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Little is known about regional differences in volume, treatment, and outcomes of STEMI patients undergoing PCI during the pandemic. The objectives of this study were to compare COVID-19 pandemic and prepandemic periods with respect to regional volumes, outcomes, and treatment of patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) between January 1, 2019 and March 14, 2020 (pre-COVID period) and between March 15, 2020 and April 4, 2020 (COVID period) in 51 New York State hospitals certified to perform PCI. The hospitals were classified as being in either high-density or low-density COVID-19 counties on the basis of deaths/10,000 population. There was a decrease of 43% in procedures/week in high-density COVID-19 counties (p

Bioresorbable polymers and biocorrodible metals are the latest developments in biodegradable materials used in interventional cardiology for the mechanical treatment of coronary atherosclerosis. Poly-L-lactic acid is the most frequently used bioresorbable polymer and initial evidence of feasibility, efficacy and clinical safety following deployment of polymer-based platforms was gained after completion of the first-in-man longitudinal ABSORB registries, Cohorts A and B and ABSORB Extend. In these studies, the biologic interaction of the first-generation Absorb Bioresorbable Vascular Scaffold (BVS) (Abbott Vascular, SC, Calif., US) with the underlying vascular tissue was evaluated in vivo with multiple imaging modalities such as intravascular ultrasound (IVUS), virtual histology-IVUS, IVUS-palpography, optical coherence tomography as well as ex vivo with coronary computed tomography. Efficacy measures following this in vivo multi-imaging assessment as well as clinical safety were comparable with current generation drug-eluting stents (DES) (Abbott Vascular, SC, Calif., US) in non-complex lesions over a 3-year follow-up. Furthermore, novel properties of functional and anatomic restoration of the vessel wall during the late phases of resorption and vascular healing were observed transforming the field of mechanical treatment of atherosclerosis from delivering only acute revascularization to additionally enable late repair and subsequent restoration of a more physiologic underlying vascular tissue. Despite the sufficient evidence and the subsequent Conformite Europeenne mark approval of the first fully biodegradable scaffold (Absorb BVS) in 2012 for revascularizing non-complex lesions, the paucity of randomized comparisons of fully bioresorbable scaffolds (BRS) with metallic DES in a "real-world" clinical setting raised controversies among the interventional community for the merit of these technologies. Only recently, results from international large-scale randomized trials from the United States (U.S.), China and Japan were revealed. Herein we provide a comprehensive overview of the ABSORB III, ABSORB China and ABSORB Japan studies demonstrating the consistent non-inferiority in clinical safety and efficacy measures of the Absorb BVS vs. current generation DES.

Background.Research has shown less aggressive treatment and poorer control of cardiovascular disease (CVD) risk factors in women than men.Methods.We analyzed sex differences in pharmacotherapy strategies and attainment of goals for hemoglobin A1c (HbA1c), blood pressure (BP), and low density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes and established coronary artery disease enrolled into the BARI 2D trial.Results.Similar numbers of drugs were prescribed in both women and men. Women were less frequent on metformin or sulfonylurea and more likely to take insulin and to be on higher doses of hydroxymethylglutaryl-CoA reductase inhibitors (statins) than men. After adjusting for baseline differences and treatment prescribed, women were less likely to achieve goals for HbA1c (OR = 0.71, 95% CI 0.57, 0.88) and LDL-C (OR = 0.64, 95% CI 0.53, 0.78). More antihypertensives were prescribed to women, and yet BP ≤ 130/80 mmHg did not differ by sex.Conclusions.Women entering the BARI 2D trial were as aggressively treated with drugs as men. Despite equivalent treatment, women less frequently met targets for HbA1c and LDL-C. Our findings suggest that there may be sex differences in response to drug therapies used to treat diabetes, hypertension, and hyperlipidemia.

