Editor`s Message - March 2003

Dear Readers, This issue of the Journal of Invasive Cardiology, which coincides with the 52nd Annual Scientific Sessions of the American College of Cardiology, includes original research articles, case reports, editorials, articles from the Journal special sections “Interventions in Peripheral Vascular Disease”, “Practice Management and Economics” and “The Electrophysiology Corner”, the new “Clinical Images” section, as well as Part VIII of the discussion series from the International Andreas Gruentzig Society 8th Biennial Meeting held in February of 2002. The first research article, submitted by Shinjo Sonoda and colleagues from the Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California, the Highlands Consulting, Inc., San Jose, California, and the Cardiovascular Research Institute in Washington Hospital Center, Washington D.C. describe the promising treatment with antiproliferative drugs via coated stents to mechanically remodel target lesions and biologically reduce neointimal hyperplasia. In this article, they report the effects of paclitaxel and define the vascular response to taxol-based eluting stents by intravascular ultrasound. In the second research article, Dr. Thuraia Nageh and associates from the Department of Cardiology at King’s College Hospital in London, England present their research assessing the effect of direct stenting on troponin I levels 24 hours after treatment and adverse cardiac events 6–18 months post-hospital discharge compared to patients undergoing stenting with balloon pre-dilatation. They found that direct stenting was associated with significantly lower troponin levels at 24 hours and decreased rates of adverse events at late follow-up. Dr. Arturo Touchard and colleagues from the Minneapolis Heart Institute have provided a commentary to accompany the article by Dr. Nageh et al. in which they discuss other studies evaluating the effect of direct stenting and the problems using direct stenting in certain lesion subsets. The third research article, submitted by Dr. Aaron Kugelmass and collaborators from the Cardiovascular Division of Henry Ford Hospital in Detroit, the Cardiovascular Division of Beth Deaconess Medical Center in Boston, HCA Inc. in Nashville, Medical City Dallas Hospital in Dallas, Cardiac Solutions Inc. in Indianapolis and Rollins Public School of Health at Emory University in Atlanta, presents a study designed to assess follow-up adverse events and need for revascularization in patients treated with stents or conventional balloon angioplasty. They determined that late revascularization is driven as much by progression of disease as it is by restenosis, and suggest that drug-eluting stents may only address part of the issue of late revascularization. The next research article, submitted by Dr. Sorin Brener of the Cleveland Clinic Foundation on behalf of the CONSERVE Investigators, presents a multi-center trial comparing a new low-pressure stent to a conventional coronary stent. Since this trial was set up as a non-inferiority study, the target revascularization rate of the low-pressure stent could not exceed 7.5% difference from the conventional stent, a result that was achieved. However, a subset analysis of patients without post dilatation of the low pressure stent showed that they had a higher rate of revascularization, which did not support the hypothesis that lower pressure deployment reduced the need for repeat treatment. In the final original research paper, Dr. A.G.C. Sutton and collaborators from the Cardiothoracic Division, the James Cook University Hospital, Middlesbrough, England, and the Postgraduate Institute, School of Health and Social Care, University of Teesside, Middlesbrough, England, United Kingdom investigate the incidence of early ( 24 hours to 7 days) reactions to 3 contrast agents [iopamidol 340 (Niopam®), a nonionic monomer; iomeprol 350 (Iomeron®), a nonionic dimer; and iodixanol 320 (Visipaque®), a nonionic dimer], commonly used in cardiac catheterization. They found that the incidence of early adverse reactions is similar with these 3 contrast agents, though late skin reactions are more common with the iodixanol 320 than with the other two agents. This issue of the Journal also includes interesting case reports with brief reviews of the literature. In the first case report, submitted by Drs. D’Agate, Kokolis and Dangas from Lenox Hill Hospital in New York City and Winthrop University Hospital in Mineola, Long Island, the authors present a case of premature coronary artery disease in systemic lupus erythematosis with extensive re-occlusion following coronary artery bypass surgery. They