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In one multicenter and several single-center studies involving 202 cases, new shapes of transradial access PCI guide catheters were tested following a standardized original protocol. The evaluation included a newly designed score for PCI complexity. Three operators successfully performed the 40 cases of the multicenter study, scoring intermediate to difficult 66% of the cases. New shapes were tested for left and right coronary artery and saphenous vein graft PCIs, with right or left transradial access. The new shapes performed adequately, including in 5F sizing. PCI success and fluoroscopy time were related to the score of complexity.

Background Key predictors of survival after OHCA have been described in the literature. Current guidelines recommend emergency angiography in patients without an obvious extra-cardiac cause of arrest. However, the value of this strategy is debated. Moreover, diagnosis of acute coronary ischaemia after OHCA remains challenging, especially in patients without ST-segment elevation. Objectives The primary objective was to identify qualitative variables associated with an increased chance of 30-d survival after OHCA. The secondary objective was to identify predictors of 30-d survival among patients with ischaemic cardiomyopathy and patients without ST-segment elevation. Afterwards, we sought to identify parameters associated with acute coronary ischaemia and positive coronary angiography in patients without ST-segment elevation. Methods Retrospective single-centre study including 123 patients resuscitated from OHCA. Baseline characteristics, resuscitation settings and angiographic findings were analysed. Results The predictors of 30-d survival after OHCA included witnessed cardiac arrest, haemodynamic instability and coronary angiography. Convertible cardiac rhythm, history of coronary disease and presence of at least two cardiovascular risk factors were associated with acute coronary ischaemia. Predictors for a positive angiography in patients without ST-segment elevation included history of coronary disease, gender, diabetes, dyslipidaemia and presence of at least two cardiovascular risk factors (all p Conclusions We identified qualitative predictors of 30-day survival after OHCA. Our findings suggest that the recognition of acute coronary ischaemia after OHCA might be improved. The identification of risk criteria may help to select the best candidates for emergency angiography.

The author describes a simple and inexpensive way to deliver high pressures within an atherosclerotic coronary artery and reports two cases. The technique used two non-compliant (NC) balloons placed in parallel and inflated together within the same coronary segment. The cases illustrate two possible indications for the technique: lesion resistant to one adequately sized NC balloon or not fully expanded coronary stents after high-pressure non-compliant ballooning.

Objective To demonstrate the safety and efficacy of a new sirolimus eluting stent with bioresorbable polymer, Ultimaster, (BP-SES) compared with everolimus-eluting, permanent polymer, Xience stent (PP-EES) in bifurcation lesions with respect to the freedom from Target Lesion Failure at 1-year. Methods Within 1,119 patients enrolled in the CENTURY II randomized controlled multicenter trial, 194 patients were treated for bifurcation lesions and randomized to either BP-SES (n = 95) or PP-EES (n = 99). The primary endpoint was freedom from target lesion failure (TLF) composite endpoint [cardiac death, MI not clearly attributable to a non-target vessel, and clinically driven target lesion revascularization (TLR)] at 1-year. Results Baseline patient demographic, angiographic, and stenting characteristics were similar in both study arms. A single stent technique with provisional or “cross over” stenting were the most widely used in both arms (93.2% BP-SES vs. 92.4% PP-EES). Freedom from TLF at 1-year was 94.7% for BP-SES and 91.9% for PP-EES (P for noninferiority 0.031). The rate of clinically driven target lesion revascularization (TLR) at 1-year was 3.2% for BP-SES and 3.0% for PP-EES (P = 0.95). There were no significant differences detected in any of the individual clinical endpoints or other secondary clinical endpoints between the study arms at 1-year follow up. Conclusions The new bioresorbable polymer sirolimus-eluting stent showed safety and efficacy profiles similar to durable polymer everolimus-eluting in the treatment of patients with bifurcation lesions at 1-year follow up. © 2015 Wiley Periodicals, Inc.

