Editor`s Message

Dear Readers, This issue of the Journal of Invasive Cardiology contains numerous original clinical research studies and related commentaries. We start the issue with a submission from Dr. Marco Costa and colleagues representing investigators from the SECURE Registry. Costa et al. describe their results in using sirolimus-eluting stents in the treatment of complex bypass graft disease. They demonstrated that in-hospital outcomes for the treatment of grafts with sirolimus-eluting stents were similar to those achieved in native vessel lesions, and 8-month clinical and IVUS evaluation in a small subset of patients also showed comparable results in these high-risk patients. Dr. James Hermiller has provided a commentary to accompany this article, reiterating the increased efficacy that has been realized with the introduction of drug-eluting stents in the treatment of vein graft disease. In the next original research article, Dr. Vassilis Voudris and colleagues from the ONASSIS Registry, describe the acute results and midterm outcomes in patients with native coronary artery stenoses who were treated at a single center with the sirolimus-eluting stent. They demonstrated that in-hospital success and complications were comparable in patients receiving bare metal stents compared to those receiving sirolimus-eluting stents, but results at one year strongly favored the drug-eluting stent, most notably influenced by the decreased need for repeat revascularization. Next, Drs. Timlin, Carnaffin, Starkey, Northridge and Leslie, report on their randomized, controlled study of long-acting levobupivacaine in the management of femoral artery sheaths after PCI. They found that patients who were randomized to receive lidocaine plus levobupivacaine had a reduced need for IV opiates while waiting for sheath removal, and reported significantly lower pain levels during the removal of their sheaths compared to those who received lidocaine alone. In the next original research article, Dr. Gaston Rodriguez-Granillo and collaborators from the RESEARCH and T-SEARCH registries report one-year clinical outcomes after coronary stenting of very small vessels using 2.25 sirolimus- and paclitaxel-eluting stents. The researchers found that the incidence of major cardiac events at one year was significantly lower in the patients receiving sirolimus stents. In multivariate analyses, presentation with acute coronary syndrome and use of the paclitaxel stent were independent predictors of late adverse events. Drs. Ariel Roguin and Ehud Grenadier have provided a commentary to accompany this article in which they review some of the recent trial data available for stent use in small vessels and comment on the results reported in the current study. Drs. Cavusoglu, Lakhani and Marmur present their research demonstrating that activated clotting time can be used to monitor the anticoagulant effect of enoxaparin and dalteparin after intravenous administration. They found that both enoxaparin and dalteparin cause a significant rise in ACT and cPTT, with a dose response of about one-half the magnitude of that obtained with unfractionated heparin. This study provides valuable information for the effective monitoring of coagulation states during and after PCI. Dr. Chi Hang Lee and associates describe their study assessing the impact of glycemic control on the occurrence of no-reflow and 30-day outcomes in diabetic patients undergoing primary PCI for acute myocardial infarction. Patients with suboptimal glycemic control were more likely to be older, more hypertensive, and more likely to have a history of stroke and poor renal function. However, there were no differences between these groups in the occurrence of no-reflow and 30-day survival, suggesting that glycemic control does not influence these outcomes. In the next original article, which is also part of our Adjunctive Therapy section edited by Deepak L. Bhatt of the Cleveland Clinic, Dr. David Allie and collaborators compare their approach in the pharmacologic management of critical limb ischemia to the strategy used by clinicians in the treatment of acute coronary syndrome. In their study, they compared outcomes of limb ischemia patients receiving bivalirudin and tirofiban with those receiving unfractionated heparin. They demonstrated that in-hospital results were very comparable, and 6-month trends favored the use of bivalirudin and tirofiban in terms of secondary reintervention and limb salvage rates. The last original research article is also part of the Intervention in Peripheral Vascular Disease section edited by Frank J. Criado of Union Memorial in Baltimore, Maryland. This article, submitted by Dr. Akio Kawamura and colleagues, studies the impact of gender on in-hospital outcomes following percutaneous intervention in patients with peripheral arterial disease. Although success and mortality rates were similar, the researchers found that women had significantly higher rates of hemorrhagic complications and need for blood transfusions compared to men, and gender was an independent predictor of hemorrhagic complications in multivariate analysis. In Clinical Images, our section editor, Dr. David Rizik and colleagues from the Scottsdale Heart Group, have provided an informative demonstration of using balloon alignment T-stenting in the very challenging treatment of bifurcation coronary artery disease. Please look for part two of our review on mitral stenosis from Dr. Enio Guérios and colleagues on pages 440-444. This review discusses current trends as well as the results of percutaneous mitral valvuloplasty in practice. We have also included a case report from Dr. C. H. Lee and colleagues from the National University Hospital in Singapore reporting on free coronary perforation following X-Sizer thrombectomy. Dr. Wai-Hong Chen and colleagues report on the clinical, angiographic, and pathological features of a patient where perforation of the coronary artery into the pericardium, myocardium and right ventricle occurred. And finally, please note that the discussion sections from the IAGS sessions on drug-eluting stents, tissue engineering and progenitor cell transplantation (from the 8th Biennial International Andreas Gruentzig Society meeting) are now posted with the July issue on www.invasivecardiology.com. It is my hope that each of the articles in this issue of the journal provides cardiovascular healthcare professionals with important information to guide the choice of effective therapy for cardiac patients. Sincerely, Richard E. Shaw, PhD, FACC