David R holmes Holmes

..Newer strategies being evaluated to enhance the safety of drug-eluting stents include different alloys and stent designs, revisions in the polymer or drug utilized, and, ultimately, bioabsorbable platforms...

..We hypothesized that the analysis of gene expression in peripheral blood mononuclear cells (PBMCs) would demonstrate differences in transcript expression between individuals who develop ISR and those who do not...

..New randomized trials and registries continue to explore the potential for device placement as an alternative to anticoagulant therapy for stroke prevention in this group of patients...

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..This revolution continues to gather speed. Creative solutions continue to be proposed, evaluated, and then brought to the patient care arena. Issues remain, but these identify opportunities for continuing improvement...

..Reperfusion therapy for acute myocardial infarction has revolutionized modern cardiovascular care...

..Although vascular brachytherapy is the only approved therapy for restenosis following bare-metal stent implantation, drug-eluting stents are now being used. Data on the relative merits of each are limited...

..In the future, more individually targeted therapy may be possible if we can more adequately assess the degree of hyperreactivity and underlying inflammation...

..An increased knowledge of the basic pathophysiology of cardiovascular disease, combined with creative technology and imaginative operators, will continue to advance the field...

..For optimal results, patients need to be selected after catheter assessment and combined echocardiography and angiography, and ablation techniques need to be scientific and rigorous...

..Programs such as the FAME initiative will grow in importance as new technologies continue to be introduced into medical practice and the need to train physicians in practice in their use expands...

..Important issues remain to be resolved, many of which have been explored in this book...

..The goal remains identification of patients at particularly increased risk of ST so that optimal prevention strategies can be developed and employed...

..We evaluated these rhythms in patients with ST-elevation myocardial infarction as a function of the 24-hour circadian cycle...

..These approaches will continue to be of paramount importance as new technologies are brought to bear on an increasingly broader group of patients with cardiovascular disease...

..Collaboration with noninvasive colleagues and training interventionalists who perform intracardiac interventions, both electrophysiologists and interventional cardiologists, should be required as part of every invasive program...

..It is both prudent and timely to review treatment strategies that employ combinations of antiplatelet and anticoagulant therapies as well as strategies aimed at reducing bleeding risk in patients treated with these therapies...

..Follow-up of these patients typically involves computed tomography imaging to document restenosis. If significant restenosis is identified, it should be treated promptly because of the potential for progression to total occlusion...

..The aim of this study was to evaluate long-term outcome of patients treated for in-stent restenosis of bare-metal stents (BMS)...

..The appropriate utilization rates of PCI in patients with chronic stable angina and preserved left ventricular function should lead to more cost-effective care of patients with stable CAD...

..replacement of major surgical procedures with less invasive approaches; and 2). redistribution of costs, with a decrease in hospital profits but potentially lower costs of health care delivery for society as a whole...

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..We assessed the efficacy and safety of percutaneous closure of the LAA for prevention of stroke compared with warfarin treatment in patients with atrial fibrillation...

..The objective of this study is to investigate the clinical outcome of a large cohort of patients with ST-segment elevation myocardial infarction (STEMI) treated with drug-eluting stents (DES) compared to bare metal stents (BMS)...

..0 mg/dL are at higher risk than nondiabetic patients, whereas all patients with a serum Cr >2.0 are at high risk for ARF. ARF was highly correlated with death during the index hospitalization and after dismissal...

..No patient died or sustained a myocardial infarction or stent thrombosis. CONCLUSIONS: The risk of bleeding may be increased in patients treated with aspirin, a thienopyridine, and warfarin early after PCI with stent placement...

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..CONCLUSION: CBA is feasible and safe, with a low incidence of procedural complications and in-hospital adverse cardiac events when used primarily for in-stent restenosis...

..The aim of this study was to describe the clinical characteristics and the outcomes of patients 90 years of age or older who were treated with percutaneous coronary intervention (PCI)...

..02). CONCLUSIONS: Mortality nine months after PCI is mildly increased in mild or moderate CKD patients. However, restenosis is not and does not account for the increased mortality...

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..Evaluation of cause of death might help elucidate disease mechanisms and be useful for developing treatment strategies...