Background The national history of mild/moderate aortic stenosis (AS) has been previously reported in 3 studies. Aim We sought to assess the impact of the severity of AS in a group of patients initially managed medically. Methods A consecutive group of 399 patients with AS as assessed in our echolab (6.2.2002‐22.7.2003). Patients with a previous aortic prosthesis or operated within 3 months after diagnosis of AS were excluded. Patients were classified according to AS severity: * mild AS (AV area > 1.5‐2 cm2) * moderate AS (AV area 1‐1.5 cm2) * severe AS (AV area 0.8‐0.99 cm2) * very severe AS (AV area 0.8 cm2 had no impact on survival. The relative impact of the AS severity in addition to the clinical parameters (log Euroscore, age, NYHA, LVEJF) was assessed by the ROC model. The predictive performance was only slightly improved (by 2 ‐ 3%) by including the AS severity. Conclusion Survival in patients with very severe AS is reduced in comparison to patients with less severe AS. Survival in patients with less severe AS (AV area > 0.8 cm2) depends mainly on clinical characteristics, but not on degree of AS severity. There seems to be a place for randomized trials on the management of patients with less severe AS (AV area: 0.8‐1 cm2).

The study sought to evaluate the benefit of the reduction in intensity and duration of the hemostasis obtained with the transradial (TR) Band compression device on the radial artery occlusion (RAO) rate. RAO is the most frequent complication of TR access for cardiac catheterization and limits future use of this safe route. Its occurrence must be minimized. Between 2009 and 2016, 3,616 TR accesses were randomized to TR Band hemostasis during 3 consecutive protocols: CRASOC I (Compression of Radial ArterieS without Occlusion): 13 versus 10 cc of air into the TR Band and for 4 hours of continuous compression; CRASOC II: 10 cc of air for 3 hours versus 2 hours of compression; and CRASOC III: 10 cc of air for 2 hours versus 1.5 hours of compression and virtual 4F introducer as default sheath (both arms). Radial artery patency was assessed by plethysmography at 24 hours, using Doppler for doubtful or negative plethysmography. The primary end point, 24 hours of RAO, was markedly reduced when hemostasis was soft (10 cc of air) and short (1.5 hours) and resulted in a 2.3% rate of RAO versus 9.4% for 13 cc, 4 hours. Hemostasis was obtained in 89% of patients with only 10 cc of air and in 97% of patients with less than the recommended 13 cc. About 8% of patients required more than the 1.5 hours of hemostasis time. In conclusion, short and soft hemostasis with the TR Band device leads to a low RAO rate.

Delivery of coronary stents can be challenging, but the use of a second or ‘buddy’ wire helps the progression of equipment through tortuous and rigid vessels. We successfully positioned a coronary stent in a distal lesion, intentionally jailing the buddy wire during stent delivery. The jailed wire was then used to proceed further with proximal coronary stenting. We report 10 cases using either the jailed or the non-jailed wire for this modified ‘buddy-in-jail’ technique.

Electronic Medical Record (EMR) and the correlate, a data processing tool or a “Solution” built through a database application is likely to play an essential role in any modern health care system [1]. A report of the American College of Cardiology/American Heart Association task force on clinical data standards has been published [2] and highlights the importance of straightforward written communication in our medical field.

Minimizing injury related to the local compression after transradial access (TRA) reduces the radial artery occlusion (RAO) rate. RAO limits future use of this access. To assess the benefit of reducing both intensity and duration of the compression. From 2009 to 2011, Crasoc I randomized 1937