Aims To perform a thorough and updated systematic review of randomized clinical trials comparing tirofiban vs. placebo or vs. abciximab. Methods and results We searched for randomized trials comparing tirofiban vs. placebo or any active control. Odds ratios (OR) were computed from individual studies and pooled with random-effect methods. Thirty-one studies were identified involving 20 006 patients (12 874 comparing tirofiban vs. heparin plus placebo or bivalirudin alone, and 7132 vs. abciximab). When compared with placebo, tirofiban was associated at 30 days with a significant reduction in mortality [OR = 0.68 (0.54–0.86); P = 0.001] and death or myocardial infarction (MI) [OR = 0.69 (0.58–0.81); P < 0.001]. The treatment benefit persisted at follow-up but came at an increased risk of minor bleedings [OR = 1.42 (1.13, 1.79), P = 0.002] or thrombocytopenia. When compared with abciximab, mortality at 30 days did not differ [OR = 0.90 (0.53, 1.54); P = 0.70], but in the overall group tirofiban trended to increase the composite of death or MI [OR = 1.18 (0.96, 1.45); P = 0.11]. No such trend persisted at medium-term follow-up or when appraising studies testing tirofiban at 25 µg/kg bolus regimen. Conclusion Tirofiban administration reduces mortality, the composite of death or MI and increases minor bleedings when compared with placebo. An early ischaemic hazard disfavouring tirofiban was noted when compared with abciximab in studies based on 10 but not 25 µg/kg tirofiban bolus regimen.

HYPOTHESIS: This study was designed to investigate the clinical and angiographic features and procedural outcomes of small‐vessel stenting in a real‐world experience during the transition era between drug‐eluting stents (DES) and bare‐metal stents (BMS). METHODS: Using one of the largest single‐institutional cohorts, this study evaluated all patients who underwent percutaneous coronary intervention (PCI) from 2002 through 2005. Analysis was restricted to patients receiving a single stent or undergoing balloon‐only angioplasty in a single anatomic site. Small‐vessel stents (SVS) were defined as 2.00 to 2.75 mm and large‐vessel stents (LVS) as 3.00 to 4.00 mm in diameter. RESULTS: A total of 19 580 stents were placed in 10 396 patients. Of 6208 patients fulfilling inclusion criteria, 1630 (26.3%) received SVS, and 4578 (73.7%) received LVS. The SVS group had more female (35.5% vs 26.3%, P < .001) and diabetic patients (27.9% vs 24.2%, P < .003) than the LVS group. Compared with LVS, SVS lesions were shorter (14.5 ± 5.8 mm vs 15.7 ± 6.4 mm, P < .0001) and more complex (66% vs 53% class B2/C lesions, P = .041). Indicators of procedural difficulty, including greater contrast volume, number of devices, total inflation time, and fluoroscopy time, were more commonly observed in the SVS group. After adjustment for confounding factors, the incidence of small treatment vessel diameter was significantly higher among the DES vs the BMS group (odds ratio [OR]: = 1.94, 95% confidence interval [CI]: 1.56–2.36). CONCLUSIONS: In addition to identifying distinct patient, lesion, and procedural performance characteristics, our study, one of the largest single‐center experiences in small‐vessel PCI, suggests that the availability of DES substantially increased the use of SVS, as opposed to balloon‐only angioplasty, in this anatomically challenging setting. Copyright © 2009 Wiley Periodicals, Inc.

1.1 Document Development Process #### 1.1.1 Writing Committee Organization The writing committee was selected to represent the American College of Cardiology (ACC) and the Society for Cardiovascular Angiography and Interventions (SCAI) and included a cardiovascular training program director

Objectives. The objective of this communication was to report the long-term follow-up of all the patients treated by Dr. Andreas Gruentzing in Zurich, Switzerland. Background. The first patients to undergo percutaneous transluminal coronary angioplasty had the procedure performed by Andreas Gruentzig in Zurich between 1977 and 1980. The method of angioplasty has changed little, and the patients undergoing these first procedures were similar to many patients undergoing angioptasty today; therefore, their long-term outcome is of significant interest. Methods. All 169 patients with angioplasty during Gruentzig's years in Zurich have now been completely followed up at 10 years. All surviving patients were contacted directly or by telephone interview, and the occurrence of each cardiac procedure and coronary event was analyzed. Results. One hundred thirty-three of the 169 patients under-went successful angioplasty. Ten-year follow-up of this group revealed an overall survival rate of 89.5%. The survival rate was 95% with single-vessel disease and 81% among those with multivessel disease. Patients undergoing unsucessful dilation and those with failed angioplasty and subsequent bypass surgery had a similar 10-year survival rate. Angiographic restenosis was present in 31% at 6 months. Late restenosis between 6 months and 10 years occurred in eight patients; however, progressive of disease in undilated segments occurred in 31 patients. In addition to a better survival rate, patients with single-vessel disease were less likely to have had bypass surgery and were more likely to be angina free at the 10-year follow-up than were patients with multivessel disease (79% vs. 67%). Conclusions. This earliest angioplasty experience was also the first to demonstrate a difference in outcome between patients with single-vessel and multivessel disease treated with angioplasty. Although angioplasty is now performed in more complex patient subsets, the long-term outcome of these “classical” angioplasty patients should be applicable to similar patients treated today.

