Coronary angioplasty with or without stent implantation for acute myocardial infarction

Grines CL, Cox DA, Stone GW, et a ., The Stent Primary Angioplasty in Myocardial Infarction Study Group N Eng J Med 1999 341 1949-1956 Abstract BACKGROUND Coronary-stent implantation is frequently performed for treatment of acute myocardial infarction. However, few studies have compared stent implantation with primary angioplasty alone. METHODS We designed a multicenter study to compare primary angioplasty with angioplasty accompanied by implantation of a heparin-coated Palmaz-Schatz stent....

Montalescot G Barragan P Wittenberg O et al Reference

N Engl J Med 2001 344 1895-1903 Abstract BACKGROUND When administered in conjunction with primary coronary stenting for the treatment of acute myocardial infarction, a platelet glycoprotein IIb IIIa inhibitor may provide additional clinical benefit, but data on this combination therapy are limited. METHODS We randomly assigned 300 patients with acute myocardial infarction in a double-blind fashion either to abciximab plus stenting (149 patients) or placebo plus stenting (151 patients) before...

A receptormediated pathway for cholesterol homoeostasis

Animal models of hypercholesterolaemia, as described in the preceding papers, as well as humans with familial hypercholesterolaemia indicated an enormous potential for the role of cholesterol metabolism in atherosclerosis. Brown and Goldstein embarked on their studies of cholesterol homoeostasis in 1972, in an attempt to understand the human genetic disease, familial hypercholesterolaemia (FH), a disease characterized by marked hypercholesterolaemia with premature myocardial infarction. FH...

Sigwart U Puel J Mirkovitch V Joffre F Kappenberger L Reference

New Engl J Med 1987 316(12) 701-706 Abstract Occlusion and restenosis are the most common reasons that transluminal balloon angioplasty may fail to provide long-term benefit. An intravascular mechanical support was therefore developed with the aim of preventing restenosis and sudden closure of diseased arteries after angioplasty. The endoprosthesis consists of a self-expandable stainless-steel mesh that can be implanted nonsurgi-cally in the coronary or peripheral arteries. Experiments in...

Clinical and economic outcomes of multi vessel coronary stenting compared with bypass surgery a singlecenter US

Reference Am Heart J 2003 145 334-342 Abstract BACKGROUND Randomized trials comparing multivessel stenting with coronary artery bypass surgery (CABG) have demonstrated similar rates of death and myocardial infarction but higher rates of repeat revascularization after stenting. The impact of these alternative strategies on overall medical care costs is uncertain, particularly within the US health care system. METHODS We performed a retrospective, matched...

George BS Myler RK Stertzer SH et al Reference

Cathet Cardiovasc Diagn 1986 12 124-138 Abstract Initial experience with the technique of kissing balloon angioplasty is described in 52 patients undergoing coronary angioplasty. Guiding catheters employing both the femoral and brachial approach were used in all but two of the coronary angioplasties and, in addition, the bilateral femoral approach was used in the renal and peripheral angioplasties. Initial success was achieved in 51 (98 ) patients. Abrupt closure requiring urgent coronary...

The TIMI risk score for unstable anginanonST elevation MI A method for prognostication and therapeutic decision making

Context patients with unstable angina non-ST-segment elevation myocardial infarction MI UA NSTEMI present with a wide spectrum of risk for death and cardiac ischemic events. OBJECTIVE To develop a simple risk score that has broad applicability, is easily calculated at patient presentation, does not require a computer, and identifies patients with different responses to treatments for UA NSTEMI. DESIGN, SETTING, AND PATIENTS Two phase 3, international, randomized, double-blind trials the...

Clinical pharmacology of higher dose eptifibatide in percutaneous coronary intervention The Pride Study

Tcheng JE, Talley JD, O'Shea JC, et al. Reference Am J Cardiol 2001 88 1097-1102 Abstract This study describes the dose-exploration phase of the PRIDE trial, an investigation of the clinical pharmacology of higher dose eptifibatide in patients who underwent elective percutaneous coronary intervention PCI . Outcomes of treatment with the platelet glycoprotein IIb IIIa inhibitors were dependent upon proper dosing selection. In this multicenter, placebo-controlled clinical study, 127 patients were...

Quantification of coronary atherosclerosis for cardiovascular risk assessment the hole in the doughnut

A tomographical section of a diseased coronary artery, which is characterized by the central lumen and the surrounding thickened vessel wall, roughly resembles a doughnut. Depending on the imaging modality used, this basic coronary anatomy is described from different perspectives. Angiographical techniques described the size and characteristics of the lumen. In contrast, tomographical techniques, including intravascular ultrasound IVUS , computed tomography CT , and magnetic resonance imaging...

