Impact of early versus late clopidogrel discontinuation on stent thrombosis following percutaneous coronary intervention with first- and second-generation drug-eluting stents.

Premature antiplatelet therapy discontinuation (ATD) after drug-eluting stent (DES) implantation is known to predict stent thrombosis (ST). However, recent data suggest that a shorter antiplatelet therapy duration is safe with newer generation DESs. The study aimed to compare the impact of early and late clopidogrel ATDs on ST in a real-world registry of first- and second-generation DES use.

Aortic valve ChromaFlo®: a feasibility study of aortic regurgitation and effective annular aortic area assessment in a porcine model.

Aortic valve annular complex was rediscovered after the introduction of transcatheter aortic valve replacement; and imaging has been crucial in determining the annular geometry. Although the procedure has evolved, complications related to the annular mechanical response following valve implantation, such as aortic insufficiency, still occur in practice. We documented the feasibility of invasive assessment of aortic valve annular complex and the detection of induced aortic insufficiency via intravascular ultrasound with ChromaFlo® technology in a porcine model.

Intra-stent tissue evaluation within bare metal and drug-eluting stents > 3 years since implantation in patients with mild to moderate neointimal proliferation using optical coherence tomography and virtual histology intravascular ultrasound.

Objective: We aimed to compare neointimal tissue characteristics between bare-metal stents (BMS) and drug-eluting stents (DES) at long-term follow-up using optical coherence tomography (OCT) and virtual histology intravascular ultrasound (VH-IVUS).

Background: Neoatherosclerosis in neointima has been reported in BMS and in DES.

Methods: Thirty patients with 36 stented lesions [BMS (n=17) or DES (n=19)] >3years after implantation were prospectively enrolled.

Operator learning curve for transradial percutaneous coronary interventions: implications for the initiation of a transradial access program in contemporary US practice.

Objectives: Our study aimed to assess the characteristics and outcomes of transfemoral approach (TFA) versus the initial steps of a transradial approach (TRA) program and to assess the learning curve of TRA in contemporary, US practice.

Background: When compared to TFA, TRA has been shown to lower bleeding and vascular complications during percutaneous coronary intervention (PCI). However, use of TRA is still low.

Intravascular ultrasound evidence of perivascular trauma during routine percutaneous coronary intervention.

We assessed whether intravascular ultrasound (IVUS) can detect evidence of coronary perforation that is not visible by coronary angiography. Approximately 15,000 consecutive percutaneous coronary interventions (PCI) performed with IVUS guidance were reviewed retrospectively, pre- and post-PCI IVUS images were compared, and IVUS findings were compared with coronary angiography and in-hospital outcomes. We detected three distinct patterns that were not present pre-PCI and that were suggestive of perforation or perivascular trauma: perivascular blood speckle in 67 % (51/76), perivascular hematoma in 17 % (13/76), and new echolucent perivascular layer in 16 % (12/76).

Long-term safety and efficacy of the everolimus-eluting stent compared to first-generation drug-eluting stents in contemporary clinical practice.

Objective: This study aimed to assess the long-term safety and clinical effectiveness of the Xience V everolimus-eluting stent (EES) compared to both Taxus paclitaxel-eluting stent (PES) and Cypher sirolimus-eluting stent (SES) in an unselected patient population.

Background: There are limited long-term data comparing Xience V EES vs the first-generation Cypher SES.

Methods: This retrospective analysis included 6069 patients treated with Cypher SES, Taxus PES, or Xience V EES from 2003-2009 at our institution.

Drug-eluting stents in patients on chronic hemodialysis: paclitaxel-eluting stents vs. limus-eluting stents.

Background: Patients requiring chronic hemodialysis (HD) are at high risk for restenosis after percutaneous coronary intervention (PCI) with bare metal stents. Outcome data on drug-eluting stent (DES) implantation in HD patients are limited and suggest superiority of paclitaxel-eluting stents (PES) over limus-eluting stents (LES).

Methods: In total, 218 consecutive patients were prospectively enrolled.

