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Absence of significant epicardial coronary artery stenosis in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was to retrospectively analyze the clinical characteristics and the outcome of such patients.All patients with myocardial infarction (MI) but without significant coronary artery stenosis (≥50%) on angiography from May 2002 to April 2011 were compared with patients undergoing percutaneous coronary intervention due to non-ST-elevation MI (NSTEMI).Of 4311 consecutive patients with MI, 272 patients (6.3%) did not show significant coronary artery stenosis (group I) and were compared with 253 NSTEMI patients (group II). Younger age (61.9±14.0 vs 65.4±12.0 years; P=.003), female sex (49.3% vs 28.9%; P.001), less severe anginal symptoms (Canadian Cardiovascular Society class III/IV 41.9% vs 49.8%; P=.05), lower level of myocardial necrosis marker (1.9±6.7 vs 27.4±68.7 ng/mL [troponin], 3.3±4 vs 14.2±20 mmol/L [creatine kinase]; P.001 for both), and higher left ventricular ejection fraction (58.7%±12.6% vs 48.1%±12.4%; P.01) were associated with group I patients. At a mean follow-up of 22.3±22.9 months, all-cause and cardiac mortality was lower in group I patients (4.9% vs 14.3%; and 2.9% vs 10.1%; P.01, for both). Event-free survival was more frequent in group I patients (58.4% vs 28.8%; P.0001) and inversely related to the troponin level.Absence of significant coronary stenosis accounts for a minority of patients presenting with MI and is associated with a better outcome compared to patients with NSTEMI, and the prognosis is inversely related to the troponin level.

Objectives Drug-eluting stents (DES) constitute a major achievement in preventing re-stenosis, concerns remain regarding the increased inflammatory responses associated with the polymers used. This analysis focuses on outcomes in patients receiving the polymer-free sirolimus-eluting stent system YUKON-Choice (Yukon-DES, Translumina, Germany). Methods From 01/2006-09/2008 all patients receiving Yukon-DES (≥2.5 mm diameter) were prospectively enrolled in our registry. The primary endpoint was long-term major adverse cardiac events (MACE). Results 701 patients were included in our registry. Mean age was 65.7 ± 10 years (73% male gender, 35.5% diabetes, and 32.2% acute coronary syndrome). 76% of the lesions were of Type B2/C. Lesion length was 24.6 ± 5.2 mm and mean stent diameter was 2.8 ± 0.4 mm. A total of 511 pts (72%) underwent 6-months angiographic follow-up, target vessel revascularization was noted in 23.5%. At 5 years clinical outcomes were: cardiac death 5.8%; myocardial infarction 3.4%; and TVR 24.6%. The incidence of MACE differed significantly between “on-label” and “off-label” indications (14.8% vs. 40.8% MACE; P 1 year) ST occurred in 0.29%. Conclusion Our data suggests that the implantation of the sirolimus-coated polymer-free YUKON-DES is safe and feasible with a very low incidence of ST in this real world patient cohort with high percentage of diabetes and small vessels. © 2013 Wiley Periodicals, Inc.

Zusammenfassung Von einem chronischen Verschluss von Koronargefasen spricht man, wenn in einem Koronargefas kein Blutfluss mehr vorhanden ist, das Gefas also zu 100% verschlossen ist, wobei der Blutfluss per definitionem seit mehr als drei Monaten unterbrochen sein muss. Die Diagnose eines chronischen Koronarverschluss kann bei entsprechendem klinischem Verdacht (vorangegangener Herzinfarkt oder schwere Angina pectoris) durch eine Herzkatheteruntersuchung gestellt werden. Chronische Verschlusse von Koronargefasen konnen durch interventionelle Revaskularisation oder per Bypasschirurgie behandelt werden, wobei fur die Indikation der klinische Status sowie Komorbiditaten wie zerebraler Status, pulmonale und vaskulare Vorerkrankungen des Patienten eine Rolle spielen. Die Prognose von Patienten mit verschlossenen Koronargefasen ist mit einer Mortalitat von 5,5% ungunstig. Eine erfolgreiche Wiedereroffnung kann die Prognose des Patienten verbessern.