Background Previous studies on the natural history of mild/moderate aortic valve stenosis used the combined end-point of death and aortic valve replacement (AVR). Aim The aim of our study was to assess the very long-term outcome (survival) of patients with mild/moderate aortic stenosis (AS). Methods A consecutive series of 760 patients with the diagnosis of mild (AVA > 1.5 cm2–2 cm2, n = 408) and of moderate (AVR > 1 cm2–1.5 cm2, n = 352) AS during the inclusion period from 01.12.2003 to 01.05.2006 were followed. Follow-up duration ≥ 10 years in all patients. Vital status (national vital statistics) was assessed on 29.10.2016. Completeness of follow-up: 100%. Mean age: 76 ± 10 y. Logistic Euroscore: 13 ± 11; Euroscore 2010: 4.3 ± 4.9. Results Overall survival at 1–5–10 years according to AS severity was respectively for mild AS: 88%–60%–39% and for moderate AS: 85%–54%–30%. The following baseline characteristics were independently (COX model) associated with poor outcome (death following follow-up) ( Table 1 ). The severity of AS was not found to be an independent prediction of poor survival (death). Moreover the median (50%) time to AVR was 9 y. in case of moderate AS and 12 y. in case of mild AS. Conclusion In this large patients cohort (760 pts) with mild/moderate AS, the very long-term outcome (> 10 y) was depending on clinical and hemodynamic variables such as age, comorbidities, LV dysfunction, signs of heart failure and renal failure, but not on the AS severity. The severity of AS seems not to have an independent impact on overall survival.

BACKGROUND/OBJECTIVES: The impact of an elevation of cardiac biomarkers occurring after percutaneous coronary intervention (PCI) on long-term outcome remains controversial. Most available data are based on observational registries using multivariable analysis. In this study, a case-control approach was used to assess separately the impact of post-PCI elevation of CK-MB on the short-term in-hospital outcome and on the long-term outcome after hospital discharge. METHODS: Between 1 January 1996 and 31 December 2008, a postprocedural rise of CK-MB was observed in 363 among 8346 consecutive PCI procedures (4·3%). The overall in-hospital mortality for patients with or without CK-MB elevation after PCI was 8·5% and 1·5%, respectively (P < 0·001). For 245 hospital survivors with CK-MB elevation, we found 245 control cases matched for 9 relevant clinical parameters in our PCI database during the same period. The long-term survival of these patients was assessed by KM estimates. RESULTS: Despite an increased in-hospital mortality among patients with periprocedural elevation of CK-MB, the long-term outcome of patients who are discharged alive is independent of CK-MB release, curves of overall survival and of survival free of recurrence of myocardial infarction being similar up to 10 years after hospital discharge. CONCLUSIONS: In our population, the elevation of CK-MB after PCI identified a high-risk subgroup for in-hospital mortality but had no impact on the long-term prognosis, once the patient is discharged alive from the hospital.

The susceptibility to oxidation of freshly isolated LDL from healthy normolipidemic individuals in three age groups was estimated by exposure of LDL to ionizing radiation followed by analyses of vitamin E, TBARS, conjugated dienes, and fluorescent products. The results clearly showed that LDL from elderly subjects was the most susceptible to oxidative damage in vitro. In particular, the greater susceptibility of LDL from elderly subjects in comparison to that from young subjects may be attributed to the much lower (4-fold) concentration of LDL vitamin E in the elderly subjects. The present study reinforces the notion that the susceptibility of LDL to oxidation increases with age.

CK-MB levels exceeding 3 times the upper limit of normal (ULN) following percutaneous coronary intervention (PCI), defining periprocedural myocardial infarction (PMI), are associated with worse outcomes. This study assessed the incidence and mechanisms of PMI and their impact on in-hospital stay.Over a 12-year period (1996-2007), 272 cases of PMI (overall incidence, 3.5%) were analyzed among 310 consecutive cases of periprocedural myocardial necrosis (PMN; CK-MBULN). Mean numbers of treated segments and stents per procedure were 1.87 ± 0.99 and 1.43 ± 1.01, respectively. Mean stent length per procedure was 29.50 ± 19.30 mm. Following analysis of angiogram, procedural data, delay between PCI and necrosis, and mechanisms of PMN were classified as follows: cryptogenic (by exclusion, 41.5%), immediate failure, side-branch occlusion (14.0% each), stent thrombosis (10.6%), prolonged ischemia (9.2%), delayed failure (8.1%), post coronary artery bypass graft (1.5%), and non-target lesion related MI (1.1%). Significantly more stents were used in stent thrombosis, prolonged ischemia during PCI, and cryptogenic cases. In-hospital mortality was 8.1% for PMN and 8.8% for periprocedural MI, decreasing from non-target lesion related MI (25.0%) to mechanisms linked to stent thrombosis (20.7%), immediate failure (17.5%), delayed failure (7.7%), cryptogenic causes (6.1%), and prolonged ischemia (3.4%). Multivariate analysis confirms that in-hospital mortality is influenced by stent thrombosis, age, ejection fraction, and extent of coronary artery disease.The precise mechanism of PMI was determined in about 60% of our series. Stent thrombosis and immediate failure had the poorest in-hospital outcomes.

