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Aims: To evaluate the rate of clinical events and bleeding risk according to age in patients undergoing percutaneous coronary intervention (PCI) with a new-generation drug-eluting stent (DES) enrolled in the RESOLUTE Global Clinical Program. Methods: This study represents a pooled analysis of five trials included in the RESOLUTE program including 5,130 patients, of whom 1,675 (32.6%) were � 70 years old (elderly patients). Results: After adjusting for confounders, age � 70 years was a significant predictor of high mortality at 30 days (0.6 vs. 0.1%, P 50.017) and 2 years (7.2 vs. 2%, P

Compared to balloon predilation, direct stenting (DS) shortens procedural time and reduces radiation and contrast exposure. A meta-analysis that included 7 studies comparing these 2 strategies revealed lower adverse event rate with DS. Studies included in the present meta-analysis were mostly observational and utilized first generation drug-eluting stent. Patient and lesion selection may explain these positive results.

Early hospital readmissions after percutaneous coronary interventions (PCI) are common and costly. From the NCDR CathPCI Registry and the Centers for Medicare and Medicaid Services, a risk prediction model was generated using 14 clinical variables, demonstrating modest discrimination. Future research is needed to identify interventions aim to reduce early readmissions. The use of this risk model may help guide these interventions.

Overlapping permanent scaffolds carries a long-term risk of target vessel failure due to late malapposition and the development of neoatherosclerosis. Potentially, overlapping bioresorbable scaffold (BRS) may lead to lower long-term risk. The GHOST-EU registry reported similar short- and mid-term risks in patients with and without BRS overlap. Larger size studies with longer follow-up are needed to confirm the safety of BRS overlap.

The use of magnets in transumbilical cholecystectomy (TUC) improves triangulation and achieves an optimal critical view. Nonetheless, the tendency of the magnets to collide hinders the process. In order to simplify the surgical technique, we developed a hybrid model with a single magnet and a curved grasper.All TUCs performed with a hybrid strategy in our pediatric population between September 2009 and July 2012 were retrospectively reviewed. Of 260 surgical procedures in which at least one magnet was used, 87 were TUCs. Of those, 62 were hybrid: 33 in adults and 29 in pediatric patients. The technique combines a magnet and a curved grasper. Through a transumbilical incision, we placed a 12-mm trocar and another flexible 5-mm trocar. The laparoscope with the working channel used the 12-mm trocar. The magnetic grasper was introduced to the abdominal cavity using the working channel to provide cephalic retraction of the gallbladder fundus. Across the flexible trocar, the assistant manipulated the curved grasper to mobilize the infundibulum. The surgeon operated through the working channel of the laparoscope.In this pediatric population, the mean age was 14 years (range, 4-17 years), and mean weight was 50 kg (range, 18-90 kg); 65% were girls. Mean operative time was 62 minutes. All procedures achieved a critical view of safety with no instrumental collision. There were no intraoperative or postoperative complications. The hospital stay was 1.4±0.6 days, and the median follow-up was 201 days.A hybrid technique, combining magnets and a curved grasper, simplifies transumbilical surgery. It seems feasible and safe for TUC and potentially reproducible.

Objectives We evaluated the safety and effectiveness of the Resolute™ zotarolimus-eluting stent (R-ZES) in real-world clinical practice through 3 years. Background A randomized comparison of the R-ZES and the XIENCE V™ everolimus-eluting stent showed no difference in any outcomes through 3-year follow-up in high-volume academic centers. RESOLUTE International is a confirmatory trial designed to evaluate the R-ZES in real-world clinical practice. Methods RESOLUTE International is a single arm, observational trial that enrolled 2,349 patients from 88 centers with only a few inclusion and exclusion criteria. The primary end-point was the composite of cardiac death and target vessel myocardial infarction (TV-MI) at 1 year. Secondary end-points include target lesion failure (TLF), target vessel revascularization (TVR), and their components, and stent thrombosis (ST). Results At 3 years 97.2% of patients completed clinical follow-up. The mean age was 63.4 ± 11.2 years, 77.8% were male, and 30.4% had diabetes. The average number of stents per patient was 1.6 ± 1.0; and mean stent length was 30.9 ± 20.5 mm. Dual antiplatelet therapy was used in 91.1% of patients at 1 year, 43.0% at 2 years, and 34.6% at 3 years. Cardiac death and TV-MI occurred in 161 patients (7.0%). There were 6 (0.3%) very late ST events for a total ST rate of 1.1% through 3 years. The rates of clinically driven target lesion revascularization (TLR), TVR, and TLF were 5.7%, 7.4%, and 11.4%, respectively. Conclusions The safety and effectiveness of the R-ZES through 3 years in this real-world all-comer study was consistent with previously reported all-comer trials. (J Interven Cardiol 2013;26:515-523)

Unprotected distal left main (ULM) lesions often require double-stenting. In the MITO Registry, a mini-crush stenting technique was safer than culotte stenting. Performing mini-crush arises as the best approach in patients with distal ULM lesions requiring elective double-stenting.