Objectives This study sought to develop a percutaneous coronary intervention (PCI) risk score for in-hospital/30-day mortality. Background Risk scores are simplified linear scores that provide clinicians with quick estimates of patients' short-term mortality rates for informed consent and to determine the appropriate intervention. Earlier PCI risk scores were based on in-hospital mortality. However, for PCI, a substantial percentage of patients die within 30 days of the procedure after discharge. Methods New York's Percutaneous Coronary Interventions Reporting System was used to develop an in-hospital/30-day logistic regression model for patients undergoing PCI in 2010, and this model was converted into a simple linear risk score that estimates mortality rates. The score was validated by applying it to 2009 New York PCI data. Subsequent analyses evaluated the ability of the score to predict complications and length of stay. Results A total of 54,223 patients were used to develop the risk score. There are 11 risk factors that make up the score, with risk factor scores ranging from 1 to 9, and the highest total score is 34. The score was validated based on patients undergoing PCI in the previous year, and accurately predicted mortality for all patients as well as patients who recently suffered a myocardial infarction (MI). Conclusions The PCI risk score developed here enables clinicians to estimate in-hospital/30-day mortality very quickly and quite accurately. It accurately predicts mortality for patients undergoing PCI in the previous year and for MI patients, and is also moderately related to perioperative complications and length of stay.

The purpose of this investigation was to evaluate the relation of coronary artery stenosis and associated pressure gradient to the magnitude of exercise-induced left ventricular dysfunction in patients with single vessel coronary artery disease. The percent stenosis and minimal cross-sectional area were measured before and after percutaneous transluminal coronary angioplasty and compared with radionuclide measurements of left ventricular function before and after angioplasty in 41 patients with proximal left anterior descending coronary artery lesions, providing 82 points of comparison. The gradient could be measured for 75 comparisons. Forty stenoses less than 50% were associated with a mean left ventricular exercise ejection fraction of 0.66 +/- 0.08 (mean +/- SD), 25 stenoses from 50 to 75% with a mean ejection fraction of 0.59 +/- 0.12 and 17 stenoses greater than 75% with a mean ejection fraction of 0.49 +/- 0.08. Thirty-five stenoses with a gradient less than 20 mm Hg were associated with a mean ejection fraction of 0.65 +/- 0.09, 24 with a gradient from 20 to 50 mm Hg with a mean ejection fraction of 0.58 +/- 0.13 and 16 with a gradient greater than 50 mm Hg with a mean ejection fraction of 0.53 +/- 0.10. These data document a relation between the magnitude of coronary artery stenosis and associated gradient to exercise-induced left ventricular dysfunction in homogeneous patient groups. However, discordance of these variables occurs commonly in individual patients.

Section Editor and Guest Editor: H. William Strauss, MD New York, New York THE DICTIONARY DEFINES PROGRESS AS “MOVEMENT TOWARD A GOAL.” In the following iFORUM editorials, we have thoughtful arguments favoring and opposed to a more detailed evaluation of patients with ST-segment elevation

Sidney C. Smith, JR, MD, FACC, FAHA, Chair Ted E. Feldman, MD, FACC, FSCAI[‡][1] John W. Hirshfeld, JR, MD, FACC, FAHA,FSCAI[‡][1] Alice K. Jacobs, MD, FACC, FAHA, FSCAI Morton J. Kern, MD, FACC, FAHA, FSCAI[‡][1] Spencer B. King III, MD, MACC, FSCAI Douglass A. Morrison, MD, PhD, FACC

