Cath Lab Digest - October 2007 - (Page 49)

OCTOBER 2007 RESEARCH 49 Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology Selected abstracts from March 2007 through August 2007 Full article text can be obtained at www.invasivecardiology.com. All abstracts are reprinted with permission. Standard high-pressure stent implantation frequently results in suboptimal stent expansion by intravascular ultrasound (IVUS) criteria. baseline risk factors and procedural characteristics, there was no significant difference in the composite endpoint of in-hospital death, myocardial infarction (MI), and repeat revascularization between men and women (6.38% in men and 2.48% in women; p = 0.051), but women had a higher rate of major and minor bleeding (0.5 vs. 2.5; p = 0.019; and 0.5 vs. 2.3; p = 0.021, respectively). On multiple logistic regression analysis, female gender was an independent risk factor for bleeding post-PCI (adjusted odds ratio [OR]5.6, 95% confidence intervals [CI]: 1.15–27.45). Conclusion. Although there is no difference in the in-hospital composite endpoint of death, MI, and repeat revascularization, African-American women are at increased risk for bleeding complications post-PCI, even when a GPI bolus-only strategy is used. J INVAS CARDIOL 2007;19(3):123-128. MARCH 2007 The Angiographic Step-Up and Step-Down: A Surrogate for Optimal Stent Expansion by Intravascular Ultrasound Haldis TA, Fenster B, Gavlick K, et al. Background. Standard high-pressure stent implantation frequently results in suboptimal stent expansion by intravascular ultrasound (IVUS) criteria. We aim to show that routine expansion of the stent to a diameter greater than the reference segment, leading to an angiographic “step-up” at the proximal stent edge and “step-down” at the distal stent edge, results in improved stent expansion. Methods. We studied 25 patients undergoing coronary stent implantation. Twelve patients were randomized to standard sizing and 13 patients to step-up and step-down sizing as the angiographic goal. IVUS was then performed on all patients to detect incomplete stent strut apposition, dissection within the stent or a suboptimal stent expansion index (SEI). SEI was defined as the minimum stent area (MSA)/average reference lumen area x 100. Optimal SEI was defined as ≥90% for a MSA9.0 mm2. Results. Four patients (33%) treated with standard stent implantation and 12 patients (92%) treated with the step-up and step-down approach (p = 0.004) achieved optimal stent expansion. No patients in either group had unapposed stent struts or in-stent dissection on IVUS. There were no major adverse cardiac events on 6-month follow up. Conclusions. Stent deployment with an angiographic step-up and step-down approach improves the likelihood of optimal stent deployment by IVUS criteria as compared to the standard angiographic endpoint. This stenting technique is a simple and frugal alternative to IVUS-guided percutaneous coronary intervention, achieving very high rates of adequate stent apposition and expansion. J INVAS CARDIOL 2007;19(3):101–105. Impact of Gender on In-Hospital Percutaneous Coronary Interventional Outcomes in African-Americans Poludasu S, Cavusoglu E, Clark LT, et al. Background. Previous studies on outcomes following percutaneous coronary intervention (PCI) have shown an increased rate of in-hospital mortality and vascular complications in women compared to men. The impact of gender on post-PCI outcomes in African-Americans has not been reported. Methods. We retrospectively analyzed 835 consecutive AfricanAmerican patients (n = 392 men and n = 443 women) who underwent PCI using a glycoprotein IIb/IIIa inhibitor (GPI) bolus-only strategy from January 2003 to August 2004 at a single institution. Baseline characteristics, procedural data, and inhospital outcomes were recorded. Results. Women were older and had a higher mean body mass index (BMI) compared to men. Men were more likely to be smokers, more often had triple-vessel disease and left ventricular dysfunction compared to women. There were no deaths or repeat revascularizations in either group. After adjustment for Limitations of Using a GuardWire® Temporary Occlusion and Aspiration System in Patients with Acute Myocardial Infarction: Multicenter Investigation of Coronary Artery Protection with a Distal Occlusion Device in Acute Myocardial Infarction (MICADO) Matsuo A, Inoue N, Suzuki K, et al. Background. The benefits of using distal protection during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) remain unknown. The prevention of no-reflow in PCI is considered a challenge and could be a contributing factor for long-term prognosis. Objectives. This study evaluated the efficacy of distal protection with the GuardWire ® distal protection device in PCI at the time of AMI revascularization. Methods. The study was conducted as a prospective, randomized, multicenter trial. Patients with AMI within 24 hours from onset were randomized into either PCI combined with a GuardWire, or PCI without distal protection. The primary endpoints were TIMI perfusion grade (TMP) and no incidence of reflow. Secondary endpoints were major cardiac events (MACE) during 6-month follow up. Results. The incidence of noreflow was similar between the GuardWire group and the control group (4% vs. 3%). TMP 3 was seen at a higher rate in the GuardWire group, but was not statistically significant (58% vs. 44%; p = 0.054). Multivariate analysis revealed that diabetes and hyperlipidemia, but not GuardWire use, were predictors of failure to achieve TMP 3. Older age and right coronary artery (RCA) infarction were associated with achieving TMP 3. MACE was observed in similar incidences between the two groups after 6month follow up. Conclusions. From our randomized study of distal protection in PCI at the time of AMI, elderly patients or those with RCA infarction were considered good candidates for distal protection; however, we could not demonstrate an improvement in long-term outcome with the use of GuardWire distal protection. J INVAS CARDIOL 2007;19(3):132-138. APRIL 07 Drug-Eluting Stent Implantation in Coronary Trifurcation Lesions Furuichi S, Sangiorgi GM, Palloshi A, et al. Background. There is no specific study evaluating the outcome of DES implantation in trifurcation lesions. Objective. To evaluate the midterm clinical and angiographic outcome of drug-eluting stent (DES) implantation in trifurcation lesions. Methods. All complications and major adverse cardiac events, including cardiac death, Q-wave myocardial infarction (MI), target lesion http://www.invasivecardiology.com

Table of Contents Feed for the Digital Edition of Cath Lab Digest - October 2007

Saints Medical Center Fibromuscular Dysplasia in Children and Adolescents Cerebral Vascular Accident Following a Pulmonary Embolism: Search for the Hidden Patent Foramen Ovale Contents Clinical Editor’s Corner Meetings Calendar CEU Education Center Radiation Tracking in the Cardiac Catheterization Lab Letter to the Editor Carotid Stenting: An update Release from Stent-jail: Beneficial Snow-Plowing? Patient Management Guidelines Searching for a Cardiovascular Position? Tips for Creating a ‘Stand-Out’ Resume Long-Term Implications of Short-Term Closure Decisions – The Evolution to Vascular Access Management and the Boomerang Catalyst System The Ten-Minute Interview with… Angie Bowles, RN, CCRN CMS Issues Final FY 2008 IPPS Rule ACVP• Membership Page Experience with a New Workhorse Guidewire Ask the Clinical Instructor: Q&A for Those New to Cath Lab A Glimpse of the Future of Clinical Education: Boston Scientific’s SimSuite Bus Visits Carnegie Institute 2007 Educational Fair Held at the Washington Hospital Center Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology What Do You Think? A Virtual Cath Lab Viewer (VCL): The Development of an Online 3D C-arm Simulator and Coronary Anatomy Viewer Clinical & Industry News Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization

Cath Lab Digest - October 2007

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