Aorto-ostial lesions (AOLs) entail several diagnostic and treatment challenges. The Flash Ostial System enables flaring of the overhanging stent, optimizing stent deployment in AOLs. Careful planning is essential to achieve optimal stent implantation and avoid early and late complications during the treatment of AOLs.

Prior to minimally invasive valve surgery, a strategy of complete revascularization did not impact overall survival. Angiographically guided revascularization may have resulted in unnecessary procedures. A larger sample size and greater atherosclerotic burden may be needed to observe an impact with complete revascularization.

During the pre-procedural (medication) phase, the use of bivalirudin monotherapy is associated with the lowest rate of bleeding in patients with Non-ST elevation myocardial infarction (Non-STEMI) undergoing an early invasive strategy. Monotherapy with either bivalirudin or unfractionated heparin (UFH) appear interchangeable in this setting. The use of GPI upstream with either drug should be discouraged due to an increased risk of bleeding and net adverse events. The use of low dose aspirin plus potent P2Y12 inhibitors followed by a transradial approach with implantation of drug-eluting coronary stents with fluorinated polymers represents an strategy that may help limit perioperative ischemic and hemorrhagic complications in these individuals.

Randomized clinical trial data suggest non-inferiority of bioresorbable vascular scaffolds (BVS) compared to current drug-eluting stent. Compared to randomized data, observational studies with BVS have revealed higher rates of scaffold thrombosis. Meticulous deployment technique of the device including appropriate vessel sizing, optimal scaffold apposition, and avoidance of overexpansion may likely limit the risk of scaffold thrombosis. Large randomized studies with longer follow-up are essential to define the role of this novel technology during routine clinical practice.

Background Coronary restenosis is a poorly understood phenomenon that remains a challenge even in the drug-eluting stent era. This study aimed to identify genes involved in the synthesis of structural and functional proteins in smooth muscle cells with increased expression in human atheromatous plaques associated with neointimal hyperplasia after bare-metal stent implantation. Methods Atheromatous plaques were obtained by directional atherectomy prior to stenting. A gene expression analysis was performed using the Affymetrix GeneChip system. The patients were subjected to intravascular ultrasound six months after the procedure for an in-stent volumetric analysis. The correlation between gene expression in atheromatous plaques and the percentage of in-stent intimal hyperplasia was evaluated. Results Most patients were male (85.7%) with a mean age of 60.2 ± 11.4 years; 35.7% were diabetic, and the percentage of in-stent intimal hyperplasia was 29.9 ± 18.7%. There was no change in the percentage of in-stent intimal hyperplasia in patients with or without diabetes (29.5% vs. 30.7%; P = 0.89). There was no correlation between the stent length and the percentage of in-stent intimal hyperplasia (r = − 0.26; P = 0.26), or between the stent diameter and the percentage of in-stent intimal hyperplasia (r = 0.14; P = 0.56). Eight genes related to smooth uscle cell structural and functional protein synthesis had a positive correlation with the percentage of in-stent intimal hyperplasia. Conclusions De novo coronary lesions exhibited an increased expression of genes related to the synthesis of structural and functional proteins in smooth muscle cells and were associated with future significant in-stent neointimal hyperplasia, thus emerging as novel therapeutic targets.

Background Embolic stroke is a major concern in atrial fibrillation (AF), and anticoagulation is the therapy of choice to prevent it. Around 20% of patients with AF have contraindications for anticoagulation (OAC). The left atrial appendage (LAA) has been identified as the most common place of thrombosis in patients with AF, particularly in those with non-valvular AF or impaired ventricular function. LAA occlusion reduces the incidence of embolic events in these patients. This article describes a case of percutaneous closure of LAA with the Amplatzer Cardiac Plug device. The patient was at high risk of embolism and had absolute contraindication for OAC. The procedure was performed at the cardiac catheterization laboratory under general anesthesia with fluoroscopic guidance and transesophageal echocardiography, and complete closure of the LAA was achieved. During the procedure, no complications were reported. The patient remained event-free at three-month follow-up, with complete exclusion of LAA. No embolic events have been reported.

Resumen es: Introduccion El tratamiento antiagregante dual con aspirina y clopidogrel constituye un tratamiento esencial para la prevencion de eventos isquemicos en ...