Kastrati A Mehilli J Dirschinger J et al Reference

Circulation 2001 103 2816-2821 Abstract BACKGROUND Increased thrombogenicity and smooth muscle cell proliferative response induced by the metal struts compromise the advantages of coronary stenting. The objective of this randomized, multicenter study was to assess whether a reduced strut thickness of coronary stents is associated with improved follow-up angiographic and clinical results. METHODS AND RESULTS A total of 651 patients with coronary lesions situated in native vessels gt 2.8 mm in...

Compensatory enlargement of human atherosclerotic coronary arteries

Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ Whether human coronary arteries undergo compensatory enlargement in the presence of coronary disease has not been clarified. We studied histologic sections of the left main coronary artery in 136 hearts obtained at autopsy to determine whether atherosclerotic human coronary arteries enlarge in relation to plaque lesion area and to assess whether such enlargement preserves the cross-sectional area of the lumen. The area...

Keeley EC Boura JA Grines CL Reference

BACKGROUND Many trials have been done to compare primary percutaneous transluminal coronary angioplasty PTCA with thrombolytic therapy for acute ST-segment elevation myocardial infarction AMI . Our aim was to look at the combined results of these trials and to ascertain which reperfusion therapy is most effective. METHODS We did a search of published work and identified 23 trials, which together randomly assigned 7739 thrombolytic-eligible patients with ST-segment elevation AMI to primary PTCA...

John M Lasala George Chrysant Adrian Messerli

The Ancillary Techniques in Interventional Cardiology Section will be diverse in covering a number of cutting balloon devices such as directional coronary atherectomy, rotational atherectomy, and distal embolic protection. Limitations on space prevent an elaborate discussion on other techniques that would qualify for the chapter. These three were chosen because they span over a decade and a half of interventional cardiology. Some are more historical in nature all have had a substantial impact...

Plaque rupture with severe preexisting stenosis precipitating coronary thrombosis

Coronary Thrombus Plaque Rupture

Br Heart J 1983 50 127-134 Abstract Ruptured atheromatous plaques were identified by step-sectioning technique as responsible for 40 of 51 recent coronary artery thrombi and 63 larger intimal haemorrhages. The degree of preexisting luminal narrowing at the site of rupture was decisive for whether plaque rupture caused occlusive thrombosis or just intimal haemorrhage. If the pre-existing stenosis was greater than 90 histologically determined then plaque rupture nearly always caused occlusive...

Primary angioplasty PPCI in STelevation myocardial infarction

Almost all acute ST-elevation myocardial infarction STEMI is due to thrombotic occlusion of the coronary artery. Non-STEMI NSTEMI , diagnosed on the basis of subsequent cardiac troponin c-Trop-T or c-Trop-I or creatinine kinase CPK rise, but without initial ST elevation on the electrocardiography ECG is probably related to intermittent or incomplete coronary occlusion. This chapter deals specifically with the treatment of STEMI. The era of reperfusion as the mainstay of treatment was ushered in...

Transluminallyplaced coilspring endarterial tube grafts longterm patency in canine popliteal artery

Invest Radiol 1969 4 329-332 Abstract Tubular prosthetic grafts introduced via carotid arteries were placed transluminally in femoral-popliteal arteries in 25 dogs using simple catheter techniques. While various impervious plastic tubes clotted promptly, the adoption of an open coilspring configuration has made possible long-term patency. Advantages of this potentially useful approach include freedom from the trauma usually associated with surgical vascular reconstruction. In this paper, Dr...

Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction a randomised study

Bonnefoy E, Lapostolle F, Leizorovicz A, et a ., on behalf of the Comparison of Angioplasty and Prehospital Thrombolysis in Acute Myocardial Infarction CAPTIM Study Group BACKGROUND Although both prehospital fibrinolysis and primary angioplasty provide a clinical benefit over in-hospital fibrinolysis in acute myocardial infarction, they have not been directly compared. Our aim was to find out whether primary angioplasty was better than prehospital fibrinolysis. METHODS We did a randomised...

Atherosclerosis and the arterial smooth muscle cell

Science 1973 1BG 1332-1339 Abstract Proliferation of smooth muscle is a key event in the genesis of the lesions of atherosclerosis. In this paper, Russell Ross reviews the current data regarding the vascular smooth muscle cell in atherosclerosis. Proliferation of smooth muscle is a key event in the genesis of the lesions of atherosclerosis. At the time this paper was written, little was known about the genesis of atherosclerosis. Previous studies had demonstrated that blood pressure, smoking...