Objectives. This study compares in-hospital and long-term outcome after angioplasty in women and men.Background. The recognition that coronary artery disease is the most common cause of death in women has increased interest in outcome studies of coronary artery disease in women.Methods. Patients who had previous coronary revascularization and those who underwent angioplasty in the setting of acute myocardial infarction were excluded. Angioplasty was performed with standard methods. Clinical data were retrieved from a clinical data base and analyzed with standard statistical methods. p]Results. There were 2,845 women and 7,940 men. The women were older (62 ± 11 vs. 57 ± 10 years) and had more hypertension (54.5% vs. 40.1%), diabetes (19.3% vs. 11.7%), grade III to IV angina (71.5% vs. 58.4%) and congestive failure (4.3% vs. 2.1%) than men (all p < 0.0001). More men had a previous myocardial infarction (35.4% vs. 31.0%) and were taller and weighed more (all p < 0.0001). The men had lower ejection fractions and more multivessel disease (31.0% vs. 25.2%) (both p < 0.0001). In women there was a trend toward more Q wave myocardial infarctions (1.1% vs. 0.75%, p = 0.10), and hospital mortality was higher (0.7% vs. 0.1%, p < 0.0001). Angina at follow-up was more common in women (40.2% vs. 26.7%, p < 0.0001). The multivariate correlates of in-hospital death were short stature, reduced ejection fraction and multivessel disease, with trends for older age and female gender. Five-year survival was 95% in men and 92% in women (p = 0.0002), However, female gender was not a multivariate correlate of long-term survival and was accounted for by other characteristics, primarily age. The multivariate correlates of long-term survival were older age, congestive failure, reduced ejection fraction, multivessel disease, diabetes, hypertension and a trend for severe angina. No difference between women and men was noted in long-term freedom from myocardial infarction. There were more additional procedures in men than in women.Conclusions. Despite higher in-hospital mortality, long-term mortality and clinical outcome were similar in both genders when age and body habitus were accounted for.

A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.07.013

ObjectivesThe purpose of this study was to evaluate endothelial function after post-dilation of bare-metal stents with paclitaxel-coated balloons (PCB) or non–drug-coated balloons (non-DCB) in a porcine model.BackgroundDCB are an attractive alternative to drug-eluting stents because they provide short duration of drug exposure, while potentially inhibiting in-stent restenosis. Drug-eluting stents are associated with impaired endothelial function. It is unknown whether this abnormal vasomotor function is mitigated by reduced duration of drug exposure.MethodsThirteen pigs underwent bare-metal stent implantation (arteries, n = 30), followed by post-dilation with either PCB (SeQuent Please, B. Braun Melsungen AG, Berlin, Germany) (n = 17) or non-DCB (n = 13). Five pigs with unstented arteries (n = 14) were controls. Coronary vasomotion was assessed 1 month after stent implantation, using acetylcholine (Ach) and nitroglycerin. Measurements were obtained for distal segments.ResultsAngiographic late loss and histological area stenosis were similar between PCB and non-DCB. However, the percentage of diameter change in response to Ach was diminished with PCB (p < 0.05), when compared with either non-DCB or naive arteries. There was no difference between non-DCB and naive arteries. Inflammatory score and intramural fibrin grading were significantly greater in PCB than non-DCB (p < 0.05). Additionally, inflammatory cell infiltration in the stented segments correlated with the degree of percentage of diameter change in response to Ach, at distal regions.ConclusionsPost-dilation of bare-metal stents with PCB was associated with impaired vasodilatory response to Ach distal to the treated segments. Vasodilatory response after post-dilation with non-DCB was similar to control arteries.

Objectives The purpose of this study was to compare outcomes for drug-eluting stents (DES) and bare-metal stents (BMS) for patients with ST-segment elevation myocardial infarction (STEMI). Background Despite some controversy related to late stent thromboses, DES are approved for use in many patients undergoing stenting. However, there are several types of patients in whom implanting a DES would be regarded as off-label use, and this study compares DES and BMS for one of these groups. Methods New York’s percutaneous coronary intervention registry was used to identify 772 patients undergoing percutaneous coronary intervention (PCI) for STEMI who received BMS and 1,154 STEMI patients who received DES between October 1, 2003, and December 31, 2004. These patients were tracked through December 31, 2005. Mortality, target vessel PCI, and subsequent coronary artery bypass graft (CABG) surgery within 2 years of undergoing the procedure were captured. Adverse outcomes were adjusted using proportional hazards methods to account for baseline differences in patients’ severity of illness. Results The BMS patients had significantly higher mortality (adjusted hazard ratio [HR] vs. DES = 2.01, 95% confidence interval [CI] 1.21 to 3.34, risk-adjusted mortality = 8.6% vs. 5.0%, p = 0.007) and significantly higher subsequent CABG surgery (adjusted HR vs. DES = 2.33, 95% CI 1.31 to 4.16, risk-adjusted rate = 6.4% vs. 3.0%, p = 0.004) rates. There was no difference by type of DES (adjusted HR for paclitaxel-eluting stent versus sirolimus-eluting stent; mortality 0.72, 95% CI 0.30 to 1.72), subsequent CABG surgery (adjusted HR = 0.60, 95% CI 0.26 to 1.40), and target vessel PCI (adjusted HR = 0.74, 95% CI 0.35 to 1.58). Conclusions In this observational study, DES were associated with lower mortality and subsequent CABG surgery when used for STEMI patients.

