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Abstract: Background: Meta-analysis of randomized trials showed superior efficacy and similar safety of drug-eluting stent over bare-metal stent in acute ST-elevation myocardial infarction (STEMI) patients. However, long-term relative outcomes of sirolimus- (SES) vs. paclitaxel-eluting stent (PES) have not been fully evaluated in randomized studies. This study compared long-term safety and efficacy of these two stents in STEMI. Methods: A total of 308 STEMI patients were randomly treated with SES (n =154) or PES (n =154). Three-year clinical outcomes were assessed. Primary outcome of interest was incidence of major adverse cardiac events (MACE) including death, myocardial infarction (MI), stent thrombosis or target vessel revascularization (TVR). Secondary outcome of interest was occurrence of very late stent thrombosis. Results: Both groups had similar baseline characteristics. During follow-up, there was no difference between the two groups in terms of death (6.5% for SES and 10.4% for PES, p =0.22), MI (2.6% vs. 3.9%, p =0.75), stent thrombosis (1.9% vs. 3.2%, p =0.72), TVR (3.9% vs. 8.4%, p =0.15) and MACE (12.3% vs. 18.8%, p =0.12). Eight patients in overall population had stent thrombosis: definite 3, probable 1, and possible 4. Cumulative incidence of stent thrombosis was gradually increased; 0.6% at 30days, 0.6% at 1year, 1.6% at 2years, and 2.6% at 3years. Very late stent thrombosis, definite or probable, occurred in 0.6% for both. Conclusion: Among non-selected STEMI patients who underwent primary angioplasty, both SES and PES might be safe and SES showed similar three-year clinical outcomes compared to PES. [Copyright &y& Elsevier]

Abstract: Background: Stent fractures after drug-eluting stent (DES) implantation have not been evaluated sufficiently in patients with long coronary artery disease. Methods: This study comprised of 415 patients, who were enrolled in the Long-DES-II study and had a complete serial angiography both before and after procedure and also at follow-up. The lesions were ≥25 mm in length and were randomly treated with sirolimus-eluting stents (SES, 210 lesions) or paclitaxel-eluting stent (205 lesions). Results: DES fracture was identified in 7 lesions (1.7%): 1 minor, 3 moderate, and 3 severe fractures. Most of the fractures occurred in patients who received SES (85.7%) and in the right coronary artery (RCA) lesions (71.4%). Lesions with fracture had a smaller minimal lumen diameter before procedure than lesions without fracture (0.38±0.55 vs. 0.71±0.46 mm, p =0.043). However, acute gain (2.28±0.39 vs. 1.44±0.60 mm, p =0.001) and late loss (0.81±0.49 vs. 0.42±0.50 mm, p =0.033) in analysis segment were greater in lesions with fracture. By multivariate analysis, the independent predictor of fracture was the RCA lesion (Odds ratio, 7.81; 95% CI, 1.45∼42.04; p =0.017). Although one patient had an intermediate angiographic narrowing at the fracture site, there was no adverse cardiac event related with fracture. Conclusions: The incidence of stent fracture in long DES implantation was not common and was associated with SES implantation or RCA lesions. Fortunately, the clinical prognosis of DES fracture was somewhat benign. [Copyright &y& Elsevier]

Abstract: The present study examined the alternative treatment of sirolimus-eluting stent (SES) implantation for in-stent restenosis (ISR) of the unprotected left main coronary artery (LMCA). Twelve patients underwent SES deployment for bare-metal ISR in the LMCA. ISR were 24±11 mm in length and located at the ostial (n =1) and distal (n =11) portion of LMCA. Bifurcation lesions were treated with one of three techniques: the stent crossing the left circumflex artery (n =7), kissing stenting (n =2) or the Crush technique (n =2). All procedures were performed using intravascular ultrasound guidance. Periprocedural CK-MB elevation ≥3 times normal occurred in 2 patients. There were no cases of significant narrowing in the left circumflex artery after the procedure. At the one-year follow-up, one patient died and there were no incidents of myocardial infarction or target lesion revascularization. The present study suggests that SES implantation may be a feasible therapeutic option for treating ISR in unprotected LMCA. [Copyright &y& Elsevier]

