Dec-06

Dear Readers, The December 2006 issue of the Journal of Invasive Cardiology includes original research articles, a continuing medical education offering, articles from the journal’s special sections Clinical Images and Genomics and Cellular Therapy, and seven online case reports which can be found on our website: www.invasivecardiology.com. In the first research article, Dr. Amir Halkin and colleagues present a study assessing clinical outcomes following percutaneous coronary intervention (PCI) comparing drug-eluting stents (DES) and bare-metal stents (BMS) in dialysis patients using the National Heart, Lung and Blood Institute Dynamic Registry. They showed that patients receiving DES had less major adverse cardiac events one year after their procedure compared to BMS. Next, Brigitta Brott and associates present their analysis of the occurrence of severe, diffuse coronary artery spasm after DES placement. They demonstrate that although rare, the outcomes in these situations are very poor and the mechanisms that lead to spasm are not well understood. A commentary by Drs. Mario Togni and Franz Eberli accompanies the Brott et al paper. In the next original article, Dr Nick Bellenger and colleagues describe their study of the use of delayed enhanced cardiovascular magnetic resonance in the diagnosis of non-ST-elevation myocardial infarction (N-STEMI) in patients presenting with troponin-positive chest pain who were found to have no obstructive coronary disease. They concluded that this approach was successful in identifying patients who suffered myocardial necrosis and required further management. Next, Dr. Ronald Lo and associates present their study to evaluate the incidence and prognosis of pacemaker lead-associated masses using transesophageal echocardiography (TEE). In their sample, they identified masses in 12% of the leads imaged, with a majority of those having endocarditis. Lead vegetation was associated with a mortality rate of 11%, while incidental masses had no significant morbidity or mortality. Drs. Kul Aggarwal and Lokesh Tejwani have provided an accompanying commentary on the value of TEE in identifying permanent pacemaker lead infections. Dr. Robert Applegate and collaborators describe their study of high-risk PCI patients with and without abciximab administration after upstream use of eptifibatide. They found that the use of abciximab after upstream eptifibatide was safe and most effective in high-risk patients with myocardial infarction rather than in those with unstable angina. In the last research article, Dr. Jang-Young Kim and collaborators report on their randomized study to evaluate the effect of a eutectic mixture of local anesthetic cream on wrist pain during transradial coronary procedures. They found that the cream was safe and effective in reducing wrist pain when the anesthetic application time was between one and three hours prior to the procedure. Also included in this issue of the journal is a special CME offering on the pharmacoinvasive management of N-STEMI acute coronary syndrome in the era of early transition to cardiac catheterization and PCI. This material was developed by the CATH (Cardiac Catheterization and Antithrombotic Therapy in the Hospital) Clinical Consensus Panel under the leadership of Dr. Marc Cohen and collaborators, and should provide the reader with a stimulating educational experience on a very important topic. This issue of the journal also contains articles from two special sections. In the first, Clinical Images, edited by Dr. David Rizik, Drs. Ravi Garg and Neeraj Jolly present a series of three-dimensional computed tomography images showing their successful use of the AngioJet® thrombectomy catheter in a patient with a contraindication to thrombolytics and who had massive pulmonary emboli. In the Genomics and Cellular Therapy section, Drs. Clemens Steinwender, Christian Gabriel and Franz Leisch describe a patient in whom they were able to successfully mobilize peripheral blood stem cells by using granulocyte-colony stimulating factor and their transcoronary transplantation after cardiogenic shock due to myocardial infarction. The seven online case reports include one by Drs. Cabarrus, Khan and Shammas who describe an unusual case of a spontaneous formation of a left anterior descending artery to a right ventricular fistula. Next, Dr. Toby Ferguson and colleagues describe two patients with cerebrovascular events associated with sexual activity and patent foramen ovale (PFO) who were subsequently treated with PFO closure, demonstrating the need for clinicians to inquire about sexual activity at the onset of a stroke. Following that, Dr. Carlos Fernandez-Pereira and colleagues present a patient with late stent thrombosis mimicking focal restenosis after sirolimus stent implantation using angiographic and ultrasound evaluation. The next case report is submitted by Dr. Farrukh Hussain and colleagues who describe their successful use of a buddy wire to perform focused-force angioplasty on a severely calcific ostial right coronary lesion. Next, Drs. Kunadian, Thornley and de Belder report on a patient who presented with a large right coronary artery aneurysm with an associated ball thrombus. They provide an excellent review of this challenging interventional situation. In the next case report, Drs. Shakir, Gomez and Anderson describe their successful management of a patient who presented with an acute inferior myocardial infarction 18 months after surgery for a type-A aortic dissection. And in the final online case report, Drs. Vicuna, Silverman and Abramowitz present a case demonstrating their successful treatment of left main disease using both the antegrade and retrograde approaches in combination. My hope is that the articles offered in this issue will provide interventionalists with timely information for the optimal treatment of their cardiac patients. Sincerely, Richard E. Shaw, PhD, FACC, FACA Editor-in-Chief