Despite a proven safety profile, the transradial approach (TRA) for coronary procedures is regarded by many as complicated and the second-choice arterial access, with a high conversion rate to transfemoral access (TFA). This study reports causes of failure and the contemporary success rate of TRA when both radial arteries are attempted first before converting to TFA.This prospective, single-center study included 1,826 consecutive patients referred for cardiac catheterization, which was performed by two trained operators between January 2005 and June 2007. Procedural data were reported in a specific database.The procedural success rate through TRA (attempting one or both radial arteries) was 98.8%. One hundred and thirty-five radial attempts failed. Inability to puncture or to wire the artery accounted for 52.6% of failures, inability to reach coronary or graft ostia accounted for 20.7% and the remaining failures were related to the inability to reach a contralateral mammary graft. By multivariate analysis, the best predictors for failures were peripheral artery disease (PAD) (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1-2.8; p = 0.016), bedside clinical assessment of either a "small radial artery" size (OR 2.6, 95% CI 1.4 to 5.0; p = 0.003) or a "difficult access" (OR 2.5, 95% CI 1.3-4.9; p = 0.006). The number of failed attempts regresses annually by about 40% (OR 0.6, 95% CI 0.4-0.8; p0.001), thus demonstrating a continuous learning curve. Although rare, hematoma combined with swelling (3.8%) arises more frequently in females (OR 2.4, 95% CI 1.4-3.9; p = 0.001) and elderly patients (OR 1.9, 95% CI 1.0- 3.7; p = 0.040).The TRA can be safely proposed for all patients, with a low conversion rate to TFA when an attempt on both radial arteries is considered first.

This prospective randomized trial was carried out in 92 patients who underwent a successful percutaneous transluminal coronary angioplasty (PTCA) and had no evidence of coronary spasm before PTCA. All patients were premedicated with calcium antagonists and platelet inhibitors and received platelet inhibitors (aspirin and dipyridamole) for 6 months after PTCA. The diltiazem group (46 patients with 50 stenoses successfully dilated) received diltiazem, 90 mg three times a day by mouth for 3 months after PTCA; in the control group (46 patients, 53 stenoses), calcium antagonists were discontinued immediately after PTCA. All patients underwent a control angiogram 5 to 10 months after PTCA unless recurrence of angina dictated its need earlier. Baseline characteristics were similar in both groups, except for the number of diseased vessels greater than or equal to 70%, which was higher in the control group (1.2 +/- 0.55 vs 0.9 +/- 0.39 for the diltiazem group, p less than 0.05). In the diltiazem group, the degree of stenosis increased from 38 +/- 15% immediately after PTCA to 42 +/- 23% at repeat angiography 8.24 +/- 4.79 months after PTCA and there were seven restenoses. In the control group, the degree of stenosis increased from 37 +/- 12% to 44 +/- 23% at repeat angiography 8.26 +/- 4.91 months after PTCA and there were 10 restenoses (NS vs the diltiazem group). In conclusion, in patients without variant angina before PTCA, adjunction of diltiazem to platelet inhibitors does not decrease the incidence of restenosis. These data suggest that coronary spasm is not the major mechanism of restenosis.

Four years after mediastinal radiation for Hodgkin's lymphoma, a 32-year-old man developed angina at rest and with varying levels of physical activity. At coronary arteriography, 40 percent to 50 percent stenoses were seen in the left coronary artery; ergonovine induced severe coronary spasm. Treatment with diltiazem eliminated all anginal attacks.