May

Dear Readers,

The May 2007 issue of the Journal of Invasive Cardiology includes original research articles, commentaries, a review article, clinical images, online case reports, and a continuation of discussions from the Biennial Andreas Gruentzig Society (IAGS) meeting.

In the first original research article, Dr. Alberto Hendler and associates from Assaf Harofeh Medical Center in Zerifin, Israel, assess outcomes in patients undergoing PCI of an unprotected left main coronary artery stenosis in an urgent setting. Comparing these patients at hospitalization and 1-year follow up to a matched cohort who underwent CABG for left main disease, the PCI group had a lower rate of major cardiac events in both the short and long term, suggesting that urgent PCI in unprotected left main is a feasible approach. In the next research article, Dr. Eugene Nikolsky and colleagues from Columbia University Medical Center and the Cardiovascular Research Foundation in New York, describe a study to evaluate fluoroscopy time and its correlation with outcomes after PCI. The authors found that prolonged fluoroscopy time was associated with prior CABG and treatment of more complex lesions, with increased rates of periprocedural complications and greater resource utilization. Drs. Troy Bunting and Lawrence Garcia from Beth Israel Deaconess Medical Center in Boston have provided a commentary on this subject. Dr. Babu Kunadian and collaborators from the James Cook University Hospital in Middlesbrough, U.K., present their study assessing outcome in cardiogenic shock patients comparing primary versus rescue angioplasty after failed thrombolysis. Cardiogenic shock patients treated with rescue PCI were treated much later than primary PCI patients and had worse outcomes after 1 year, especially in patients over the age of 75 years. Drs. Pranab Das, Robert Dieter and Aravinda Nanjundappa have provided a commentary to accompany the article by Kunadian and associates.

In the next research article, Dr. Hitinder Gurm and colleagues from the University of Michigan in Ann Arbor and the Cleveland Clinic in Cleveland, Ohio, report their evaluation of the myocardial protective effects of bivalirudin in patients undergoing rotational atherectomy. In comparison to patients receiving heparin, those receiving bivalirudin had a similar incidence of myonecrosis, with lower rates (though not statistically significant) of CK-MB. In the last original research article, Dr. Kimberly Skelding and colleagues from Geisinger Medical Center in Danville, Pennsylvania, the Mayo Clinic in Rochester, Minnesota, Cardiology Consultants PA in Daytona Beach, Florida and William Beaumont Hospital in Royal Oak, Michigan, present their study validating a predictive risk score for radiocontrast-induced nephropathy following PCI. Applying the William Beaumont Hospital Risk Score to the Mayo Clinic PCI registry, the score was able to distinguish those patients who were at both high and low risk for radiocontrast-induced nephropathy, indicating that this score can be useful in identifying patients who could have improved outcomes with the use of more aggressive preventive measures.

This issue also includes an interesting review article on HIV disease in thrombocardiology provided by Drs. Ener, Palermo, O’Murchu, Burke, Wolf and Van Decker from the Temple University School of Medicine in Philadelphia. They review the literature on the effects of protease inhibitor therapy on premature coronary artery disease and other cardiovascular manifestations, and discuss possible relationships of stent thrombosis and hypercoagulability.

In the Clinical Images section, Drs. Rajesh Sachdeva, Kunal Sarkar and Ravi Sureddy from the University of Arkansas for Medical Sciences, present images showing kinking of the left internal mammary artery graft that produced myocardial ischemia in a patient during the expiratory phase of respiration. The patient was eventually treated with the placement of a stent in the native circulation.

This issue of the journal also includes 9 case reports that are published online (www.invasivecardiology.com). I encourage you to visit the website to read these interesting and timely reports. First, Drs. Islam Bolad and Lawrence O’Meallie from Tulane University School of Medicine in New Orleans, Louisiana, describe an unusual occurrence of spontaneous closure of an iatrogenic circumflex artery-to-coronary vein fistula in a transplant patient. In the next case report, Drs. Makaryus, Boutis and Goldner from the Long Island Jewish Medical Center in New Hyde Park, New York, present a case demonstrating the successful use of coronary venous angioplasty and stenting to facilitate biventricular pacemaker left ventricular lead implantation. Drs. Downey, Warner and Kimmelstiel from Tufts-New England Medical Center in Boston, diagnose and treat a patient with Aspergillus prosthetic valve endocarditis causing a functional aortic stenosis.

Next, Dr. Fernando Alfonso and colleagues from San Carlos University Hospital in Madrid, describe their successful approach using intracardiac echocardiography guidance of alcohol septal ablation in a patient with hypertrophic obstructive cardiomyopathy. Drs. Ecker, Levy and Hopkins from Kaleida Health, the University of Buffalo and SUNY at Buffalo, New York, present their approach to treating a patient with a symptomatic acute left petrous carotid dissection with a Neuroform intracranial stent. In the next report, Dr. Surender Malhotra and colleagues from the Medical College of Georgia and VA Medical Center in Augusta, Georgia, describe a patient with congenitally corrected transposition of the great arteries who presented with life-threatening ventricular tachycardia and a single coronary ostium. Next, Drs. Ramana, Wilbur and Leya from Loyola University Medical Center in Maywood, Illinois, describe a patient who had successful ethanol septal ablation from refractory tachycardia with subsequent cardiac transplantation. The authors review the use of ethanol septal ablation in refractory VT and the acute pathologic and histologic changes it produces.

Next, Drs. Kharouf, Cao and Hijazi from the University of Chicago Comer Children’s Hospital, present a case that demonstrates the challenges of managing a patient who had successful closure of a coronary artery fistula that was followed by a myocardial infarction. In the last online case report, Drs. Theleman, Gottlich and Schussler from Baylor University Medical Center in Dallas, Texas, have provided a report on an unusual variant of Kugal’s artery arising from an anomalous left circumflex coronary artery.

And finally, be sure to the journal’s website to read the IAGS discussion entitled New Developments in Gene Therapy and Stem Cell for Angiogenesis in the Treatment of Myocardial Infarction.

It is my hope that the articles in this issue of the journal provide cardiovascular healthcare professionals with important information that assists them in the effective management of cardiac patients.

Sincerely,

Richard E. Shaw, PhD, FACC, FACA

Editor-in-Chief