Oct-05

Dear Readers, This issue of the Journal of Invasive Cardiology includes research articles, case reports, a CME offering in the area of pediatric cardiology, a review, as well as articles from our journal sections on peripheral vascular disease, pediatric intervention and clinical images. In addition, we are now publishing our case reports directly on www.invasivecardiology.com. I encourage you to visit the website to read the interesting and informative case reports that are part of our October issue. Please see the complete list on page A6. The first research article, submitted by James Hermiller of St. Vincent’s Hospital in Indianapolis, along with collaborators from Carolinas Medical Center in Charlotte, Sequoia Hospital in Redwood City, St. Mary’s in Saginaw, Northern Michigan Hospital in Petoskey, and Abbott Vascular Devices, reports the initial multicenter evaluation comparing the StarClose vascular closure system to manual compression. They demonstrated that the StarClose system was not inferior to standard compression with respect to safety, and that the system offered advantages in reducing time-to-hemostasis and ambulation compared to manual compression. In the next original research article, Dr. Maurits Dirksen and associates from Onze Lieve Vrouwe Gasthuis in Amsterdam, The Netherlands, present the results of the Aggrastent Trial, designed to determine if early discharge (within 4 days) following PCI with transradial stent implantation under GP IIb/IIIa blockade in the setting of ST-segment elevated MI is feasible. They found that of the patients who were treated according to protocol, a majority were able to be discharged early. Next, Dr. Mayraj Ahmad and colleagues from Hamilton Health Sciences at McMaster University, report on their study of the impact of implementing routine cholesterol profile measurements and standardized orders post-PCI on the number of patients receiving statin therapy. They found that these approaches led to an increase in statin use after PCI, but did note that one-third of the patients still had LDL levels above the recommended guidelines. Drs. Victor Mejia and Joseph Carver of the University of Pennsylvania have provided a related commentary. Dr. Sridhar Sampath Kumar and collaborators from the Montefiore Medical Center/Albert Einstein College of Medicine, along with their Department of Epidemiology and Population Health, present the results of their application of the Mayo Clinic Risk Score in predicting outcomes in patients undergoing primary angioplasty in the New York State PCI registry. They found that mortality rates significantly increased in patients with higher Mayo Clinic Risk scores. Drs. Allyson Edmundson and James T. Mann of Wake Heart Research present their study evaluating possible radial artery injury with the use of the transradial approach. Using IVUS, they demonstrated that patients who had the radial approach were more likely to have nonocclusive injury in the arterial segment corresponding to the location of the radial sheath. In addition, they found intimal hyperplasia with smaller IVUS dimensions in these patients, but did demonstrate that vasodilatory response was maintained in these arteries. Dr. Steve Goldberg has provided an accompanying commentary. The next original research article, Dr. Wai-Hong Chen and colleagues from Queen Mary Hospital in Hong Kong, report the results of the ASIAD (Abciximab in Stenting Inhibits Restenosis Among Diabetics) Trial. An analysis of angiographic follow-up in over 90% of the patients revealed no significant difference in rates of angiographic restenosis, death, myocardial infarction or target lesion revascularization between the patients who received abciximab and those who did not. This issue contains an original research article which is also a special CME offering in the area of pediatric intervention. Dr. Douglas Luxenberg and associates from the University of Chicago and the University of Pennsylvania, present the advantages of using intracardiac echocardiography with a new 8 Fr catheter to guide the closure of atrial septal defects and patent foramen ovale. They provide excellent educational material for readers to broaden their understanding of this diagnostic technique. Dr. Dinesh Arab and colleagues from Loyola University, have provided a comprehensive review of antiplatelet therapy in anticoagulated patients requiring coronary intervention. They have performed an extensive review of studies that examine the risk of subacute thrombosis with various platelet regimens and the risk of thromboembolism with and without warfarin. They discuss the issues in treatment decisions that must balance the risk of bleeding with the risk of thromboembolism. The Clinical Images section, edited by Dr. David Rizik from the Scottsdale Heart Group, contains two interesting articles. In the first, Dr. Oguz Yavuzgil and colleagues from Ege University School of Medicine in Izmir, Turkey, show a spontaneous coronary artery dissection diagnosed during emergency coronary artery bypass surgery that had no visible intimal tear or flap on coronary angiography. The second article, submitted by Dr. Gabriel Contreras and collaborators from the Montreal Heart Institute, features a new laser guidewire that can facilitate the crossing of chronic total occlusions. This issue includes a case report from Dr. Shigenori Ito and colleagues discussing an approach they used when protruding stent struts obstructed the guidewire at the trunk of the ostial left main. We have also included a case with review of the literature by Drs. Juliano, Wong and Naidu from the New York Presbyterian Hospital/Weill Cornell Medical Center. The authors a case in which they used alcohol septal ablation to treat a failed surgical myectomy in a patient with hypertrophic obstructive cardiomyopathy. They review the literature on hypertrophic cardiomyopathy and invasive therapies that have been used. In the Interventions in Peripheral Vascular Disease section, edited by Dr. Frank Criado of Union Memorial Hospital/Medstar Health in Baltimore, Drs. Aqel, Gupta and Zoghbi from the University of Alabama at Birmingham and the VA Medical Center in Birmingham, report an interesting case of concomitant atherosclerotic stenosis and fibromuscular dysplasia causing renal artery stenosis. In our Interventional Pediatric Cardiology section, edited by Dr. P. Syamasundar Rao from St. Louis University School of Medicine, includes an article by Drs. Harikrishnan, Narayanan and Sivasubramonian that describes a rare complication of a sizing-balloon tear during treatment of an atrial septal defect. It is my hope that the articles in this issue of the Journal provide cardiovascular healthcare professionals with important information that will assist them in the effective management of cardiac patients.