Background— Treatment of bifurcations is a complex problem. The clinical value of treating side branches is an unsolved problem in the field of interventional cardiology. Methods and Results— We initiated a prospective randomized controlled trial. One hundred and ten patients with bifurcations were randomly assigned to 2 arms: Stenting of the main branch (MB, Taxus-stent, paclitaxel-eluting stents) and mandatory side branch (SB) percutaneous coronary intervention (PCI; kissing balloons) with provisional SB stenting (therapy A), or stenting of the MB (paclitaxel-eluting stents) with provisional SB-PCI only when the SB had a thrombolysis in myocardial infarction flow P =0.4), 71.4% (A) versus 77.8% were men ( P =0.4), patients with diabetes were present in 25.0% versus 25.9% ( P =0.9). The MB was left anterior descending artery in 80.4% versus 81.5% (A versus B, P =0.9). The SB-PCI and kissing balloon-PCI were performed according to the study protocol in 82.1%/73.2% versus 16.7%/13.0% ( P P =0.9). A final thrombolysis in myocardial infarction flow 3 (MB) was reached in all patients (groups A and B), final thrombolysis in myocardial infarction flow 3 (SB) was observed in 96.4% versus 88.9% (A versus B, P =0.3). Radiation time (min) and contrast medium (mL) were 14.2/210 (group A) versus 7.8/151.6 (group B; P for both P =0.9), target lesion revascularization was 17.9% (A) versus 14.8% (B, P =0.7), and late lumen loss (MB) was 0.2 mm (A) versus 0.3 mm (B, P =0.5). In group B, no PCI of the SB was done during follow up. Conclusion— A simple strategy using paclitaxel-eluting stents with only provisional SB-PCI may be of equal value to a more complex strategy with mandatory SB-PCI. Clinical Trial Registration— URL: http://www.controlled.trials.com. Unique identifier: ISRCTN22637771.

Background Arteriovenous fistulas (AVF) and arterial pseudoaneurysms (PSA) are potentially harmful complications of diagnostic and interventional cardiac catheterisation. Incidence, risk factors and clinical outcome are not well defined yet, although important for stratification and treatment. Methods A total of 18,165 consecutive patients undergoing cardiac catheterisation were enrolled in our prospective registry. For the diagnosis of AVF and PSA a clinical examination was performed in every patient followed by a Duplex examination in case of clinical suspicion of AVF/PSA. The impact of the following risk factors was assessed: age, body mass index, puncture of left vs. right groin, gender, hypertension, sheath size, peripheral artery disease, coumadin therapy, glycoprotein IIb/IIIa-inhibitors, pre-treatment with thrombolytics, and emergency procedures. Results Within 3 years a total of 334 complications were found (1.8%). The incidence of AVF and PSA was 0.6% ( n =107) and 1.2% ( n =227), respectively. The following significant independent risk factors were identified: arterial hypertension (odds ratio [OR])=1.86, female gender (OR=1.65), and emergency procedures (OR=2.13). During follow-up (mean 48±10 months) only 11% of all AVF underwent operative repair due to symptoms. All PSA could be treated successfully either by manual compression, thrombin injection, or surgery. The overall mortality was 0.8%. Conclusion Almost 2% of patients undergoing cardiac catheterisation acquire femoral AVF or PSA, for which patient- or procedure-related risk factors could be identified. Most of AVF and PSA could be managed conservatively or without any treatment, the overall mortality is low.