BACKGROUND: Dialysis patients are at a higher risk of bleeding after PCI; however, due to their exclusion from randomized clinical trials, the optimal antithrombotic regimen for this population remains unknown. We sought to evaluate the comparative safety and effectiveness of bivalirudin monotherapy versus unfractionated heparin (UFH) monotherapy in dialysis patients undergoing percutaneous coronary intervention (PCI). METHODS: We included dialysis patients who underwent PCI in a multicenter registry between January 2010 and September 2015 at 47 Michigan hospitals. We compared in-hospital outcomes between bivalirudin versus UFH; excluding those treated with glycoprotein IIb/IIIa inhibitors. Optimal full matching was used to account for the non-random use of these drugs. RESULTS: Of 177,963 patients who underwent PCI, 4,303 (2.4%) were on dialysis. Among those, 1,257 (29.2%) received bivalirudin monotherapy and 2,112 (49.1%) received UFH monotherapy. Patients treated with bivalirudin had fewer comorbidities. After matching, there were no significant differences in outcomes between those who received bivalirudin versus UFH: bleeding (adjusted odds ratio: 0.67; 95% confidence interval: 0.41–1.07; P=0.093); major bleeding (0.81; 0.19–3.50; P=0.77); transfusion (1.01; 0.77–1.33; P=0.96); repeat PCI (0.57; 0.14–2.24; P=0.42); stent thrombosis (0.56; 0.05–5.83; P=0.63); and death (0.84; 0.46–1.51; P=0.55). CONCLUSIONS: We found no significant differences in in-hospital outcomes between bivalirudin and UFH monotherapy among dialysis patients undergoing PCI. Randomized clinical trials are needed to determine the optimal anticoagulant regimen for this population.

Early hospital readmissions after percutaneous coronary interventions (PCI) are common and costly. From the NCDR CathPCI Registry and the Centers for Medicare and Medicaid Services, a risk prediction model was generated using 14 clinical variables, demonstrating modest discrimination. Future research is needed to identify interventions aim to reduce early readmissions. The use of this risk model may help guide these interventions.

Unprotected distal left main (ULM) lesions often require double-stenting. In the MITO Registry, a mini-crush stenting technique was safer than culotte stenting. Performing mini-crush arises as the best approach in patients with distal ULM lesions requiring elective double-stenting.

BACKGROUND The relationship of the ischemic time to primary angioplasty and the quality of myocardial reperfusion according to infarcted territory among patients with ST-segment elevation myocardial infarction (STEMI) is unclear. METHODS This study consisted of 140 patients with STEMI within 12 h from the symptom onset and undergoing a primary angioplasty from the Protection of Distal Embolization in High-Risk Patients with Acute ST-Segment Elevation Myocardial Infarction Trial. ST-segment resolution (STR) at 60 min was analyzed by an independent corelab using continuous ST monitoring. Patients were divided according to anterior (n=74) and nonanterior (n=64) locations and according to ischemic time in quartiles (

We report the time to stable ST-segment reperfusion (TSTR) after primary angioplasty and its relationship with the clinical results; 137 patients who underwent primary angioplasty were included as part of the analysis. All patients had 24 hours ST-segment monitoring. Time to stable STR was defined as the beginning of ST-segment reperfusion (STR) lasting >4 hours without ST-segment reelevation. Six-month mortality was associated with slower TSTR (median 166.5 vs 6 minute, P = .001). Time to stable STR cutoff value of 136.5 minutes was identified as the best mortality predictor (area under the curve: 0.86, P = .001). Multivariate analysis identified Killip class ≥2 (P = .042), TSTR cutoff value (P = .002), and final thrombolysis myocardial infarction (TIMI) flow grade III (P = .067) as predictors of 6-month mortality. Time to stable STR may be a novel continuous electrocardiogram (ECG) parameter following primary angioplasty, which can identify high-risk patients that need to be considered for additional treatments.

