Aortic Valve Stenosis Treatment Disparities in the Underserved: JACC Council Perspectives.

Underserved minorities make up a disproportionately small subset of patients in the United States undergoing transcatheter and surgical aortic valve replacement for aortic stenosis. The reasons for these treatment gaps include differences in disease prevalence and patient, health care system, and disease-related factors. This has major implications not only for minority patients, but also for other groups who face similar challenges in accessing state-of-the-art care for structural heart disease.

Early Access to the Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm: The Minnesota Resuscitation Consortium Twin Cities Unified Protocol.

Background: In 2013 the Minnesota Resuscitation Consortium developed an organized approach for the management of patients resuscitated from shockable rhythms to gain early access to the cardiac catheterization laboratory (CCL) in the metro area of Minneapolis-St. Paul.

Methods And Results: Eleven hospitals with 24/7 percutaneous coronary intervention capabilities agreed to provide early (within 6 hours of arrival at the Emergency Department) access to the CCL with the intention to perform coronary revascularization for outpatients who were successfully resuscitated from ventricular fibrillation/ventricular tachycardia arrest.

"No culprit" ST-elevation myocardial infarction: role of cardiac magnetic resonance imaging.

Patients with presumed ST-elevation myocardial infarction (STEMI) have no clear culprit artery in approximately 10-15% of cases. We examined the value of cardiac magnetic resonance (CMR) for diagnosis in patients with "no culprit" STEMI. Data from a comprehensive prospective registry of STEMI patients were reviewed from March 2003 to December 2009.

Treatment of refractory angina in patients not suitable for revascularization.

A growing number of patients, particularly those with advanced, chronic coronary artery disease, experience symptoms of angina that are refractory to treatment with β-blockers, calcium-channel blockers, and long-acting nitrates, despite revascularization. The management of patients with refractory angina who are unsuitable for further revascularization is strikingly different across the world, and is contingent on local resources and available expertise. Mortality in this patient population has decreased, but enhancing quality of life remains a challenge.

Percutaneous management of a long saphenous vein graft aneurysm: a case report and review of literature.

Aneurysms of saphenous vein grafts are rare but can result in complications such as myocardial infarction or death. Percutaneous treatment has included a variety of approaches, including covered stents. Long aneurysms in saphenous vein grafts pose an additional challenge due to the lack of coronary covered stents with sufficient length.

Improved efficiency in acute myocardial infarction care through commitment to emergency department-initiated primary PCI.

Study Objective: Demonstrate improved efficiency of initial and subsequent in-hospital care following emergency department (ED) physician-initiated primary angioplasty (1 PCI).

Methods: An observational study was undertaken in ST-elevation myocardial infarction patients presenting to a community hospital emergency department. Outcomes of patients who received ED physician-directed 1 PCI were compared with patients previously treated by a mix of ED physician and cardiologist co-determined thrombolysis or 1 PCI.