To define the clinical, angiographic and procedural correlates of quantitative coronary dimensions after directional coronary atherectomy, 400 lesions in 378 patients were analyzed with use of qualitative morphologic and quantitative angiographic methods. Successful atherectomy, defined by a less than 75% residual area stenosis, tissue retrieval and the absence of in-hospital ischemic complications, was performed in 351 lesions (87.7%). After atherectomy, minimal cross-sectional area increased from 1.2 +/- 1.1 to 6.6 +/- 4.4 mm2 (p less than 0.001) and percent area stenosis was reduced from 87 +/- 10% to 31 +/- 42% (p less than 0.001). By univariate analysis, device size (p less than 0.001) and left circumflex artery lesion location (p = 0.004) were associated with a larger final minimal cross-sectional area. Conversely, restenotic lesion (p = 0.002), lesion length greater than or equal to 10 mm (p = 0.018) and lesion calcification (p = 0.035) were quantitatively associated with a smaller final minimum cross-sectional area. With use of stepwise multivariate analysis to control for the reference area, atherectomy device size (p = 0.003) and left circumflex lesion location (p = 0.007) were independently associated with a larger final minimal cross-sectional area, whereas restenotic lesion (p = 0.010), diffuse proximal disease (p = 0.033), lesion length greater than or equal to 10 mm (p = 0.026) and lesion calcification (p = 0.081) were significantly correlated with a smaller final minimal cross-sectional area. The number of specimens excised, the number of atherectomy passes and atherectomy balloon inflation pressure did not correlate with the final minimal cross-sectional area. Thus, directional atherectomy results in marked improvement of coronary lumen dimensions, at least in part correlated with the presence of certain clinical, angiographic and procedural factors at the time of atherectomy.

Over a 5 year period at three centers, 53 patients underwent percutaneous transluminal angioplasty of a right coronary artery ostial stenosis. The procedure was successful in 42 patients (79%) and unsuccessful in 11, of whom 5 (9.4%) required emergency coronary artery bypass grafting because of abrupt closure. The right coronary ostial lesion had distinctive technical requirements to achieve success, including high pressure balloon inflation (10 ± 4 atm) and the need for unconventional right coronary guide catheters. Technical factors that account for increased difficulty in these patients include: 1) problems with guide catheter impaction and ostial trauma; 2) inability to inflate the balloon with adequate guide catheter support; and 3) need for increased intracoronary manipulation. The stenoses were quite discrete (4 ± 5 mm) and calcified in the majority (40) of the 53 patients. Long-term follow-up (mean 12.5 months, range 4 to 60) of these patients demonstrated clinical recurrence of angina in 20 patients (48%) and angiographically proved restenosis in 16 (38%). Repeat coronary angioplasty was successful in three of six patients for relief of symptoms for over 6 months. In conclusion, angioplasty of the right coronary ostial lesion compared with nonostial dilation leads to 1) a subopto\nal early success rate; 2) an apparent high risk of emergency bypass surgery; and 3) a high restenosis rate. Careful assessment of the patient with this lesion and improved technology appear to be warranted.

