Search

The objectives of this study were to investigate the incidence, predictors, and clinical significance of isolated postprocedural troponin-I elevations in a consecutive series of patients who underwent percutaneous coronary intervention. We observed, in a series of 1,128 patients, that isolated troponin-I elevations without concomitant creatine kinase elevations occurred in 17% of patients after percutaneous coronary intervention, and that even troponin-I elevations 5 times above the upper limit of normal did not predict events after hospital discharge.

Among 214 patients treated with abciximab within 24 hours of full-dose thrombolytic therapy, major bleeding occurred in 50 patients (23%; 95% confidence interval [CI] 18% to 30%) and intracranial hemorrhage occurred in 3 patients (1.4%; 95% CI 0.3% to 4%). The independent multivariate predictors of major bleeding were age (odds ratio [OR] 1.53/10 years, 95% CI 1.05 to 2.21, p = 0.03), time from thrombolytic to abciximab (OR 0.91/hour, 95% CI 0.83 to 0.99, p = 0.03), and intra-aortic balloon pump insertion (OR 4.42, 95% CI 2.00 to 9.72, p = 0.0002).

Percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) is associated with higher rates of adverse cardiac events. Recent data suggest that adverse events are reduced in DM after PCI using stents with abciximab. We performed a retrospective analysis of a prospective PCI registry for all patients with DM who underwent stent placement at the Mayo Clinic from 1995 to 1997 (n = 570), and divided them into 2 groups based on whether abciximab was administered. Characterization and comparison of the clinical and angiographic variables, procedural outcomes, and short- and long-term event rates between groups was performed. The baseline clinical characteristics of the groups were similar, but patients treated with abciximab were more likely to be men with a lower left ventricular ejection fraction. Patients treated with abciximab had more multivessel intervention, saphenous vein graft intervention, and thrombus before intervention. The 30-day mortality rate (0.6% vs 3.0%, p = 0.03) and repeat PCI (0% vs 1.1%, p = 0.03) was lower in patients treated with abciximab. The 30-day rates of bypass surgery, myocardial infarction (MI), and a composite of death, MI, and revascularization were similar. The 1-year event rates did not differ significantly between patients taking and not taking abciximab for the end points of death (8.9% vs 8.8%, p = 0.97), MI (13.3% vs 11.4%, p = 0.57), bypass surgery (10.3% vs 6.2%, p = 0.20), repeat PCI (14.7% vs 15.9%, p = 0.76), and a composite of death, MI, and revascularization (30.4% vs 26.7%, p = 0.43). After adjusting for baseline variables, abciximab did not influence the occurrence of late adverse events.

In patients receiving coronary stents treated with aspirin and coumadin, the peak incidence of stent thrombosis occurs on the fifth and sixth days following the implantation procedure. Little is known about the timing of stent thrombosis in patients treated with aspirin and ticlopidine. We compared the timing of coronary stent thrombosis in patients treated with ticlopidine and aspirin with the timing in those receiving coumadin and aspirin. A retrospective databank analysis was performed and 39 patients were identified who experienced stent thrombosis after successful coronary stent implantation. Of these, 21 had been treated with ticlopidine and aspirin and 18 with coumadin and aspirin therapy. The median time from stent implantation to stent thrombosis in the ticlopidine and aspirin group was 12 hours (interquartile range 6 to 72 hours) compared with 4 days in the coumadin and aspirin group (interquartile range 21 to 68 hours) (p

Transcatheter aortic valve implantation (TAVI) has become an option for patients with symptomatic severe aortic stenosis whose co-morbidities place them at high surgical risk. However, little is known regarding treatment allocation. From May 2008 to May 2011, all high-risk patients with symptomatic severe aortic stenosis referred to an experienced single-center TAVI clinic were reviewed. A total of 170 consecutive patients were evaluated. Of these, 58 (34%) were accepted for TAVI (mean age 81 ± 8 years). Thirty-three patients (19%) were accepted for conventional aortic valve replacement (AVR; mean age 83 ± 6 years). Sixty-two patients (37%) were treated conservatively (mean age 83 ± 6 years). Seventeen patients (10%) died awaiting complete assessment. At 30 days, all-cause mortality was 10% in the TAVI group, 3% in the conventional AVR group, and 32% in the conservatively treated group. Multivariate-adjustment identified the absence of chronic obstructive pulmonary disease (hazard ratio 0.30, 95% confidence interval 0.09 to 0.98, p0.05) and the absence of frailty (hazard ratio 0.19, 95% confidence interval 0.07 to 0.55, p0.01) as independent predictors of conventional AVR. In conclusion, of the high-risk patients with severe aortic stenosis referred for TAVI at a large single center, approximately 1/2 were accepted for intervention (conventional AVR or TAVI), and roughly 1/3 were treated conservatively.

We conducted a retrospective comparison of paclitaxel-eluting stents (PESs, n = 60) versus bare metal stents (BMSs, n = 137) in consecutive patients who underwent primary or rescue percutaneous coronary intervention over 1 year. The PES cohort had no in-stent thromboses and had a 65% (p = 0.02) decrease in the combined end point of death, recurrent myocardial infarction, and target vessel revascularization at 1 year compared with the BMS group. PES implantation appears to be safe and possibly superior to BMS implantation in terms of 1-year major cardiovascular outcomes in the setting of ST-elevation myocardial infarction.