Objectives: We sought to investigate the prevalence and clinical outcome of congenital left ventricular aneurysms (LVAs) and diverticula (LVD) in a large adult population. Methods: We retrospectively studied the left ventricular angiograms of 12,271 consecutive patients undergoing cardiac catheterization at our institution and analyzed the medical records of the patients. Results: The overall prevalence of LVA/LVD was 0.76% (94 patients): there were 42 patients with LVA (0.34%) and 52 patients with LVD (0.42%). Men were more likely to have LVA (62 vs. 38%), and women were more likely to have LVD (75 vs. 25%; p = 0.001 for both). The mean time of follow-up was 56 ± 6 months and was focused on clinical events, rehospitalization and survival. Mortality was 6% with no cardiac death. Patients with LVD were significantly more likely to have embolic events (p = 0.04). Patients with LVA and LVD were more likely to have rhythm disturbances compared with controls (p = 0.01 for both). Incidence of syncope was not different in both groups (p = 0.4 and 0.12, respectively). There was no reported incidence of rupture. Conclusion: This large single-center study suggests that the prevalence of LVA/LVD in adults is up to 20-fold higher than previously reported. One third of the affected patients in our series had nonfatal cardiovascular events during follow-up, with a predominance of embolic events in the LVD group.

Objectives: A newly discovered heart syndrome mimicking acute coronary syndrome has been termed ‘Tako-Tsubo cardiomyopathy’ (TTC). Differentiation from acute myocardial infarction using the ECG is an important issue in clinical practice. Methods: We retrospectively analyzed patients admitted for cardiac catheterization between September 2003 and September 2006. Results: From 26,593 cardiac catheterization procedures, we identified 21 patients with suggested TTC (0.08%). Trigger mechanisms were present in 38.1%; all patients had elevated troponin levels (mean 3.9 ng/ml). Median age was 68.4 years; 90.5% were female. Hypertension was seen in 85.7% and atrial fibrillation in 19.1%. Specific ECG findings related to a TTC are: a mild elevation of the ST segment arising from the S curve of the QRS complex, where the maximum ST segment elevation at the basis of the T wave is Follow-Up Data: Mean follow-up was 13.2 months. 47.6% were free from angina or dyspnea, most of the patients received β-blockers/ACE inhibitors (76.2%). One patient had a sudden cardiac death (4.8%), 1 patient became an implantable cardioverter-defibrillator primarily due to resuscitation. Conclusion: TTC is a rare syndrome mimicking acute coronary syndrome that shows a specific ECG pattern and does not appear to be an unambiguously benign disease.

The case of a patient who developed a femoral artery pseudoaneurysm following cardiac catheterization is described. After 2 failed attempts of ultrasound-guided compression repair, the patient underwent percutaneous thrombin injection with, beside of complete closure of the pseudoaneurysm, a severe limb ischemia due to distal thrombin migration with consecutive clot formation finally resulting in thigh amputation of the affected leg. Indications, advantages, and disadvantages of various options for the treatment of iatrogenic femoral artery pseudoaneurysms (vascular surgery, ultrasound-guided compression, percutaneous thrombin injection, and other nonsurgical treatment modalities), as well as risk factors for distal migration of liquid thrombin after percutaneous injection, are discussed in this report.

A literature on systematic treatment protocols for patients after resuscitation for cardiac arrest is lacking. We evaluated a systematic protocol, including ECG, echocardiogram, urgent cardiac catheterisation ("STEMI-like" workflow), CT scans, laboratory findings, IABP, hypothermia, and cMRI, prospectively over 5 years. The primary endpoint was the Cerebral Performance Category Scale (CPCS). During the period from January 2008 to December 2012, 212 patients were included. The mean age was 66.7 years, n = 151 (71.2 %) were male, mean time from the first medical contact to start of catheterisation was 76.6 min, and ventricular fibrillation (VF) was present in n = 99 (46.7 %). A significant coronary artery stenosis was seen in n = 130 (61.3 %), PCI was performed in n = 101 (47.6 %), an ACS was found in n = 100 (47.2 %), n = 91 patients (42.9 %) had another cardiac cause, an extra-cardiac cause was found in n = 12 (5.7 %, mostly a cerebral process), and in 9 patients (4.3 %), no cause was identifiable. A significant difference in mortality was found for patients with TIMI flow 2/3 vs. 0/1 (65.4 vs. 95.7 %, p