Soon after the introduction of coronary angioplasty, it became evident that many of the arteries that had been opened would eventually re-narrow, and the therapeutic benefit would be lost. This restenosing of the vessel was caused by a process of elastic recoil after the balloon inflation

[Figure][1] Fascinating things show up in our e-mail everyday and perhaps some of you got the one I received this morning. A nicely animated set of slides posed the question: “What do you do if you are driving and suddenly begin to feel a heart attack coming on?” After considering

[Figure][1] We are still receiving many good clinical research papers on stenting, stenting technology, and stenting outcomes, but you may notice that papers on structural heart disease and peripheral vascular disease sometimes outnumber those on coronary interventions. The advances in

[Figure][1] As I am flying to San Diego for one of our periodic JACC journals editors meetings, I have time to reflect. One of our only protected times is now being invaded by the Wi-Fi in the sky, or as Delta calls it, the “Go-go in-flight internet.” Resisting this current craze to

[Figure][1] As I completed my 2-month sabbatical in academic medical centers of South Africa I began to reflect on what a marvelously stimulating experience it had been. The opportunity to travel and see what others do is rewarding, but the chance to actually work together with them over

While information is crucial to medical care, organizing clinical and financial data into useful, accessible information is difficult. Since 1972 Emory University has approached this with a clinical database (CDB) which includes all cardiac catheterizations, coronary angioplasties and cardiac surgical procedures. Clinical data have been transcribed onto forms and hand keyed. Financial data from the hospital and the Emory Clinic have been loaded via tape. While the CDB has been used for clinical research, increasingly there are demands to manage cardiovascular medicine on a daily basis. The computer system was a traditional system with a central processor and terminals, some of which had access via modem. This model has proven unworkable due to 1) limited access geographically, 2) difficult access for personnel not familial with with sophisticated database management system tools, 3) increased expectations of what computers should do because of exposure to graphical user interfaces (GUls) on personal computers, 4) inability to extend data collection into new areas via paper forms and 5) increased demands for service as a daily management tool. Independently of this effort Emory University has put into place an Enterprise network. In 1993 the CDB, on a Unix server, was made available on the network. Access is now available via any IBM PC or compatible or Macintosh on the network. Access for both individual and group data is being continually upgraded and simplified using GUI approaches. Local databases in cardiothoracic surgery and cardiac catheterization have been created to function in client server mode, providing enhanced function and electronic data transfer. The network approach is permitting expansion of the CDB into areas not previously included, specifically electrophysiology, congestive heart failure and echocardiography. Ultimately the financial data should be transferred over the network as well. This model, consistent with contemporary computing, is already improving daily activity and is expected to yet have a greater impact as the CDB, access tools and local systems continually evolve and improve.

[Figure][1] In his book The World Is Flat: A Brief History of the 21st Century and other writings, globalization guru and New York Times columnist Thomas Friedman has focused on technology, financial markets, world trade, and now supply chains to explain his concepts. He refers to the “

Both Palmaz-Schatz stents (PSS) and directional atherectomy (DCA) are reported to be suitable for treating restenotic lesions and claim to decrease subsequent restenosis. The purpose of this study was to compare in hospital outcome and follow-up (FU) of these two technologies with balloon angioplasty. Records of 1087 patients with restenosis that underwent elective (PSS) implantation (116 patients, 122 lesions). DCA (103 patients, 108 lesions), balloon angioplasty in 868 patients, 965 lesions) from January 1988 to March 1994 were reviewed. Mean follow-up was 1.22 ± 0.73 years. PSS DCA Balloon P Lesion success (%) 117 (95.9) 102 (944) 920 (95.3) 0.87 MLD post (mm) 2.87 ± 0.67 2.84 ± 0.77 2.20 ± 0.96 0.0001 In hospital death (%) 1 (0.9) 0 (0.0) 4 (0.5) 0.63 O-Wave MI (%) 2 (1.8) 1 (1.0) 15 (1.8) 0.85 CABG(%) 5 (4.3) 3 (2.9) 30 (3.5) 0.84 6 months follow-up PTCA(%) 31 (35) 30 (31) 247 (31) 0.74 CABG(%) 19 (22) 21 (22) 141 (19) 0.58 Recurrent angina (%) 34 (37) 34 (34) 340 (42) 0.25 Death (%) 9 (8.5) 4 (39) 37 (4.3) 0.14 Download : Download high-res image (74KB) Download : Download full-size image Conclusion Although a larger lumen was obtained with PSS and DCA, this was not associated with a significant reduction in revascularization, recurrent angina or death at six months. Event free survival curves reveal overlapping and low event free survival at 3 years.