RESUMENIntroducciónLa isquemia crítica de miembros inferiores representa una manifestación extrema de laenfermedad vascular periférica crónica. La revascularización quirúrgica es el tratamientode elección para los pacientes con esta patología, ya que pese a ser un procedimiento invasivoreduce la tasa de amputación y de mortalidad. Sin embargo, tiene una tasa alta de complicaciones.Durante la última década, el perfeccionamiento y la introducción de nuevas tecnologíaspercutáneas han derivado en un crecimiento importante en la estrategia endovascular.Su baja morbilidad comparada con la de la alternativa quirúrgica ha llevado a un rápido yexplosivo incremento en su indicación.ObjetivoEvaluar los resultados clínicos en pacientes con lesiones críticas de miembros inferiorestratados de forma endovascular en un centro de alto volumen.Material y métodosDesde enero de 2005 hasta diciembre de 2008 se realizaron 60 procedimientos en 55 pacientes.ResultadosLa edad de los pacientes fue de 72,5 ± 10,6 años (rango 49-91); el 60,7% eran de sexomasculino, el 57% padecían diabetes y el 48,8%, enfermedad coronaria. El 50% de los pacientespresentaron dolor del miembro en reposo y el resto, lesiones tróficas menores en el41% y mayores en el 9%. Se trataron en total 74 lesiones: 14 aortoilíacas, 23 femoropoplíteas,28 infrapoplíteas y 9 bypass vasculares. En el seguimiento a 30 días, la tasa de reintervenciónde urgencia fue del 10,9%, la de amputación del 5,4%, la de muerte del 3,6% y la de eventoscardíacos mayores (muerte, infarto agudo de miocardio, accidente cerebrovascular,reintervención o amputación) fue del 10,9%. Luego de 30 días, el seguimiento alejado (media727 ± 442 días) arrojó las siguientes tasas: reintervención 11,7%, amputación 7,4%,infarto agudo de miocardio 2%, accidente cerebrovascular 2%, muerte 11,7% y eventos cardíacosmayores 27,4%. Las tasas de reintervención, amputación y eventos cardíacos mayoresdurante todo el estudio fueron del 21,4%, 14,3% y 30,3%, respectivamente.ConclusionesEl tratamiento endovascular representa una alternativa atractiva para pacientes conisquemia crítica de miembros inferiores al reducir el riesgo de amputación. Sin embargo,esta población presenta un riesgo cardiovascular incrementado en el pronóstico alejado.REV ARGENT CARDIOL 2010;78:129-133.

Background: Women have higher risk of contrast-induced nephropathy than men. The purpose of this study was to determine the relative impact of gender on long-term renal function after percutaneous renal interventions (PRI). Methods and Results: We included all patients undergoing PRI. Men (n = 72) and women (n = 28) had similar age, men had more diabetes, coronary and peripheral artery disease, higher serum creatinine and similar glomerular filtration rate (GFR), and prevalence of chronic kidney disease (CKD) stage ≥3 when compared with females. At follow-up, men had a significant improvement in GFR and systolic blood pressure, while females did not. The presence of severe CKD and male gender were the only predictors of long-term GFR improvement. Conclusion: Male patients and patients with poor baseline renal function showed an important benefit with PRI, suggesting that it is not too late for renal revascularization if properly indicated.

Una proporción importante de pacientes con estenosis aórtica (EAo) grave poseencomorbilidades que incrementan el riesgo de la cirugía de reemplazo valvular aórtico. Elimplante percutáneo de válvula protésica surge como una alternativa en este grupo depacientes. Se comunican dos casos de pacientes de edad avanzada portadores de EAo gravea los que se les realizó con éxito el implante percutáneo de una prótesis valvular aórticaCoreValve y se describen los criterios para la selección de pacientes y la técnica de implantepercutáneo.REV ARGENT CARDIOL 2009;77:203-207.

RESUMENIntroducciónEl pronóstico de los pacientes que sufren un infarto agudo de miocardio con supradesniveldel ST (IAMST) ha mejorado notoriamente, en particular como resultado de la terapia dereperfusión. A pesar de estos avances, los pacientes con diabetes mellitus (DM) constituyenun grupo de alto riesgo. La hiperglucemia en pacientes con IAMST se asocia con peor pronóstico, independientemente del diagnóstico previo de DM.ObjetivoEvaluar el valor pronóstico de la glucemia en ayunas (GA) durante un IAMST tratado conangioplastia primaria.Material y métodosDe 227 pacientes con diagnóstico de IAMST se excluyeron 31 con DM y 7 derivados paraterapia de rescate tardío. Se registraron la glucemia en la admisión (GAd) y la GA; la población se dividió según la GA en: grupo A ³ 110 mg/dl (hiperglucémicos) y grupo B < 110 mg/dl (normoglucémicos).ResultadosLa población en estudio quedó conformada por 189 pacientes. La edad fue de 62,1 ± 10,5años, sexo masculino 82%, tabaquistas 40%, el tiempo dolor-balón fue de 2,75 horas (25-75% intercuartiles 2-4,75), el porcentaje con clasificación de Killip & Kimball (KK) ³ 3 fuedel 12,1% y el 38% presentaron localización anterior. Se registraron 15 (7,9%) muertesintrahospitalarias, todas en pacientes hiperglucémicos. Por análisis multivariado, lospredictores independientes de mortalidad intrahospitalaria fueron la edad (p = 0,048) y laGA como variable continua (p = 0,002). Para los eventos cardíacos mayores (muerte, reIAMe insuficiencia cardíaca), la clasificación de KK ³ 3 (p = 0,001), la GA (p = 0,001) y eldeterioro moderado/grave de la función sistólica (p = 0,016) fueron sus únicos predictoresindependientes. La GAd no resultó predictora independiente de muerte o de eventos cardíacosmayores.ConclusionesLos resultados del presente estudio sugieren que la GA posee valor pronóstico a corto plazoen pacientes no diabéticos que cursan un IAMST. La GA identifica tempranamente y enforma sencilla a una población de riesgo alto.REV ARGENT CARDIOL 2009;77:361-366.