Relation of preprocedural assessment of myocardial contractility reserve on outcomes of aortic stenosis patients with impaired left ventricular function undergoing transcatheter aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) is associated with improved left ventricular (LV) function in patients with aortic stenosis (AS) and LV dysfunction; however, the outcome after TAVI of patients with low left ventricular ejection fraction (LVEF) is unclear. This study aimed to characterize the baseline, procedural, and long-term outcomes of patients with low LVEF undergoing TAVI and to assess the prognostic utility of pre-TAVI balloon aortic valvuloplasty (BAV) and dobutamine stress echocardiography (DSE) to predict TAVI benefits. Consecutive patients with symptomatic severe AS who underwent TAVI from 2007 to 2013 were analyzed.

Long-term safety and efficacy of second-generation everolimus-eluting stents compared to other limus-eluting stents and bare metal stents in patients with acute coronary syndrome.

Objectives: This study aimed to investigate the long-term safety and efficacy of everolimus-eluting stents (EES) compared with other limus-eluting stents and bare metal stents (BMS) in ACS patients.

Background: There have been concerns about the long-term safety of drug-eluting stents in the setting of acute coronary syndrome.

Methods: The study cohort included 1,612 patients presenting with acute coronary syndrome who underwent BMS, SES, E-ZES, or EES implantation.

Acquired thrombocytopenia after transcatheter aortic valve replacement: clinical correlates and association with outcomes.

Aims: This study aimed to evaluate incidence and correlates for low platelet count after transcatheter aortic valve replacement (TAVR) and to determine a possible association between acquired thrombocytopenia and clinical outcomes.

Methods And Results: Patients undergoing TAVR from two medical centres were included in the study. They were stratified according to nadir platelet count post procedure: no/mild thrombocytopenia, ≥100 × 10(9)/L; moderate, 50-99 × 10(9)/L; and severe, <50 × 10(9)/L.

Safety and long-term outcomes after percutaneous coronary intervention in patients with human immunodeficiency virus.

Objective: This study aims to report the long-term outcomes after percutaneous coronary intervention (PCI) in human immunodeficiency virus (HIV+) patients.

Background: Sparse data exists regarding the risk of patients with HIV who undergo PCI.

Methods: Using a case-control design, we compared baseline characteristics, procedure-related outcomes, in-hospital, and 2-year clinical outcomes of 112 consecutive HIV+ patients versus 112 HIV- controls matched for age, gender, and diabetes mellitus who underwent PCI from April 2003 to September 2011.

Impact of previous coronary artery bypass grafting on patients undergoing transcatheter aortic valve implantation for aortic stenosis.

Re-operation after coronary artery bypass grafting (CABG) is associated with increased risk for morbidity and mortality. Transcatheter aortic valve implantation (TAVI) is an alternative for patients with aortic stenosis, but the outcomes of patients with a history of CABG are unknown. The aim of this study was to explore the association between previous CABG and the outcome of patients undergoing TAVI.

Incidence and correlates in the development of iatrogenic femoral pseudoaneurysm after percutaneous coronary interventions.

Objective: We aimed to identify the correlates in the development of post-percutaneous coronary intervention (PCI) iatrogenic femoral pseudoaneurysm (IFP).

Background: IFP is one of the more common vascular complications of PCI.

Methods: From February 2008 to June 2012, 10,169 consecutive patients who underwent PCI were retrospectively studied.

Correlates for mortality in patients presented with acute myocardial infarct complicated by cardiogenic shock.

Objective: This study aimed to explore the correlates for mortality in patients treated with both primary percutaneous coronary intervention (PCI) and intra-aortic balloon pump counter-pulsation (IABP).

Background: Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is associated with high mortality rates.

Methods: From a cohort of patients with AMI, treated with both primary PCI and IABP and who met strict definitions for CS to identify correlates associated with mortality, the study compared patients who died in-hospital to those who survived to discharge.

Management of a large atrial septal occluder embolized to the left ventricular outflow tract without the use of cardiac surgery.

Transcatheter closure of secundum-type atrial septal defects (ASDs) using the AMPLATZER™ Septal Occluder (ASO) has been in use for more than a decade since its US Food and Drug Administration approval in 2001. Device embolization remains an uncommon complication, which can sometimes occur after the initial deployment. Previous reports of ASO devices embolized to the left ventricle have primarily been managed by open-heart surgical retrieval.

