Editor`s Message (May 2003)

Dear Readers, This issue of the Journal of Invasive Cardiology includes original research articles, case reports, brief reviews, and articles from the Journal special sections “Acute Coronary Syndromes”, “Clinical Decision Making”, and the “Clinical Images” section, and a discussion section from the 7th Biennial Andreas Gruentzig Society Meeting. The first research article, submitted by Dr Louis Carnendran and associates at Harrisburg Medical Associates in Harrisonburg, Virginia present their evaluation of the safety and efficacy of low-dose enoxaparin and glycoprotein IIb/IIIa inhibitors during percutaneous coronary interventions. Their study showed that a low dose of enoxaparin is safe and feasible to use in conjunction with GP IIb/IIIa inhibitors, achieving a low rate of in-hospital and 30-day major cardiac events. Drs. Gruberg and Beyar have written a commentary on the Carnendran et al. article. In the second original research article, Dr. Nicolas Shammas and colleagues from the Genesis Heart Institute, Cardiovascular Medicine Group and the Genesis Health System in Davenport, Iowa present an assessment of in-hospital complications of peripheral vascular interventions using unfractionated heparin as the primary anticoagulant. The authors provide a detailed characterization of the complications and predictors for salvage revascularization. They also demonstrated an increase in complications with increasing heparin doses, suggesting that direct thrombin inhibitors may produce better results than heparin. Dr. Deepak Bhatt has provided a commentary on the Shammas et al. article. In the third original research article, Dr. Kenya Nasu and colleagues, on behalf of the investigators of the Perclose Accelerated Ambulation and DISchargE (PARADISE) trial outlines the findings of this registry assessing the clinical effectiveness of a suture-mediated percutaneous vascular closure device for achieving homeostasis following coronary interventions. This multicenter trial showed that times to ambulation and discharged were improved and time to hemostasis were decreased compared to control patients. The final research paper, submitted by Dr. Martin Karch and associates from the Deutsches Herzzentrum Munchen Medizinische Klinik, Klinikum rechts der Isar and Technische Universitat Munchen in Munich, Germany, summarizes their investigation into the differences between sustained and non-sustained forms of human atrial fibrillation using multielectrode endocardial recordings. They showed that the beat-to-beat atrial fibrillation interval and overall degree of atrial fibrillation organization significantly increased from sustained to non-sustained atrial fibrillation. Dr. Todd Cohen has provided a commentary to accompany the Karch et al. paper. This issue of the Journal also includes interesting case reports representing unusual clinical presentations and two case reports with brief reviews of the literature. Drs. Makaryus, Stechel and Green from North Shore University Hospital in Manhasset, New York have provided an interesting care report and literature review describing a 74-year-old-woman who presented with a rare combination of a left main coronary artery fistula to the left superior vena cava with drainage into the coronary sinus. In the second case report, Dr. Koichi Kishi and colleagues from the Division of Cardiology at the Tokushima Red Cross Hospital in Tokushima, Japan describe an uncommon complication in which a pseudoaneurysm developed in an artery that was successfully stented for treatment of a chronic, total occlusion. In the third case report, Dr. Carlos Cafri and colleagues from the Cardiology Department at Soroka Medical Center and Faculty of Health Sciences at Ben Gurion University in Beer Sheva, Israel the authors have provided descriptions of 3 patients who experienced abrupt coronary closure. They show how angiographic visualization of the vessel distal to the occlusion site can reveal the mechanism of the closure and guide the choice of appropriate therapy. The next case report, submitted by Drs. DeTommasi, Rogge and Houghton from the Division of Cardiology at Albany Medical College in Albany, New York, describes an unusual patient with refractory vasomotor angina that resulted from unrecognized hyperthyroidism. In the last case report, submitted by Drs. Strike, Robinson and Dymond from St Bartholomew’s Hospital in West Smithfield, UK, the authors describe their use of the X-Sizer aspiration catheter in conjunction with abciximab and stenting to successfully treat occluded saphenous vein grafts. Three of our special clinical sections are featured in this issue. In the first special section, Acute Coronary Syndromes, edited by Dr. Lloyd Klein from the Section of Cardiology, Rush Heart Institute at Rush-Presbyterian-St. Luke’s Medical Center in Chicago, Illinois, Dr. Klein has invited Drs. Heidar Arjomand, Bassam Roukoz, Satish Surabhi and Marc Cohen from MCP Hahnemann University Hospitals, Drexel University College of Medicine in Philadelphia and Newark Beth Israel Hospital, Mount Sinai School of Medicine in Newark, New Jersey to discuss issues of platelets and antiplatelet therapy in patients with diabetes mellitus. The authors have provided an excellent discussion of the state of platelets in diabetic patients with heart disease and they provide insight into effective therapies for this patient group. In the second special section, the Clinical Images section, edited by Dr. David Rizik, Director of Interventional Cardiology for Scottsdale HealthCare Hospitals, Dr. Walter Parham and associates from the J. Gerard Mudd Catheterization Laboratory at the St. Louis University Health Science Center in St. Louis, Missouri have provided valuable images showing the management of iliac stent movement complicating peripheral vascular intervention using a novel rescue technique. In the final special section, the Clinical Decision Making section, edited by Dr. Michael Sketch from Duke University Medical Center in Durham, North Carolina, Drs. Shigenori Ito, Takeshi Suzuki and Takahiko Suzuki from the Division of Cardiovascular Medicine at the Toyohashi Heart Center and the Division of Cardiology at Toyokawa City Hospital in Japan demonstrate their use of the cutting balloon after rotational atherectomy in a young adult patient with suspected Kawasaki Disease. This issue of the Journal is completed with a transcript of the discussion of the problems in identifying and treating the vulnerable plaque that occurred at the International Andreas Gruentzig Society meeting held in St. Lucia in February of 2002. This lively discussion demonstrates that there are a number of unresolved issues in managing this difficult clinical problem and points to the need for continued research into innovative methods to identify the vulnerable plaque. 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. Richard E. Shaw, PhD, FACC Editor-in-Chief