Meditations on secondary revascularisation in the aftermath of the SYNTAX trial.

Many patients will experience a return of symptoms after their initial revascularisation procedure necessitating secondary revascularisation (SR). The options for this second procedure are inherently influenced by the primary method adopted for revascularisation. Patients with single vessel disease are most suited to percutaneous coronary intervention (PCI) for both primary and secondary revascularisation.

Five-year clinical outcomes after coronary stenting of chronic total occlusion using sirolimus-eluting stents: insights from the rapamycin-eluting stent evaluated at Rotterdam Cardiology Hospital-(Research) Registry.

Background: The use of drug eluting stents (DES) in patients with a successfully recanalized chronic total occlusion (CTO) has been associated with a significant decrease in the need for repeat revascularization, and a favorable short-term clinical outcome when compared with the use of bare metal stents (BMS). Our group, however, has previously reported similar rates of target lesion revascularisation (TLR) and major adverse cardiovascular events (MACE) at 3 years follow-up in patients with a successfully opened CTO who were treated with either a sirolimus eluting stent (SES) or a BMS. The objective of this report was to evaluate the outcomes of these patients at 5-years clinical follow-up.

Takotsubo cardiomyopathy: a review of the literature.

Although takotsubo cardiomyopathy is a rare entity, it is an important differential in patients presenting with symptoms, signs, and electrocardiographic changes suggestive of an acute myocardial infarction. Since it was first recognized in 1991, it has gained increasing attention worldwide; however, its etiology and consequently the optimal management still remains unclear. Here, the authors provide a review of the current literature accompanied with images of a typical case from our department.

Assessment of the SYNTAX score in the Syntax study.

Aims: The SYNTAX score has been designed to better anticipate the risks of percutaneous or surgical revascularisation, taking into account the functional impact of the coronary circulation with all its anatomic components including the presence of bifurcations, total occlusions, thrombus, calcification, and small vessels. The purpose of this paper is to describe the baseline assessment of the SYNTAX score in the Syntax randomised trial, the corelab reproducibility, the potential difference in score assessment between the investigator and the corelab, and to ascertain the impact on one-year outcome after either percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) in patients with complex coronary artery disease.

Methods And Results: To assess the reliability of Syntax scoring, 100 diagnostic angiograms from the Syntax trial were randomly selected and assessed independently by two observers.

Coronary angioplasty: do we need to EuroSCORE?

An effective risk score for patients undergoing coronary angioplasty is yet to be established. In this article we discuss the merits of using the EuroSCORE risk model for assessing these patients, and propose a potential modification to the system.

Carcinoid syndrome diagnosed by echocardiography.

Right heart failure is a common presentation to both general physicians and cardiologists. Echocardiography is a useful investigation, and usually imaging of the liver is confined to helping estimate the right atrial pressure. We report a case of right heart failure where incidental imaging of the liver architecture during transoesophageal echocardiography helped in establishing the final diagnosis.

Is sensible use being made of an inpatient Holter monitoring and transthoracic echocardiogram service within acute medicine?

Transthoracic echocardiograms (TTE) and 24-hour Holter recordings are commonly requested investigations for patients presenting with symptoms thought to be due to underlying cardiac pathology. The objective of this study was to audit the use of inpatient TTE and Holter monitors in acute medical patients under the care of physicians other than cardiologists within a tertiary cardiology referral centre. This was accomplished by a retrospective analysis of 4,623 TTE and 3,145 Holters reported by cardiologists between 8 October 1999 and 3 November 2005.