Commercial versus PARTNER study experience with the transfemoral Edwards SAPIEN valve for inoperable patients with severe aortic stenosis.

In patients with aortic stenosis who cannot have surgery, transcatheter aortic valve replacement using the Edwards SAPIEN valve has been shown to improve survival rate and is approved for commercial use in the United States. This study aims to assess the clinical profile, procedural characteristics, and in-hospital complications in patients treated with a commercial SAPIEN valve outside the clinical trial context. We retrospectively analyzed 69 consecutive patients who underwent transcatheter aortic valve replacement with a commercial SAPIEN valve compared with 55 Placement of AoRTic traNscathetER valves (PARTNER) trial patients from cohort B enrolled in the same institution by the same Heart Team.

A propensity score matched analysis to determine if second-generation drug-eluting stents outperform first-generation drug-eluting stents in a complex patient population.

Background: Drug-eluting stents (DES) are routinely used in complex patients, but the impact of 1st- versus 2nd-generation DES on clinical outcomes has not been well described. This study aimed to assess the efficacy and safety of 2nd-generation (everolimus-eluting) DES compared to 1st-generation (sirolimus- and paclitaxel-eluting) DES in a selected, higher-risk population with complex clinical and angiographic features.

Methods: The study included 5693 consecutive patients with the presence of ≥ 1 predefined complex clinical and angiographic characteristic treated with either generation DES.

Outcomes of patients with chronic lung disease and severe aortic stenosis treated with transcatheter versus surgical aortic valve replacement or standard therapy: insights from the PARTNER trial (placement of AoRTic TraNscathetER Valve).

Objectives: The study aimed to evaluate the impact of chronic lung disease (CLD) on outcomes of severe aortic stenosis patients across all treatment modalities.

Background: Outcomes of patients with CLD undergoing transcatheter aortic valve replacement (TAVR) have not been systematically examined.

Methods: All patients who underwent TAVR in the PARTNER (Placement of AoRTic TraNscathetER Valve) trial, including the continued access registry (n = 2,553; 1,108 with CLD), were evaluated according to CLD clinical severity.

Effect of marital status on the outcome of patients undergoing elective or urgent coronary revascularization.

Background: Marriage confers various health advantages in the general population. However, the added value of marriage among patients who undergo percutaneous coronary intervention (PCI) beyond the standard cardiovascular risk factors is not clear. This study aimed to assess the effects of marital status on outcomes of patients undergoing elective or urgent PCI.

Safety and feasibility of performing staged non-culprit vessel percutaneous coronary intervention within the index hospitalization in patients with ST-segment elevation myocardial infarction and multivessel disease.

Objectives: To determine whether staged percutaneous coronary intervention (PCI) within the same hospitalization as primary PCI is safe.

Background: In ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease undergoing primary PCI, staged non-culprit vessel PCI at a separate session is recommended.

Methods: We conducted a retrospective analysis of 282 consecutive STEMI patients with multivessel disease who underwent primary PCI followed by staged PCI of the non-culprit vessel.

Prognostic implications of percutaneous coronary interventions performed according to the appropriate use criteria for coronary revascularization.

Objectives: To assess the prognostic implication of the ACCF/AHA/SCAI appropriate use criteria (AUC) for coronary revascularization in a cohort of non-acute coronary syndrome patients.

Background: The AUC for coronary revascularization were developed in order to deliver high-quality care; however, the prognostic impact of these criteria remains undefined.

Methods: Consecutive patients (n=3817) undergoing elective percutaneous coronary intervention (PCI) at MedStar Washington Hospital Center since the 2009 AUC publication were retrospectively grouped according to AUC as an "Appropriate," "Inappropriate," or "Undetermined" indication for PCI.

Racial disparity with on-treatment platelet reactivity in patients undergoing percutaneous coronary intervention.

Background: On-treatment platelet reactivity to clopidogrel is variable and in part genetic dependent. In African American (AA) patients, the relation between on-treatment platelet reactivity to clopidogrel and the factors that influence this interaction is unknown. The present study aims to evaluate on-treatment platelet reactivity to clopidogrel in AA patients and its interaction to race and CYP2C19*2 loss of function mutation.