February 2002 Editor`s Message

Dear Readers, This issue of the Journal of Invasive Cardiology includes original research articles, case reports, articles from the Journal special section “Clinical Decision Making”, a teaching collection, and the new special section “Acute Coronary Syndromes”. The first research article, submitted by Dr. Christoph Hehrlein and collaborators from the Department of Cardiology at the University of Freiberg in Germany and the Heart Institute at Borgess Medical Center in Kalamazoo, Michigan, describes a novel indexing system used to compare residual stenosis following the delivery of the DUET and NIR stents. They show that the stents have different angiographic characteristics and the “dogbone” effect plays a role in the extent of residual stenosis following stenting. In the second research article, Drs. Leonard Schwartz and Amr Morsi from the Division of Cardiology, Department of Medicine at Toronto General Hospital in Toronto, Canada present the draw-back stent deployment technique for the treatment of coronary branch ostial lesions. They demonstrate that the technique leads to a high rate of successful stent placement and with no untoward events. The last research article, submitted by Dr. Corrado Tamburino and collaborators from the Institute of Cardiology at Ferrarotto Hospital in Italy and The Carl and Edyth Lindner Center for Research and Education in Cincinnati, Ohio summarizes the researchers findings in a randomized trial assessing the effect of the prophylactic use of abciximab on long lesions treated with stents. Their study demonstrates that the use of abciximab is associated with improved in-hospital and late outcomes without producing an increase in bleeding complications. This issue of the Journal contains articles from two of our special sections. I am honored to introduce the newest of our special sections titled 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 initiates this series with an article that outlines his goals for this special section and his perspective on the evolution of interventional techniques as a primary treatment for patients who present with acute coronary syndrome. I am sure that you will enjoy the interesting articles that will appear in this section and appreciate the novel approaches that Dr. Klein intends to use to make this special section a relevant and exciting learning experience. The first article included in this series comes from Dr. Lynn Preston and associates from the Section of Cardiology and Heart Institute at Rush. The authors describe a prospective study comparing angiographic morphology of culprit lesions in saphenous vein grafts versus native coronary arteries in patients presenting with unstable angina. They demonstrated that culprit lesions in vein grafts were more likely to contain ulcerated plaque and thrombus compared with native vessels. In the Clinical Decision Making section, edited by Dr. Michael Sketch from Duke University Medical Center in Durham, North Carolina, Dr. Paolo Esente and colleagues from St. Joseph’s Hospital Health Center in Syracuse, New York present an unusual case involving coronary perforation occurring during PTCA. The case presentation is followed by a description of potential management strategies from expert clinicians on the board of the Journal, including Dr. Tim Fischell, Dr. Ted Parris, Dr. Bernhard Meier and Dr. Thomas Linnemeier. Although there are common themes across these experts, it is fascinating to note the specific features of the case that are emphasized by each physician. This issue of the Journal also includes a set of interesting case reports representing unusual clinical situations. In the first case report, submitted by Drs. Timurkaynak, Ciftci and Cengel from the Department of Cardiology at the Gazi University School of Medicine in Ankara, Turkey, the authors describe their use of an angioplasty guidewire to successfully cannulate a patient with an anatomically difficult left coronary ostium. The second case report, from Drs. Kandzari, Harrison and Behar from the Division of Cardiology at the Duke University Medical Center in Durham, North Carolina shows how the authors used echocardiographic color flow myocardial blush and coronary arteriography to detect an anomalous left coronary artery originating from the pulmonary artery in an elderly woman. The final case report, submitted by Drs. Osula and Ramsdale from the Cardiothoracic Center Liverpool in Liverpool, United Kingdom describes their successful use of a cutting balloon and rotational atherectomy to treat a difficult case of in-stent restenosis at the ostium of the LAD. The CME offering included in this issue, submitted by Dr. Barry S. Weinstock from the Bay Area Heart Center in St. Petersburg, Florida presents a thorough overview of the emerging approaches to patient management of acute myocardial infarction with the use of fibrinolytics. I hope that many of you will take the opportunity to read this article and complete the questions for this educational activity. This issue is completed with a case report from Drs. Stephen T. Thew and Lloyd W. Klein from the Rush Heart Institute and Rush-Presbyterian-St. Luke’s Medical Center in Chicago, Illinois. They described a case in which a coronary guidewire became unraveled after positioning an undeployed stent during elective angioplasty of the left anterior descending coronary artery. It is my hope that all of the articles in this issue of the Journal provide information that is useful for cardiologists in the daily care of patients with cardiac disease. Sincerely, Richard E. Shaw, PhD, FACC Editor-in-Chief