Risk of thrombosis in human atherosclerotic plaques role of extracellular lipid macrophage and smooth muscle cell

Davies MJ, Richardson PD, Woolf N, Katz DR, Mann J OBJECTIVE To assess the size of the lipid pool and the number of smooth muscle cells and monocyte macrophages in human aortic plaques that were intact and to compare the results with those in aortic plaques undergoing ulceration and thrombosis. DESIGN The lipid pool was measured as a percentage of the total cross sectional area of the plaque. Immunohistochemistry was used to identify cell types monocytes macrophages M phi by EBM11 and HAM56,...

Hochman JS Sleeper LA White HD et al

To assess the effect of early revascularization ERV on 1-year survival for patients with acute myocardial infarction AMI complicated by cardiogenic shock, the SHOCK Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock trial, an unblinded, randomized controlled trial was conducted from April 1993 through November 1998. Thirty-six referral centers with angioplasty and cardiac surgery facilities enrolled 302 patients with AMI and cardiogenic shock due to predominant left...

Preface

Percutaneous coronary intervention PCI is one of the most commonly performed cardiac procedures. Physicians, all healthcare professionals and healthcare managers, as well as patients and their families, the world over, are aware that it is a very useful and powerful tool to help improve the lives of patients with coronary heart disease. But how did we get here Cardiologists of our generation were in training when PCI was in its infancy. There was no evidence base to guide us and we witnessed...

Widimsky P Budesinsky T Vorac D et al Prague Study Group Investigators Reference

Eur Heart J 2003 24 94-104 Abstract BACKGROUND Primary percutaneous coronary intervention PCI is shown to be the most effective reperfusion strategy in acute myocardial infarction AMI . The aim of this multicentre national randomized mortality trial was to test whether the nationwide change in treatment guidelines transportation of all patients to PCI centres was warranted. METHODS The PRAGUE-2 study randomized 850 patients with acute ST elevation myocardial infarction presenting within lt 12 h...

Jeptha P Curtis John F Setaro

The introduction of stents stands as one of the truly revolutionary steps in the history of interventional cardiology. Since worldwide approval of the balloon-expandable Palmaz-Schatz stent, the use of stents has become a routine part of percutaneous coronary interventions PCI . In 2002 it was estimated that stents are used in more than 80 of all coronary interventions at a cost of over 1.6 billion dollars in the USA alone. These numbers do not factor in the increased costs associated with...

Detre K Holubkov R Kelsey S et al Reference

N Engl J Med 1988 318 265 Abstract In August 1985, the Percutaneous Transluminal Coronary Angioplasty Registry of the National Heart, Lung, and Blood Institute reopened at its previous sites to document changes in angioplasty strategy and outcome over time. The new registry entered 1802 consecutive patients who had not had a myocardial infarction in the 10 days before angioplasty. Patient selection, technical outcome, and short-term major complications were compared with those of the 1977 to...

Kip KE Faxon DP Detre KM Yeh W Kelsey SF Currier JW Reference

Patients with diabetes mellitus are at increased risk for cardiovascular disease. Data on baseline clinical and angiographic characteristics and short- and long-term outcomes of 281 diabetic and 1833 nondiabetic PTCA patients in the multicenter National Heart, Lung, and Blood Institute 1985-1986 PTCA Registry were analyzed. Diabetic patients were older, were more likely to be female, and had more co-morbid baseline conditions, triple vessel disease, and atherosclerotic lesions. Angiographic...

Hyperlipidemia and atherosclerosis

Response Injury Hypothesis

Science 1976 193 1094-1100 Abstract Chronic hyperlipidemia initiates and maintains lesions by endothelial cell desquamation and lipid accumulation. In this paper, Ross and Harker describe the effect of hyperlipidemia on the growth of vascular lesions, with and without mechanical injury, in primates. The article begins with an overview of the response to injury hypothesis to explain atherosclerosis development. According to this hypothesis in 1976 , everyone is susceptible to various forms of...

Acute myocardial infarction intracoronary application of nitroglycerin and streptokinase

Rentrop KP, Blanke H, Karsch KR, et al. Reference Clin Cardiol 1979 2 354-363 Abstract In five patients with acute myocardial infarction, the effects of both intracoronary nitroglycerin NTG and subsequent intracoronary streptokinase application were evaluated. In addition, transluminal recanalization was performed in one of these patients. Injection of NTG into the infarct-related coronary artery resulted in improved distal filling of the subtotally occluded left circumflex artery in one...

Evolution and progression of atherosclerotic lesions in coronary arteries of children and young adults

Arteriosclerosis 1989 9 Supp I-19-I-32 Abstract In an autopsy study of the evolution of atherosclerotic lesions in young people, we obtained the coronary arteries and aortas of 1160 male and female subjects who died between full-term birth and age 29 years. In this article, we report the light and electron microscopic observations of the coronary arteries of 565 of these subjects in which we fixed the coronary arteries by perfusion with glutaraldehyde under pressure. From birth, the intima was...