A congenital left ventricular aneurysm or diverticulum is a rare cardiac malformation described in 418 cases since the first description in 1816, being associated with other cardiac, vascular or thoracoabdominal abnormalities in about 75%. It appears to be a developmental anomaly, starting in the 4th embryonic week. Diagnosis can be made after exclusion of coronary artery disease, local or systemic inflammation or traumatic causes as well as cardiomyopathies. Clinically, most congenital left ventricular aneurysms and diverticula are asymptomatic, but some of them may cause systemic embolization, heart failure, valvular regurgitation, ventricular wall rupture, ventricular tachycardia, or sudden cardiac death. Diagnosis is established by imaging studies such as echocardiography, magnetic resonance imaging or left ventricular angiography, visualizing the structural changes and accompanying abnormalities. Mode of treatment has to be individually tailored and depends on clinical presentation, accompanying abnormalities and possible complications, options include surgical resection, especially in symptomatic patients, anticoagulation after systemic embolization, radiofrequency ablation or implantation of a cardioverter defibrillator in case of symptomatic ventricular tachycardias, occasionally combined with class I or III antiarrhythmic drugs. Because of the usually benign course of congenital left ventricular aneurysms and diverticula in the adulthood, most of them can be managed conservatively.

Background In a number of coronary bifurcation lesions, both the main vessel and the side branch (SB) need stent coverage. Objectives To analyze the procedural performance and the impact on radiation times (RT) and contrast medium consumption (CMC) of the Axxess™ stent system (Biosensors, Switzerland) treating de novo bifurcation lesions (DBL). Methods One hundred and ten consecutive prospectively enrolled cases (Axxess Group) and 110 age, sex, and lesion location matched controls undergoing mandatory (Group A, n = 56) or provisional (Group B, n = 54) SB intervention were analyzed. Results Although more pre-dilatation was performed in the Axxess Group (92.7% vs. 46.4% [Group A] vs. 24.1% [Group B]), and more stents were used (2.4 vs. 1.2 vs. 1.05), RT and CMC were significantly lower in the Axxess Group [7.9 min/129 ml vs. 14.2 min/209 ml vs. 7.8 min/152 ml; P

Aims Inadvertent lead malposition (ILM) in the left heart is a potential cause of thromboembolism and, therefore, a complication of heart rhythm device implantation [HRDI: pacemaker, implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy (CRT)]. The aim of the study was to report the incidence and clinical outcome of ILM. Methods and results Postoperative lateral and posterior–anterior chest X-rays of all consecutive patients undergoing HRDI from 2007 through 2012 were retrospectively analysed. During the study period, 2579 patients underwent HRDI at our institution. ILM was present in six patients (0.34%, 50% male, mean age 71.5 ± 9.4 years). In one and four patients, malposition was in the left atrium and ventricle, respectively. In one case, the RV-lead was placed in a coronary sinus branch. In four patients, ILM was detected intra-operatively or in the early postoperative period. In the remaining two patients, malposition was not recognized and they suffered cerebral embolism 4 months and 1 year after implantation. ILM was corrected during the same hospital stay (four cases), or during follow-up by percutaneous extraction (two cases). Patients with ILM had significantly more scoliosis (16.7 vs. 0.17%; P = 0.01), congenital heart disease (CHD: 33.3 vs. 0.4%; P = 0.003), or prior surgery for CHD (16.7 vs. 0.5%; P = 0.03). The likelihood of ILM was also increased when HRDI was performed by an inexperienced operator (

Direct stenting without antecedent dilatation may reduce procedural time, costs, and radiation exposure, and may result in less vessel injury. The purpose of this investigation was to compare immediate and long-term clinical and angiographic outcomes of direct stenting with stent placement after initial balloon dilation. Three hundred thirty-five symptomatic patients with single or multiple coronary lesions (diameter reduction 60% to 95%) of < or =30 mm length and with a vessel diameter of 2.5 to 4.0 mm were randomized either to direct stenting (group A, n = 171) or stenting after predilation (group B, n = 164). Patients with vessels with excessive calcification, severe proximal tortuosity, or occlusion were excluded. All patients were asked to return for routine repeat angiography at 6 months, irrespective of symptoms. Feasibility of direct stenting was 95% in group A, with 5% requiring crossover to predilation. Successful stent placement after predilation was performed in all 164 patients in group B. Direct stenting was associated with less procedural duration (group A 42.1 +/- 18.7 minutes vs group B 51.5 +/- 23.8 minutes, p = 0.004), radiation exposure time (group A 10.3 +/- 7.7 minutes vs group B 12.5 +/- 6.4 minutes, p = 0.002), amount of contrast dye used (group A 163 +/- 69 ml vs group B 197 +/- 84 ml, p