IntroducciónLa angioplastia primaria tiene una eficacia limitada ya que deja a un grupo considerable de pacientessin lograr una reperfusión miocárdica tisular adecuada. Los factores clínicos, angiográficosy terapéuticos que influyen en el grado de reperfusión no han sido claramente establecidos.ObjetivosIdentificar los factores independientes asociados con la ausencia de reperfusión tisular luegode la angioplastia primaria.Material y métodosSe analizaron 140 pacientes incluidos prospectivamente en el estudio aleatorizado Protectionof Distal Embolization in High-Risk Patients with Acute ST-Segment Elevation MyocardialInfarction Trial (PREMIAR). Este estudio evaluó la utilización de un filtro de proteccióndistal durante la angioplastia en el infarto agudo de miocardio con supradesnivel del segmentoST en pacientes de alto riesgo trombótico (solamente incluyendo flujo coronario basalTIMI 0-2). El punto final primario fue la resolución completa del segmento ST a los 60minutos, definida como disminución del ST ≥ 70% con el empleo de monitorización continuadel segmento ST. Se desarrolló un modelo de regresión logística para identificar los predictoresindependientes.ResultadosSe observó resolución completa del segmento ST a los 60 minutos luego de la angioplastiaen 82 pacientes (63%), mientras que 53 pacientes (37%) presentaron resolución incompletaque se asoció con una tasa de mortalidad, reinfarto y/o insuficiencia cardíaca a los 30 díasdel 8,5% y 18,9%, respectivamente (p = 0,07). Los pacientes que no lograron una reperfusióntisular adecuada tuvieron con más frecuencia compromiso de localización anterior (79%versus 33%; p = 0,001), mayor frecuencia cardíaca (81 ± 20 versus 70 ± 15; p < 0,001) ymenor proporción de fumadores actuales (25% versus 51%; p = 0,002) respecto de aquelloscon reperfusión tisular óptima. Se observó además una tendencia a mayor presencia dediabetes (26% versus 16%; p = 0,13), mayor tiempo desde el inicio de los síntomas a laangioplastia (minutos) (217 ± 167 versus 182 ± 134; p = 0,19) y clase Killip > 1 (30%versus 17%; p = 0,07), respectivamente. El análisis multivariado demostró que el infarto delocalización anterior (OR 8,22, IC 95% 3,67-18,4; p < 0,001) se asoció con ausencia dereperfusión completa, mientras que el uso de inhibidores de la glicoproteína IIb/IIIa (OR4,21, IC 95% 1,34-13,22; p = 0,014) y el tabaquismo actual (OR 3,84, IC 95% 1,58-9,50; p =0,003) se correlacionaron con una reperfusión completa.ConclusionesUna proporción considerable de pacientes sometidos a angioplastia primaria no logran unareperfusión tisular adecuada. Este fenómeno se asocia con peor pronóstico. La presencia deinfarto de localización anterior se correlaciona con una extensión menor del grado de reperfusióntisular. Contrariamente, el tabaquismo actual y el uso de inhibidores de la glicoproteína IIb/IIIa se asocian con una reperfusión tisular más profunda luego de la angioplastia primaria.REV ARGENT CARDIOL 2009;77:174-180.