[Figure][1] Spencer B. King III, MD, MACC Editor-in-Chief, JACC: Cardiovascular Interventions Here in late July, I am close to jumping on a flight to Washington, DC, to protest a grave injustice. No, not the looming destruction of the economies of the free world, but the closing of one

[Figure][1] As I become increasingly depressed about the prospects of meaningful health care reform, I wonder in the early morning sleeplessness what we interventional cardiologists can do. The inertia created by the self-interested components of healthcare delivery may result in squandering

[Figure][1] In this election year, the Internet is rife with rumors. Like the politicians, the interventional community is not immune to misinformation. Recent headlines have stated that the American College of Cardiology (ACC) is “appeasing” interventionalists and “handing over the

Since Gruentzig’s original description of the use of percutaneous transluminal coronary angioplasty in selected patients, there has been intense interest in extending the indications to include many subsets of patients with coronary artery disease [1]. One logical extension of this procedure is the use of angioplasty under direct vision in combination with coronary artery bypass. Intraoperative use of this technique has been described previously by others [2–6].

In recent years angioplasty has been used increasingly in patients with more severe disease. Technological improvements, including new interventional devices has also changed the practice of interventional cardiology. To determine the impact of these changes on intervention in vein grafts, the results of intervention in 1284 patients undergoing procedures between 1980 and 1993 were reviewed. Results (mean or %): year 80–2 83–4 85–6 87–8 89–0 91–2 93 P n 52 112 99 191 299 359 172 Age 55 57 60 62 62 64 65 l0.0001 3 VD/LM 46% 29% 42% 62% 53% 67% 69% l0.0001 EF 63 60 53 54 50 51 49 l0.0001 Prior MI 39% 49% 52% 62% 63% 56% 60% 0.009 New Dew 0 0 0 1% 11% 35% 27% l0.0001 %DS Pre 80 78 78 77 77 80 81 0.003 %DS Post 33 27 27 29 26 17 17 l0.0001 Ang Succ 81% 89% 84% 85% 88% 96% 94% l0.0001 Q MI 1.9 2.7 3.0% 0.5% 2.3% 0.8% 1.8% NS Cabg 3.8 1.8% 4.0% 2.6% 3.3% 0.8% 2.4% NS Death 0 0 3.0% 1.0% 1.3% 1.4% 1.2% NS Vein graft interventions have become more common. Despite an older and more severely diseased population with more prior myocardial infarctions (MI), lower ejection fractions (EF) and more 3 vessel or left main disease (3 VD/LM), the angiographic success (Ang Succ) and residual stenosis (%DS Post) have improved, without increased complications of Q wave myocardial infarction (Q MI), emergency coronary bypass surgery (CABG) or in hospital death (Death). In recent years new interventional devices (New Dev) have been used in a large minority of patients, contributing to the improved results.

[Figure][1] As editors of JACC: Cardiovascular Interventions , we are often asked whether we are enjoying editing this journal. The questions seem to imply that editing a journal must be an onerous task without much endorphin stimulation. I find that perception far from the truth. Actually

Understanding the reasons for variations in physician resource utilization in coronary angioplasty (PTCA) and coronary surgery (CABG) is essential to efficiently organizing, managing, and paying for these procedures. To evaluate the extent of variations in physician resource utilization for CABGs and PTCAs and the reasons for these variations, the resource-based relative value scale (RBRVS), an index of relative weights for physician work and practice costs, is used to evaluate physician practice patterns. Given their extensive clinical review, RBRVS weights represent new, unique, comprehensive measures of physician resource utilization where 1 unit value is equivalent to an intermediate office visit for an established patient. Our investigation uses 3 years of clinical and financial data on 392 randomized patients with multivessel coronary artery disease (EAST data). receiving the initial therapy of either CABG or PTCA. RBRVS weights are assigned to each procedure code (CPT) and the distribution of RBRVS units and their allocation among different types of services are analyzed. Results show significant differences in physician resources for both CABGs and PTCAs. Among CABG patients, nearly a ninefold variation in physician resource units is evident (108 ± 46) and, for PTCA, a 29-fold variation exists (66 ± 54). At three years, the average physician resource utilization for CABG is 64% greater than PTCA. Significant differences are also evident in surgical, laboratory, imaging, and consult resources even after accounting for casemix. The findings demonstrate that the RBRVS is a viable and useful analytical tool for managerial and clinical personnel.