Congenital left ventricular aneurysm (LVA) or diverticulum (LVD) is rare cardiac anomalies. We aimed to analyse the clinical characteristics and outcome in all ever published patients.MEDLINE, Web of science, Google and EMBASE, and reference lists of relevant articles were searched for publications reporting on LVA or LVD patients.We identified 809 patients published since 1816 [354 (49.1%) LVA, 453 (50.6%) LVD, 2 (0.3%) both]. Mean age at diagnosis was 34.1±27 (LVA) and 29.7±27.6years (LVD; p=0.05). 48.9% were male. LVA was larger (38.7±22.5mm versus 31.4±21.2mm; p=0.002) and frequently found in submitral location (33% versus 4.9%; p0.001), LVD was frequently located at the LV-apex (61.2% versus 28.7%; p0.001). LVD was often associated with cardiac (34.2% versus 11%; p0.001) or extracardiac anomalies (32.7% versus 3%; p0.001). LVA patients presented more frequently with ventricular tachycardia/fibrillation (18.1% versus 13.1%; p=0.01), the incidences of rupture (4% versus 4.5%; p=0.9), syncope (8.3% versus 5.1%; p=0.1), and embolic events (4.9% versus 3.6%; p=0.4) at presentation were not different between LVA and LVD. Mean follow-up was 56.3±43months. Cardiac death occurred more frequently in the LVA group (11.5% versus 5.0%; p=0.05) at a median age of 0.8 [LVA] and 2.5 [LVD] years. The leading cause of cardiac death was congestive heart failure in the LVA-group (50.0% versus 0.0%; p=0.01), and rupture in the LVD-group (75.0% versus 27.3%; p=0.04).LVA and LVD are distinct congenital anomalies with different clinical and morphological characteristics. The prognosis of LVA is significantly worse during long-term follow-up.

Objective Absence of significant epicardial coronary artery disease (CAD) in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was to analyse the clinical characteristics and outcome of such patients with advanced age. Methods We retrospectively analysed 4,311 patients with acute onset of chest pain plus necrosis marker elevation. Two hundred and seventy two patients without CAD on angiogram (6.3%) were identified. Out of them, 50 (1.2%) patients ≥ 75 years (Group I) were compared with (1) 222 acute coronary syndrome (ACS) patients without CAD on angiogram < 75 years (Group II), and (2) 610 consecutive patients ≥ 75 years with Non-ST-elevation Myocardial Infarction (NSTEMI) undergoing percutaneous coronary intervention (Group III). Results Group I compared to Group III patients made up for more females (64.0% vs. 49.2%; P < 0.0001), and had more severe anginal symptoms on presentation [Canadian Cardiovascular Society (CCS) class I/II, 26.0% vs. 49.8%; P = 0.02]. Group I patients also had lower troponin levels (0.62 ± 0.8 ng/mL vs. 27 ± 74 ng/mL; P < 0.02), lower leukocyte count (9.4 ± 3.13 × 109 vs. 12 ± 5.1 × 109; P = 0.001) and better preserved left ventricular function (56.7% ± 14.3% vs. 45% ± 11%; P < 0.0001). Event-free survival (cardiac death, myocardial infarction, recurrent angina, and re-hospitalisation) was more frequent in Group I and II patients compared to Group III patients (64.9%, 66.7%, and 41.6%, respectively; P < 0.0001). Conclusions ACS in patients ≥ 75 years without CAD is very infrequent, associated with a (1) similar outcome compared to ACS patients < 75 years without CAD, and (2) significant better outcome compared to NSTEMI patients ≥ 75 years.

