Cath Lab Digest - October 2007 - (Page 50)

50 RESEARCH OCTOBER 2007 revascularization (TLR), and target vessel revascularization (TVR) were recorded in-hospital and during clinical follow up. Results. A total of 15 consecutive patients undergoing percutaneous coronary intervention with DES in de novo trifurcation lesions were identified. Lesions were located as follows: 13 (86.7%) at the distal left main coronary artery (LMCA) comprising the left anterior descending artery (LAD), the left circumflex artery (LCX) and an intermediate branch; 1 between the LAD, diagonal, and septal branches; and 1 between the LCX, obtuse marginal and posterior lateral branches. Stenting was performed in all 3 branches in 8 patients, in 2 branches in 6 patients, and in 1 branch in 1 patient. The mean follow-up period was 19.0 ± 8.3 months. TLR occurred in 3 patients (20%) with LMCA lesions. TVR occurred in 6 patients (40%). Of those, 3 were due to TLR, while the other 3 for progression of nontarget lesions. No deaths, Q-wave MIs or stent thromboses were recorded. Conclusion. Most trifurcation lesions were found in the distal LMCA. DES implantation in trifurcation lesions can be performed with a low incidence of death, Q-wave MI or stent thrombosis. J INVAS CARDIOL 2007;19(4):157-162. coronary intervention procedures (PCI) performed via a femoral access at a single site (WFUBMC). A total of 4,371 procedures including 2,956 CATH and 1,415 PCI performed prior to use of THP-MC, and treated with manual compression, served as the control group. Ambulation was permitted 2–3 hours after THP-MC, and 3–8 hours after MC. Propensity to receive a THP was calculated, and adjusted inhospital outcomes evaluated. Results. Time to hemostasis was similar for THP-MC (13.0 ± 3.3 min) compared to MC (14.4 ± 5.7 min), p = 0.51 for CATH, and was shorter for THP-MC (14.2 ± 5.4 minutes) compared to MC (20.1 ± 5.4 min), p <0.001, for PCI. Overall, the unadjusted incidence of any vascular complication (VC) was 0.6% for THP-MC and 1.0% for manual Methods. From March 1 to June 30, 2005, Cura stent implantation was instituted as the default strategy for percutaneous coronary intervention in 49 consecutive ST-Elevation Myocardial Infarction (STEMI) patients (male 86%; average age 55 ± 10 years; diabetes 31%). Results. The angiographic success rate was 100%. In-hospital adverse events consisted of 1 in-hospital death (2% heart failure). A total of 27 patients (56%) underwent 8month angiographic follow up. Binary restenosis occurred in 6 patients (22%), and late loss was 0.74 ± 0.89 mm. At 9-month follow up, a total of 5 patients had 6 major adverse events (1 death, 1 reinfarction, and 4 target lesion revascularizations). There was no incidence of stent thrombosis. Angioplasty for unprotected left main coronary disease in the urgent clinical setting is feasible, showing a relatively low shortand long-term rate of MACCE. compression, p = 0.036. The propensity score-adjusted odds ratio for any VC comparing THP-MC to manual compression was 0.58 (0.34–0.99) for all procedures, 0.42 (0.20–0.87) for diagnostic procedures and 0.86 (0.39–1.88) for PCI. Conclusions. In this large, singlecenter, contemporary observational study, use of THP-MC shortened manual compression time for PCI procedures, permitted early ambulation and was as safe as conventional manual compression. J INVAS CARDIOL 2007;19(4):164-170. Methods. We enrolled 51 acute myocardial infarction patients with left main disease as the culprit lesion and treated them by percutaneous coronary intervention. This cohort was followed for major adverse cardiac and cerebrovascular events (MACCE) in-hospital and at 30 days, 6 months and 1 year, and was compared with a population of 35 CABG patients matched for clinical and angiographic characteristics. Results. The estimated MACCEfree survival at 6 months and 1 year was 90% and 88%, respectively. The overall MACCE was 6%. Analysis of the surgical cohort showed an overall MACCE of 17%. In the final Cox model, significant predictors of MACCE were Parsonnet score for surgical risk (HR 1.93, 95% CI 1.15–7.3; p = 0.04) and diabetes mellitus (HR 1.73, 95% CI 1.03–3.8; p = 0.038). Conclusions. Angioplasty for unprotected left main coronary disease in the urgent clinical setting is feasible, showing a relatively low short- and long-term rate of MACCE. J INVAS CARDIOL 2007;19(5):202-206. Propensity Score Analysis of Vascular Complications after Diagnostic Cardiac Catheterization and Percutaneous Coronary Intervention Using Thrombin Hemostatic Patch-Facilitated Manual Compression Applegate RJ, Sacrinty MT, Kutcher MA, et al. Objectives. To evaluate the adjusted risk of vascular complications after thrombin hemostasis patchfacilitated manual compression (THP-MC) for femoral artery access site management. Background. Thrombin hemostatic patches shorten time to hemostasis after cardiac procedures involving femoral artery access, but whether these patches are as safe as manual compression remains uncertain. Methods. THP-MC (D-Stat Dry, Vascular Solutions, Minneapolis, Minnesota) was used in 3,464 consecutive patients including 2,464 diagnostic cardiac catheterizations (CATH) and 1,000 percutaneous Conclusion. Cura stent implantation appears to be feasible and safe in the treatment of STEMI. However, the binary restenosis rate and late loss at angiographic follow up were similar to that of bare-metal stents, and therefore compare unfavorably with other proven benchmark DES. J INVAS CARDIOL 2007;19(4):182-185. An Evaluation of Fluoroscopy Time and Correlation with Outcomes after Percutaneous Coronary Intervention Nikolsky E, Pucelikova T, Mehran R, et al. Objective. We evaluated shortterm prognosis and resource utilization of consecutive patients treated with percutaneous coronary intervention (PCI) as a function of fluoroscopy time. Background. Advances in interventional cardiology are reflected in the growing complexity of PCI leading to an increasing use of fluoroscopic guidance. The relationship between fluoroscopy time and inhospital outcomes after PCI has not been addressed. Methods. In a retrospective analysis of a prospectively collected database including a total of 9,650 patients, the mean fluoroscopy time was 18.3 ± 12.2 minutes. Outcomes were stratified by fluoroscopy time. Results. Compared to patients within the 75th percentile, those with prolonged fluoroscopy time were older and had a higher prevalence of prior coronary artery bypass surgery (CABG), chronic renal insufficiency, peripheral arterial disease, type B2/C lesions, and baseline TIMI MAY 2007 Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery in the Emergent/Urgent Setting Hendler A, Kaluski E, Blatt A, et al. Background. Treatment of unprotected left main coronary disease by percutaneous interventions, even in the urgent setting, is still not an approved indication. However, the evolution of transcatheter technology and supporting devices, along with greater skill in high-volume centers, led the interventional community to deal with these cases. This study aimed to investigate whether the percutaneous approach in this cohort could be a viable alternative to coronary artery bypass graft (CABG) surgery in the urgent setting. Sirolimus-Eluting, Bioabsorbable Polymer-Coated Constant Stent (Cura™) in Acute ST-Elevation Myocardial Infarction: A Clinical and Angiographic Study (CURAMI Registry) Lee C, Lim J, Low A, et al. Background. There are safety concerns over the current polymerbased drug-eluting stents (DES) on the possible delayed healing process and adverse reactions to the polymer when drug elution is completed. Cura™ (Orbus Neich) is a sirolimuseluting, bioabsorbable, polymercoated constant stent.

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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