Editor`s Message - November 2003

This issue of the Journal of Invasive Cardiology coincides with the Annual Scientific Sessions of the American Heart Association and includes original research articles, case reports, a special review, two CME offerings and articles from the journal special sections “the Electrophysiology Corner,” “Clinical Decision Making” and “Clinical Images.” The first research article, submitted by Dr. Kenneth Mahaffey from the Duke Clinical Research Institute on behalf of the ATBAT investigators, is a report of a multicenter trial examining the role of bivalirudin as adjunct therapy for patients with heparin-induced thrombocytopenia undergoing percutaneous coronary intervention. They demonstrated that excellent results could be achieved and major bleeding was not a problem in these patients. In the next original research article, Dr. Kevin Cochran and colleagues from the Department of Medicine and Division of Cardiology at Loyola University Medical Center in Maywood, Illinois report on their experience using lepirudin, a recombinant hirudin, in patients with thrombocytopenia undergoing either coronary or peripheral intervention. They demonstrated that good results could be achieved, but cautioned operators when using lepirudin in combination with GP IIb/IIIa inhibitors, clopidogrel and aspirin. Dr. George Dangas of the editorial board has provided a commentary to accompany these papers. In the third original research article, Dr. David Rizik from the Scottsdale Heart Group at Scottsdale Healthcare Hospital in Scottsdale, Arizona, with authors from multiple centers around the United States, presents a study to determine the safety and feasibility of pre-treating coronary artery lesions with the cutting balloon prior to stent implantation. They demonstrated that the cutting balloon can be used effectively to attain significant gains in minimal stent cross-sectional areas at relatively low balloon pressures. Dr. Raoul Bonan of the editorial board has provided a commentary for this article. In the fourth original research article, Dr. Haresh Mehta and collaborators from the Swiss Cardiovascular Center Bern, University Hospital in Bern, Switzerland present their study to determine the influence of experience and amount of stent usage on operator results for both in-hospital and one-year outcomes. They found that there was no relationship between propensity for using stents and in-hospital and one-year results, suggesting a provisional approach to stenting rather than elective stenting. Dr. Eric Peterson of the editorial board has provided a commentary for the Mehta et al. article. In the fifth research article, Dr. Ken Kozuma and collaborators from the Department of Cardiology, Thoraxcentre Erasmus Medical Center and the Daniel den Hoed Cancer Center in Rotterdam, The Netherlands provide an interesting comparison between quantitative coronary angiography and serial volumetric 3-D IVUS in detecting coronary arterial remodeling after intracoronary brachytherapy. Their analysis showed that QCA may not reliably predict vessel remodeling in brachytherapy patients and that IVUS may be necessary to evaluate remodeling after radiation. The last original research article, submitted by Dr. Richard Heuser from St. Joseph’s Hospital and Medical Center in Phoenix, Arizona on behalf of his colleagues in the United States and Canada participating in the START trial, reports on the use of beta radiation and stenting to prevent restenosis in longer (> 15 mm) lesions. Compared to a control group not receiving beta radiation, patients having beta radiation had superior in-hospital and late outcomes. Dr. Luis Gruberg has provided a commentary on this paper. This issue of the Journal also includes four interesting case reports representing unusual clinical presentations, with two of them providing brief reviews of the literature. In the first case report, submitted by Drs. Shahid Aziz and David Ramsdale from the Cardiothoracic Center in Liverpool, England, the authors describe a case in which the left internal mammary artery originated from the third part of the left subclavian artery and discuss the clinical relevance of this situation. In the second case report, Dr. Ohara and colleagues from the Division of Cardiology at Tokushima Red Cross Hospital describe their successful treatment of a patient with acute aortic dissection complicated with an acute myocardial infarction due to an occlusion in the left main coronary artery. The next article, a case report with a brief review of the literature, was submitted by Dr. William Hillegass and associates from the University of Alabama at Birmingham. They present an unusual situation in which in-stent restenosis recurred in a gastroepiploic coronary bypass graft and was treated with brachytherapy. In the last case and review, submitted by Dr. Benjamin I. Lee and colleagues from the Washington Hospital Center, the Cardiovascular Research Institute, Cardiology Associates, PC, and Capitol Cardiology, PC, in Washington, D.C., present two difficult cases of percutaneous coronary artery stenting of the anomalous right coronary artery. Three of our special clinical sections are featured in this issue. In the Clinical Images section, Dr. David Rizik and associates from the Scottsdale Heart Group show a patient who presented with extensive thrombus in the main pulmonary artery that was successfully treated with thrombolytic therapy. In the Electrophysiology Corner edited by Dr. Todd Cohen of the Department of Cardiology at Winthrop-University Hospital in Mineola, New York, the utility of noncontact three dimensional mapping of the left atrium in ectopic atrial tachycardia is shown by Dr. Cohen and colleagues. In Clinical Decision Making, section editor Dr. Michael Sketch from Duke University Medical Center has invited Drs. Daemon, Lemos and Serruys from the Thoraxcenter, Erasmus Medical Center in Rotterdam, The Netherlands to submit an interesting case. Their case involves multi-lesion “culotte” and “crush” bifurcation stenting with sirolimus-eluting stents. Drs. Bernhard Meier, Howard Cohen and David Kandzari have provided their views on what their approaches would be in treating this patient and the issues involved. This issue of the Journal contains an excellent review article provided by Dr. Gregg Fonarow from the UCLA Prevention Cardiology Program in Los Angeles, California. Dr. Fonarow provides a thorough review of cardiovascular protective medications that may have a profound impact on the long-term outcomes of patients undergoing PCI procedures and recommends that all invasive cardiologists take advantage of the “teachable moment” that exists immediately post PCI. We have also included two CME offerings. The first article, written by Ian Crocker, MD of Emory University in Atlanta, outlines the use of radiation source selection in vascular brachytherapy. The second offering reviews achieving hemostasis when treating chronic anticoagulant patients and is written by Drs. Bonnie Weiner, Thomas Fischer and Sergio Waxman from the University of North Carolina, Chapel Hill, North Carolina, and Tufts New England Medical Center, Boston, Massachusetts. 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.