Hintergrund: Die kathetervermittelte Therapie degenerierter aortokoronarer Venenbypasse ist haufig mit einer periinterventionellen Embolisation von Thromben, Plaqueartikeln und atherosklerotischem Debris verbunden. Fallbeschreibung: Ein 66-jahriger mannlicher Patient mit operativer Myokardrevaskularisation 1995 wurde aufgrund eines akuten koronaren Ischamiesyndroms in unsere Abteilung stationar eingewiesen. Unter einer antiischamischen Kombinationstherapie konnte eine klinische Stabilisierung erzielt werden. In einer elektiven Koronarangiographie stellten sich zwei kritische Stenosen im Venengraft zum Ramus interventricularis anterior (RIVA) als klinisch fuhrende Lasionen heraus. Nach einer 24-stundigen Vorbehandlung mit einem Glykoprotein-IIb/IIIa-Inhibitor wurden im Bereich der distalen Stenose ein Stentgraft (Jostent™, Jomed) und im Bereich der proximalen Stenose ein Magic Wallstent™ (Boston Scientific) implantiert. Nach einer Hochdruckdilatation im Magic Wallstent™ verblieb keinerlei residuelle Stenose. Im weiteren Verlauf klagte der Patient uber heftige Stenokardien, die mit ausgepragten ST-Hebungen uber den linksprakordialen Ableitungen einhergingen. Angiographisch war der RIVA nach der koronaren Bypassanastomose okkludiert. Nach Einfuhren eines X-Sizer™-Absaugsystems (EndiCOR Medical, Inc.) in den Venengraft und das proximale Drittel der Vorderwandarterie konnte nach mehrfacher Aspiration eine komplette Reperfusion des RIVA wiederhergestellt werden. Die maximale CK-Aktivitat betrug postinterventionell 127 U/l. In einer Kontrollkoronarangiographie nach 7 Tagen war der RIVA weiterhin perfundiert. Schlussfolgerung: Das X-Sizer™-Absaugsystem erscheint als eine erfolgversprechende Therapieoption zur perkutanen transluminalen Thrombektomie bei stattgehabter Makroembolisation mit No-Reflow-Phanomen bei Katheterinterventionen in degenerierten Venenbypassen.

Using drug-eluting balloons for the treatment of bifurcation lesions without stenting provides a safe and efficient treatment option for bifurcation lesions. We initiated a controlled prospective multicentric registry using drug-eluting balloons (DEB, Dior ®, Eurocor Inc, Germany) for the

Drug-eluting stents (DES) constitute a major achievement in preventing re-stenosis, concerns remain regarding the increased inflammatory responses associated with the polymers used. This analysis focuses on outcomes in patients receiving the polymer-free sirolimus-eluting stent system YUKON-Choice (Yukon-DES, Translumina, Germany).From 01/2006-09/2008 all patients receiving Yukon-DES (≥2.5 mm diameter) were prospectively enrolled in our registry. The primary endpoint was long-term major adverse cardiac events (MACE).701 patients were included in our registry. Mean age was 65.7 ± 10 years (73% male gender, 35.5% diabetes, and 32.2% acute coronary syndrome). 76% of the lesions were of Type B2/C. Lesion length was 24.6 ± 5.2 mm and mean stent diameter was 2.8 ± 0.4 mm. A total of 511 pts (72%) underwent 6-months angiographic follow-up, target vessel revascularization was noted in 23.5%. At 5 years clinical outcomes were: cardiac death 5.8%; myocardial infarction 3.4%; and TVR 24.6%. The incidence of MACE differed significantly between "on-label" and "off-label" indications (14.8% vs. 40.8% MACE; P 0.001). Incidence of definitive/probable stent thrombosis (ST) was 1.14% (8/701); very late (1 year) ST occurred in 0.29%.Our data suggests that the implantation of the sirolimus-coated polymer-free YUKON-DES is safe and feasible with a very low incidence of ST in this real world patient cohort with high percentage of diabetes and small vessels.