..Thus, detection of this early stage of atherosclerosis may provide important information to identify patients who benefit from aggressive preventive strategies...

..1% of abciximab patients (P=0.014). CONCLUSIONS: Use of therapeutic ultrasound in vein graft lesions in patients with acute coronary syndrome had poor angiographic outcome and increased the incidence of acute ischemic complications...

..This algorithm, when applied in the ED, affords an excellent opportunity to identify patients who might benefit from a more aggressive cardiovascular risk factor management strategy...

..CONCLUSIONS: Stent thrombosis is even more rare in the current era than in earlier trials. Number of stents placed was an independent correlate of stent thrombosis. Most patients who suffer stent thrombosis either die or suffer MI...

..This study sought to describe the acute morphologic differences that result from septal myectomy and alcohol septal ablation using cardiac magnetic resonance (CMR) imaging...

..Although abciximab increases the risk of bleeding in all patients, the increase in relative risk is not significantly greater in patients with CRI. Thus, abciximab may be given safely in patients with CRI who are undergoing PCI...

..CONCLUSIONS: This study observed no increased risk of death, including sudden cardiac death, among adult patients with HCM who had myocardial bridging diagnosed at coronary angiography...

..782 (standard deviation, 0.018). CONCLUSIONS: Eight variables were combined into a convenient bedside risk scoring system that estimates the risk of complications after PCIs...

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..It is effective in both native coronary arteries and vein graft interventions. However, the long-term outcome of patients with vein graft intervention was worse...

..These data suggest that SRI may be the optimal method for objective, quantitative assessment of regional myocardial dysfunction...

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..3 versus 37.5 to 46.1 mm(3), respectively; P=0.16 to 0.72). CONCLUSIONS: Tranilast does not improve the quantitative measures of restenosis (angiographic and intravascular ultrasound) or its clinical sequelae...

..The current study was designed to determine whether drug-eluting stents (DES) are superior to bare-metal stents (BMS) in patients with stable angina...

..The feasibility of this treatment is now established, suggesting that percutaneous therapy is safe, practical and possibly effective to eliminate the need for anticoagulation and significantly reduce cardioembolic events...

..There was no significant difference in either the frequency or the cause of death with implantation of either sirolimus-eluting or bare metal stents...

..This coordinate is important in determining the role of restenosis in the clinical failure of endovascular therapy of peripheral arterial disease...

..On follow-up, the short-term and long-term outcomes of patients with PAD were worse, with higher mortality, MI, and need for repeated target vessel revascularization...

..27-10.0; P=0.015), but not with the endpoint of future death and revascularization. CONCLUSION: Measurement of plasma PAPP-A level in patients with chronic stable CAD has an independent prognostic value on the occurrence of death and ACS...

..Stent deployment or crushing may be a good alternative to retrieval...

..Therefore, a stent was placed, and the patient became angina-free. Lipid-rich plaques are a cause of angiographic filling defects. Intravascular ultrasound is an integral part of coronary artery evaluation...

..Thus, significant LV dysfunction was still associated with increased in-hospital and 1-year mortality in patients having contemporary PCI...

..In this population, 56% of patients survived to be discharged from the hospital, and of the hospital survivors, 75% were alive at 1 year...

..Overall, hemostasis was achieved in 96% of patients, with 89% of our patients able to ambulate immediately and 7% able to ambulate after intermediate duration bed rest...

..Large randomized controlled trials have demonstrated that percutaneous coronary intervention with the routine use of drug-eluting stents is safe and effective. However, octogenarians are usually excluded from these trials...

..These observations may help identify patients at risk for complete heart block after septal reduction procedures for HCM...

..In the absence of a definitive clinical trial to support this view, how should the prudent, cutting-edge cardiologist proceed?..

..0 vs. 0.8 +/- 0.6; P < 0.05). Combination therapy of adenosine and nitroprusside is safe and provides better improvement in coronary flow compared to intracoronary adenosine alone in case of impaired flow during coronary interventions...

..In patients with RI, DES implantation yielded better outcomes than did use of bare-metal stents. Randomized trials are needed to define optimal treatment of these high-risk patients with coronary artery disease...