus paclitaxel-eluting stents in patients with chronic renal insufficiency.

Background: Chronic renal insufficiency (CRI) is associated with an increased incidence of restenosis and stent thrombosis. Drug-eluting stents (DES), when compared to bare metal stents (BMS), reduce the incidence of restenosis in these patients. This study aimed to examine whether there are differences in clinical outcome after implantation of sirolimus-eluting stents (SES) versus paclitaxel-eluting stents (PES) in patients with CRI who are subjected to coronary intervention.