Response: We think that the case selection in our study is an interesting point of debate, and we thank Albertal et al for their letter. We believe that the principle of using a simple strategy …

The characterization of patients who have acute coronary syndrome (ACS) without critical stenosis is unclear. First, we wanted to learn more about the angiographic and demographic characteristics of patients with non-ST-segment-elevation myocardial infarction who were not in need of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Second, we wanted to look for further cardiac events during follow-up. We retrospectively analyzed all patients with ACS plus ischemic-marker elevation from May 2002 through September 2005. Follow-up was obtained primarily by telephone interviews. Of the 1,437 ACS patients who were screened, 127 (8.8%) had noncritical stenosis (study group), and 509 (35.4%) had sufficient stenosis (50%) to warrant PCI (control group). Patients with noncritical stenosis (or =50%) were significantly younger, were more frequently women, and had fewer risk factors. Myocardial infarction or PCI/CABG occurred in no patients with noncritical stenosis (follow-up, 12.2 mo) and in 5.1% or 16.1% (respectively) of patients with critical stenosis (follow-up, 11.1 mo; P0.05 for revascularization). Cardiac death was more likely in patients without critical stenosis, but insignificantly so (2.4% vs 1.8%, P=0.6). SUBANALYSIS: Of patients without critical stenosis, 52.8% had smooth coronary arteries, and 47.3% had mild-to-moderate atherosclerosis (stenosisor =50%). Follow-up revealed no deaths in the 1st subgroup and 3 cardiac deaths (5%) in the 2nd (P=0.06). We conclude that the prognosis of patients without significant stenosis was significantly better in regard to revascularization, but statistically the same in regard to mortality.

Background:The transradial approach is associated with low complication rates. The D Stat Radial® vascular closure system offers hemostatic pressure locally at the puncture site with residual venous flow. Methods:We prospectively included 113 consecutive patients presenting between August 2006 and December 2006. Diagnostic coronary procedures were performed using 4 Fr or 5 Fr sheaths, while 6 Fr devices were used for PCI. In every case at least 5.000 IU heparin was given. Compression with the retention strap was planned for ∼3 hours before the pad was fixed using a medical strip. All data were entered into a database after a two-dimensional ultrasound examination study of the puncture site. Results:The mean age was 65 years (±SD 10.3), with 62% being male. Patients presenting with acute coronary syndrome amounted to 6.2%, where 5r F sheaths were usually used with these patients (64.6%). PCI was carried out in 21.2% of cases. The system was applied successfully in all patients. The mean duration of compression was 4.6 hours (±SD 1.4). Bleeding after removal of the system occurred in 18.6% of cases, which resulted in prolonged compression in 17.7%. A hematoma >5 cm was seen in 4.4% of the sample. Ultrasound examinations revealed closure of the radial artery in 6.2%. Conclusions:We conclude that this new device operates efficiently, but bleeding occurred in 18.6%. Compression time should be extended to 6 hours.

Objective: A visible thrombus remains a risk factor during percutaneous coronary intervention (PCI). Methods: Between October 2004 and March 2005, we treated all patients who consecutively presented with acute coronary syndrome + angiographically visible thrombus using the Export Aspiration System (group 1, n = 79). We retrospectively analyzed all consecutive patients who had been treated without a thrombectomy device (group 2, n = 79). Results: Final TIMI flow 3 or myocardial blush grade (MBG) 3 after completing PCI in group 1 and 2 was seen in 54 patients (68.4%) versus 57 patients (72.2%, P = 0.6) and in 45 patients (57.0%) versus 44 patients (55.7%, P = 0.9), respectively. Final TIMI flow 0 or MBG 0 in group 1 and 2 was observed in eight patients (10.1%) versus four patients (5.1%, P = 0.23) and in 24 patients (30.4%) versus 16 patients (20.3%, P = 0.15), respectively. Histologic evaluation: Histologic evaluation revealed mostly mixed thrombotic material (83.6%). Microscopic material was seen in 91.8% of cases. MACE: Total MACE rate during hospital stay was 11.4% in both groups. Conclusion: Using the Export Aspiration System in patients presenting with acute coronary syndrome + visible thrombus provides no substantial benefit. © 2007 Wiley-Liss, Inc.