IntroducciónEl surgimiento de los stents liberadores de droga (SLD) ha disminuido la tasa de reintervención del vaso tratado (RVT). No obstante, incluso con SLD, el tratamiento percutáneo de lesiones en bifurcación aún constituye un desafío debido a una tasa todavía elevada de RVT.ObjetivoEvaluar los resultados clínicos en pacientes con bifurcaciones tratados con SLD o sin éstos en un centro de alto volumen.Material y métodosDesde abril de 2003 hasta agosto de 2006 se realizaron 1.910 angioplastias; 235 (12,3%) pacientes presentaron bifurcaciones.ResultadosLa edad de los pacientes incluidos fue de 62 ± 11 años; el 86% era de sexo masculino, el 19,2% padecía diabetes y el 22,7% tenía cirugía coronaria previa. El 54% de los pacientes presentaron bifurcaciones verdaderas. Se utilizó SLD en el 44,3%; el 22,5% requirió el implante de dos stents (en ambas ramas), mientras que el procedimiento se concluyó con kissing balloon final en el 24,5% de los casos. En el seguimiento alejado (mediana 430 días), la RVT fue del 16,7%, 13,9% con SLD y 17,2% con stent convencional (SC) (p = ns). La tasa de trombosis angiográfica fue del 3%, 1,9% para SLD y 4,6% para stent convencional (p = ns). Las tasas de infarto y muerte cardíaca fueron del 3,4% y del 2,9%, respectivamente, sin diferencias entre los dos grupos. La tasa combinada de muerte cardíaca, infarto, trombosis y RVT fue del 21,7%, 16,3% con SLD y 25,2% con stent convencional (p = 0,04).ConclusiónEl tratamiento percutáneo de lesiones en bifurcación continúa siendo un desafío. Es probable que técnicas más simples con implante de un solo stent, preferentemente SLD, y la implementación de kissing balloon final sea la opción más recomendable en la mayoría de los casos.

Distal embolization may decrease myocardial reperfusion after primary percutaneous coronary intervention (PCI). Nonetheless, results of previous trials assessing the role of distal protection during primary PCI have been controversial. The Protection of Distal Embolization in High-Risk Patients with Acute ST-Segment Elevation Myocardial Infarction Trial (PREMIAR) was a prospective, randomized, controlled study designed to evaluate the role of filter-based distal protection during PCI in patients with acute ST-segment elevation myocardial infarction at high risk of embolic events (including only baseline Thrombolysis In Myocardial Infarction grade 0 to 2 flow). The primary end point was continuous monitoring of ST-segment resolution. Secondary end points included core laboratory analysis of angiographic myocardial blush, ejection fraction measured by cardiac ultrasound, and adverse cardiac events at 6 months. From a total of 194 enrolled patients, 140 subjects were randomized to PCI with or without embolic protection, and 54 were included in a registry arm due to the presence of angiographic exclusion criteria. Baseline characteristics were comparable between arms. The rate of complete ST-segment resolution (>or=70%) at 60 minutes was similar in patients treated with or without distal protection (61.2% vs 60.3%, respectively, p = 0.85). Angiographic myocardial blush (67% vs 70.7%, p = 0.73), in-hospital ejection fraction (47.4 +/- 9.9% vs 45.3 +/- 7.3%, p = 0.29), and combined end point of death, heart failure, or reinfarction at 6 months (14.3% vs 15.7%, p = 0.81) were consistently achieved in a similar proportion in the 2 groups. In conclusion, the use of filter-based distal protection is safe and effectively retrieves debris; however, such use does not translate into an improvement of myocardial reperfusion, left ventricular performance, or clinical outcomes.

IntroducciónLos estudios aleatorizados han demostrado la superioridad del uso de los stents liberadores de droga (SL) sobre los stents convencionales (SC). La información en nuestro medio sobre el implante de SL en lesiones de tipo reestenosis intrastent (RIS) es escasa.ObjetivoComparar los resultados clínicos obtenidos en pacientes sometidos a implante de SL versus SC o angioplastia con balón (grupo convencional) en un centro de alto volumen de la Argentina.Material y métodosSe incluyeron todos los pacientes sometidos a angioplastia electiva por RIS desde enero de 2002 hasta julio 2006 y se dividieron en dos grupos: grupo SL (n = 116) y grupo convencional (n = 102).ResultadosNo hubo diferencias en las características basales, excepto por una incidencia menor de infarto previo y una presentación mayor con síndrome coronario agudo en el grupo SL. En este grupo se observó un porcentaje mayor de lesiones difusas, con el resultado de un número superior de stents implantados (1,1 ± 0,3 versus 0,5 ± 0,4; p < 0,001) y mayor longitud total del stent que en el grupo convencional (35,5 ± 16,5 versus 9,9 ± 7,6 mm; p < 0,001). Se observó una tasa similar de muerte, infarto y revascularización de urgencia a los 30 días de seguimiento. En el seguimiento alejado, en el grupo SL hubo menos necesidad de nuevo procedimiento de revascularización (12,9% versus 24,5%; p = 0,02). No se observaron diferencias significativas en la tasa de muerte e infarto en el seguimiento alejado.ConclusiónLos resultados del estudio sugieren que el uso de SL en un centro de alto volumen de la Argentina es seguro y eficaz, en comparación con las técnicas convencionales.