Abstract: With technical improvement, noninvasive cardiac imaging modalities, including multislice computed tomography and magnetic resonance imaging, can offer sufficient imaging quality to differentiate cardiac anatomies. These noninvasive modalities also can identify aortic and pulmonary vascular abnormalities clearly in the same study. We report a case with severe pulmonary hypertension associated with peripheral pulmonary stenosis and supravalvular aortic stenosis in a 29-year-old woman with Williams syndrome, which was identified similarly with both invasive and noninvasive imaging modalities. The need for invasive tests can be reduced with appropriate improvement and validation of these noninvasive tests. [Copyright &y& Elsevier]

Abstract Background We aimed to compare the myocardial ischemic burden assessed using semi-quantitative and quantitative analysis of computed tomography-myocardial perfusion imaging (CT-MPI) with that of single-photon emission computed tomography (SPECT). Methods From 2011 to 2013, 97 patients who underwent CT-MPI and SPECT were evaluated. The extent and severity of perfusion defects were assessed on a 5-point scale using a standard 16-segment model, and were expressed as summed stress score (SSS) and summed difference score (SDS). Receiver operating characteristic (ROC) curves for quantitative parameters were generated for the diagnosis of abnormal perfusion defect (SSS ≥ 4) and presence of ischemia (SDS ≥ 2) on SPECT. Results On CT-MPI, 298 (19.2%) of the 1552 segments showed perfusion abnormalities during stress, whereas perfusion abnormalities were shown in 179 (11.5%) segments on SPECT-MPI. On a per-person basis, there was good agreement, with intraclass correlation coefficients of 0.78 for SSS and 0.72 for SDS. A significant reduction of attenuation in stress and myocardial perfusion reserve index, along with an increase in % defect volume of CT-MPI, were demonstrated as the degree of perfusion defect or ischemia on SPECT increased. On the ROC curves, % defect volume on CT-MPI demonstrated the highest area under the curve: 0.91 for abnormal perfusion defect and 0.89 (all p < 0.001) for the presence of ischemia on SPECT. Conclusions Semi-quantitative analysis of CT-MPI showed good accordance with SPECT. A quantitative approach for CT-MPI, especially % defect volume, may provide additional value in the identification of myocardial perfusion abnormalities. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT01696006. Highlights • CT-MPI showed good agreement with SPECT by a semi-quantitative approach. • The % defect volume demonstrated excellent accuracy in the detection of perfusion abnormality on SPECT. • The % defect volume may play an additional role to identify myocardial perfusion defect and ischemia. [ABSTRACT FROM AUTHOR]

Abstract: Background: The clinical and echocardiographic parameters associated with the risk of developing new onset atrial fibrillation (AF) in congestive heart failure (CHF) have not been studied comprehensively. We determined if dyssynchronous left atrial (LA) lengthening and contraction predicted future development of new onset AF in patients with CHF. Methods: One hundred fifty-eight patients who were admitted for CHF without past or current AF were evaluated. We measured the time to peak velocity and time to peak strain with reference to the QRS complex during ventricular systole (reservoir) and late diastole (atrial contraction) in mid-portion of 4 LA walls. Dyssynchronous atrial lengthening and contraction (atrial dyssynchrony) was defined as the standard deviation of each parameter. Results: New onset AF developed in 21 patients (13.3%) after a mean follow-up of 43±15 months. Based on univariate Cox analysis, older age, larger LA dimension and volume index, lower LA fractional shortening, and the presence of atrial dyssynchrony were associated with new onset AF. In multivariate Cox analysis, atrial dyssynchrony based on strain (>39 ms, HR 10.0, p =0.003) and LA size (≥45 mm, HR 4.3, p =0.016) were independent predictors of new onset AF in CHF. Conclusions: We demonstrated that atrial dyssynchrony based on strain is the strongest univariate and multivariate predictor for new onset AF in hospitalized patients with CHF. [Copyright &y& Elsevier]