A congenital left ventricular aneurysm or diverticulum is a rare cardiac malformation described in 418 cases since the first description in 1816, being associated with other cardiac, vascular or thoracoabdominal abnormalities in about 75%. It appears to be a developmental anomaly, starting in the 4th embryonic week. Diagnosis can be made after exclusion of coronary artery disease, local or systemic inflammation or traumatic causes as well as cardiomyopathies. Clinically, most congenital left ventricular aneurysms and diverticula are asymptomatic, but some of them may cause systemic embolization, heart failure, valvular regurgitation, ventricular wall rupture, ventricular tachycardia, or sudden cardiac death. Diagnosis is established by imaging studies such as echocardiography, magnetic resonance imaging or left ventricular angiography, visualizing the structural changes and accompanying abnormalities. Mode of treatment has to be individually tailored and depends on clinical presentation, accompanying abnormalities and possible complications, options include surgical resection, especially in symptomatic patients, anticoagulation after systemic embolization, radiofrequency ablation or implantation of a cardioverter defibrillator in case of symptomatic ventricular tachycardias, occasionally combined with class I or III antiarrhythmic drugs. Because of the usually benign course of congenital left ventricular aneurysms and diverticula in the adulthood, most of them can be managed conservatively.

We investigated 16 patients with ST segment elevation myocardial infarction who had an occluded coronary artery (TIMI 0) at initial angiogram. Instead of balloon angioplasty and stenting, patients were subjected to thrombectomy (Endicor X-sizer) and stenting. In 15/16 patients the occlusion could be crossed by the thrombectomy device resulting in TIMI flow 3 in all of them. Thereafter, stenting was performed. At final angiogram all 15 patients continued to show TIMI flow grade 3. Twelve-lead ECG was performed prior to and post-intervention. ST elevation was measured as the sum of eight leads for anterior infarction and of five leads for inferior infarction. In 13/15 patients, ECG analysis was possible (2 developed bundle branch block post-intervention). In all 13 patients, a >50% ST decrease of the initial amount of ST elevation was observed reaching a >70% reduction in 11 patients. Procedural complications were low (one coronary dissection after thrombectomy) and 30 days follow-up was uneventful. Thrombectomy using the Endicor X-Sizer device may become an attractive mechanical reperfusion strategy for patients with acute myocardial infarction.

Background Treatment of coronary bifurcation lesions is a complex problem. Methods This retrospective single-center study included all consecutive patients with PCI of coronary bifurcations with stent covering of the side branch (SB) between January 2008 - August 2011. Two methods were compared: group A represented patients without treatment of SB, group B were patients with treatment of SB. Results Our study group (n = 98) was group A (n = 64, 65.3%) and group B (n = 34, 34.7%). Mean follow-up was 14.1 (group A) vs 12.3 (group B, p = ns) months. Mean age (years) was 70.3 (group A) vs. 67.0 (group B, p = ns), NSTEMI/STEMI was present in 54.7% (group A) vs. 41,2% (group B, p = ns). Duration of x-raying (min, group A vs group B) and the amount of contrast medium (ml) were significantly lower in group A: 18.1 min vs 20.1 min and 225.8 ml vs 307.4 ml (p

Treatment of coronary bifurcation lesions is a complex issue. This retrospective observational study included patients (pts) who underwent PCI of a de novo coronary bifurcation lesion between January 2008 - August 2011. We included all consecutive patients where the side branch had been covered

Drug-eluting stents constitute a major achievement in preventing restenosis, concerns remain regarding the increased inflammatory and thrombogenic responses associated with the polymers used. This analysis focuses on outcomes in patients receiving the polymer-free microporous rapamycin-eluting stent

There is a need for a systematic treatment protocol for patients after resuscitation. A systematic diagnostic approach including ECG, echocardiogram, urgent cardiac catheterization (“STEMI-like” workflow), pulmonary angiography, CT scans, pre-defined laboratory findings, IABP, hypothermia and