Postprocedural aortic regurgitation (PAR) after transcatheter aortic valve implantation (TAVI) is associated with a worst clinical outcome. The presence of chronic aortic regurgitation in TAVI candidates increases PAR risk but not overall survival. Future valve prototypes will likely reduce the degree and frequency of this complication.

Bioresorbable vascular scaffolds (BVS) remain experimental for the treatment of coronary bifurcations (B) and further clinical data is needed before widespread adoption in this setting. Preliminary, clinical outcome in B using a provisional stenting or double stenting approach with BVS is encouraging and close to the one observed with next-generation drug-eluting stent. Improvements in device navigability, reduction in strut bulk and reabsorption time may render the device more predictable and simpler to use.

Key Points The SYNTAX score is an angiographically based tool useful for clinical decision-making prior to coronary revascularization. The residual SYNTAX score (after angioplasty) is an independent predictor of clinical long-term outcome in patients with complex coronary artery disease. Both scores require functional lesion assessment. Adding clinical risk factors to both scores enhances their performance.

Ischemic postconditioning protects against reperfusion injury. Adjunctive use of manual thrombus aspiration improves reperfusion results in patients undergoing primary angioplasty. Combining both strategies (ischemic postconditioning and thrombus aspiration) may have additive effects in terms of myocardial salvage. The PORT trial will study the role of ischemic postconditioning in patients undergoing primary angioplasty with thrombus aspiration.

Key Points Bioresorbable coronary scaffold emerges as an attractive alternative to permanent scaffolds. Bioresorbable scaffold restenosis, similar to permanent, appears strongly related to underexpansion. The use of intravascular imaging should be recommended in patients undergoing bioresorbable scaffold implantation

Antecedentes Estudios aleatorizados demostraron la superioridad del uso de stents liberadores de droga (SL) sobre el stent convencional (SC). La información en nuestro medio sobre el implante de SL es escasa. Objetivo Comparar los resultados clínicos obtenidos en pacientes sometidos a implante de SL versus SC en un centro terciario de la Argentina. Material y métodos Se incluyeron todos los pacientes sometidos a angioplastia electiva desde abril de 2003 hasta junio de 2005 y se dividieron en dos grupos: los pacientes sometidos a implante de uno o más SL (grupo SL, n = 373) y los sometidos solamente a implante de SC (grupo SC, n = 857). Resultados Las características basales fueron similares entre los dos grupos. En el grupo SL se observó un porcentaje mayor de lesiones en la arteria descendente anterior (50,6 versus 40,6%; p < 0,001) y de lesiones tipo reestenosis intrastent (16,6 versus 8,7%; p < 0,001) junto con un tamaño menor del vaso (3,01 ± 0,57 versus 3,11 ± 0,57; p = 0,068) y una longitud mayor de la lesión (20,6 ± 9,0 versus 15,9 ± 7,8; p < 0,001) que en el grupo SC. En cuanto a los stents implantados, su longitud total fue mayor (36,7 ± 18,1 versus 28,2 ± 17,7; p = 0,002) y su diámetro promedio fue menor en el grupo SL que en el SC (3,09 ± 0,47 versus 3,17 ± 0,44; p = 0,007). Se observó una tasa similar de muerte, infarto y revascularización de urgencia a los 30 días de seguimiento. Al año, en el grupo SL se redujo la incidencia de nuevas revascularizaciones (7,2% versus 11,7%; p > 0,001), gracias a una reducción de la tasa de cirugía coronaria (1,4% versus 5,8%; p = 0,045). Conclusión El uso de SL en un centro terciario de la Argentina demostró que es seguro y, en comparación con el implante de sólo SC, dio por resultado una tasa menor de reintervención, primariamente por haber reducido la tasa de cirugía de revascularización miocárdica

We report the outcomes of patients who had in-stent restenosis (IRS) that was treated with intravascular brachytherapy (IVBT) or sirolimus-eluting stent (SES) implantation. The benefit of IVBT for treating ISR is well documented. SES implantation decreases first-time ISR and, in preliminary reports, has been used to treat ISR. Fifty consecutive patients who had ISR were treated; the first 25 patients underwent SES implantation and the next 25 patients were treated with IVBT using a beta-Cath System (a 40-mm strontium-90/yttrium-90 source). Quantitative angiographic and intravascular ultrasound follow-up were performed at 5.2 +/- 1.1 and 12.1 +/- 1.2 months; clinical follow-up was performed at 15 months. SES deployment and IVBT were successful in all patients. At 12-month follow-up, 8 patients who underwent IVBT had angiographic recurrence (4 in the stent and 4 at the stent edge); only 1 patient who underwent SES implantation developed recurrent ISR. At 12 months, in-stent late luminal loss was similar between the SES and IVBT groups (0.35 +/- 0.45 vs 0.34 +/- 0.46 mm, p = 0.9); however, in-stent net luminal gain was higher in the SES group than in the IVBT group (1.32 +/- 0.13 vs 0.57 +/- 0.19 mm, p