have also provided a review of the progression of this disease and treatment modalities that have been utilized. In the second case report, Drs. Kostov, Stankovic and Colombo from the Department of Interventional Cardiology at the Centro Cuore Columbus in Milan, Italy describe their management of a patient with aortic root and extensive coronary dissections complicating recanalization of a chronic right coronary artery occlusion. They demonstrate that conservative management in which no stenting was done proved to be beneficial for this patient. In the last case report, Drs. Camille Brasselet and colleagues from the Departments of Cardiology and Cardiothoracic Surgery at CHU Robert Debre in Reims Cedex, France report on an unusual formation of a pseudo aneurysm 3 months after successful stenting that required surgical treatment for successful management. This issue also includes articles from 3 of our special clinical sections. In the first special section, Interventions in Peripheral Vascular Disease, edited by Dr. Frank Criado of the Division of Vascular Surgery at the Union Memorial Hospital/Medstar Health in Baltimore, Maryland, Dr. Steven Siu-lung Li from the Division of Cardiology at Queen Elizabeth Hospital in Kowloon, Hong Kong presents his approach to protect renal function during renal artery stenting by using the PercuSurge GuardWire Plus system. The next special section, which covers current trends in Practice Management and Economics and is edited by Dr. Ron Riner from the Riner Consulting Group in St. Louis, Missouri, focuses on development of Heart Centers. Dr. Riner has invited Mr. Ron Schmidt of Parma Community General Hospital in Parma, Ohio to describe the process he and his team went through to transform their community hospital program into a progressive, state-of-the-art cardiac treatment facility. Dr. Riner has also provided an editorial in which he emphasizes that effective heart programs must plan ahead, organize and commit to a plan, sometimes breaking away from what traditionally has been done. The last special section, the Electrophysiology Corner, edited by Dr. Todd Cohen at Winthrop-University Hospital in Mineola, New York, includes 2 articles: one from Dr. Angelo de Paola and colleagues from the Federal University of São Paulo–Paulista School of Medicine in São Paulo, Brazil and the other from Dr. Cohen. Dr. de Paola describes a rare complication of radiofrequency catheter ablation in which the right coronary artery was injured, leading to acute distal occlusion that was successfully treated with mechanical reperfusion. The patient was doing well at 1-year follow-up after the initial therapy. Dr. Cohen has included a short editorial highlighting the results of the Companion Trial and the significance of this for clinical practice. Under the direction of Dr. David Rizik, Director of Interventional Cardiology for Scottsdale HealthCare Hospitals, the Journal is beginning a new section titled “Clinical Images”. The purpose of this section is to present case studies that utilize different image modalities that illuminate in complementary ways the clinical issue of interest. In this issue of the Journal, Dr. Scot Schultz and associates from the Cardiac Surgical Associates of Southwest Florida and the Naples Heart Group in Naples Florida show the progression of diagnosis and treatment of a patient who developed mechanical valve thrombosis that was successfully treated with thrombolytic therapy. Dr. Gerald Dorros from the William Dorros-Isadore Feuer Interventional Cardiovascular Disease Foundation in Phoenix, Arizona has provided a very provocative and thought provoking discussion of the evolution of carotid stenting problems with its comparison to surgical techniques, and issues in the training of physicians to perform this procedure effectively. I hope that all of you will read this editorial and take it as a call to action that will bring about competencies in the treatment of this disease, which debilitates so many patients. This issue is completed with a transcript of the discussion on treatment of patients with intractable angina that occurred at the International Andreas Gruentzig Society meeting held in St. Lucia in February of 2002. This lively discussion shows that there are a number of unresolved issues in managing this difficult clinical situation and points to the need for continued research into innovative treatments for these challenging clinical presentations. It is my hope that all of the articles in this issue of the Journal provide information that is useful for cardiovascular specialists in their daily care of patients with cardiovascular disease.