Background Although target lesion revascularization (TLR) has been dramatically decreased by using drug-eluting stents (DESs) in de-novo lesions, their efficacy for in-stent restenosis (ISR) has not yet been well established. Methods We retrospectively analysed patients treated for ISR with DESs from three referral hospitals. Results Eighty-seven consecutive patients, from June 2002 to April 2004, were included, with a mean age of 64 ′ 11 years; 83% were men, 32% had diabetes, 47% had had a previous myocardial infarction and 16% had low left ventricular ejection fraction. Angiographic characteristics were as follows: mean vessel diameter, 3.05 ′ 0.4 mm; lesion length, 17.8 ′ 7.7 mm; diameter stenosis, 84.0 ′ 10.7%; and complex lesion, 81 %. The restenosis was focal in 45%, diffuse/proliferative in 51.3% and total occlusion in 3.7% of the cases. Sirolimus- and paclitaxel-eluting stents were used in 42 and 58% of the patients, respectively. Stent diameter was 3.1 ′ 0.3 mm and the length was 26.1 ′ 5.8 mm. Angiographic success was achieved in all patients, with one patient experiencing a post-procedural non-Q-wave myocardial infarction. At 6-month clinical follow-up, two patients had died from non-cardiac deaths, five had experienced a new TLR (5.7%, four percutaneous and one coronary artery bypass graft) and eight (9.2%) had had major adverse cardiac events. A stress test was performed in 60% of the population; target vessel ischemia was observed in one patient (3.3%). Conclusion In this non-select cohort of patients, the use of DESs is a safe and effective strategy for ISR lesions.

We performed serial intravascular ultrasound analysis in patients who underwent balloon dilatation for in-stent restenosis. Early lumen loss was detected by intravascular ultrasound and was associated with minimal changes at the edges and at the external elastic membrane. These results on intravascular ultrasound suggest compression and decompression as the main mechanisms for early lumen loss after dilatation of in-stent restenotic lesions.

Objectives The purpose of the study was to examine the safety and efficacy of 17-beta-estradiol–eluting stent implantation on coronary de novo lesions. Background Recent animal data indicate that local delivery of 17-beta-estradiol promotes re-endothelialization, inhibits cell migration and proliferation, and prevents restenosis. Methods A total of 30 consecutive patients underwent 17-beta-estradiol–eluting BiodVysio (Biocompatibles Ltd., London, United Kingdom) stent implantation for the treatment of coronary de novo lesions. Clinical, angiographic, and intravascular ultrasound (IVUS) analysis was performed at six-month follow-up. Results All stents were successfully deployed and patients were discharged home without clinical events. A total of two patients exceeded 50% intra-stent narrowing by angiography, whereas no patients experienced edge restenosis. One patient had focal intra-stent restenosis (60% diameter stenosis) with no symptoms and negative stress test, whereas the other patient had diffuse restenosis, requiring target vessel revascularization. No other patient experienced any major adverse cardiac event. Follow-up IVUS revealed a neointimal hyperplasia volume of 32.3 ± 16.4 mm3, whereas the stent volume was 143.7 ± 43.7 mm3, resulting in a neointimal volume obstruction of 23.5 ± 12.5%. None of the patients had ≥50% volume obstruction by IVUS. Conclusions Implantation of 17-beta-estradiol–eluted BiodVysio stents appears feasible and safe, showing low rates of binary restenosis and revascularization. These results warrant further confirmation with a large, randomized multicenter trial.

Ischemic postconditioning protects against reperfusion injury. Adjunctive use of manual thrombus aspiration improves reperfusion results in patients undergoing primary angioplasty. Combining both strategies (ischemic postconditioning and thrombus aspiration) may have additive effects in terms of myocardial salvage. The PORT trial will study the role of ischemic postconditioning in patients undergoing primary angioplasty with thrombus aspiration.

Prior to minimally invasive valve surgery, a strategy of complete revascularization did not impact overall survival. Angiographically guided revascularization may have resulted in unnecessary procedures. A larger sample size and greater atherosclerotic burden may be needed to observe an impact with complete revascularization.