JACC. Cardiovascular interventions
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JACC Cardiovasc Interv · Nov 2013
Fluoroscopic guide to an ideal implant position for Sapien XT and CoreValve during a valve-in-valve procedure.
This study sought to provide a guide to the fluoroscopic appearances of various valve-in-valve (VIV) combinations by deploying a transcatheter heart valve (THV) within a degenerated surgical heart valve (SHV) in an ideal position. ⋯ To achieve an optimal result when considering VIV, it is important to be familiar with the structure and fluoroscopic appearances of the failed SHV, the THV used, and their combination.
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JACC Cardiovasc Interv · Nov 2013
Routine assessment of on-clopidogrel platelet reactivity and gene polymorphisms in predicting clinical outcome following drug-eluting stent implantation in patients with stable coronary artery disease.
This study sought to assess the usefulness of clopidogrel-pathway genotyping and on-treatment platelet reactivity (OTR) testing in predicting major adverse cardiac events (MACE) in stable coronary artery disease (CAD) patients receiving drug-eluting stents (DES) under dual antiplatelet (clopidogrel plus aspirin) therapy. ⋯ CYP2C19 metabolizer status is an independent predictor of MACE after DES implantation and can be used for prognostication in all stable CAD patients. High OTR, as assessed by the VerifyNow P2Y12 test, is an independent predictor of MACE only for high-risk subsets, that is, patients with diabetes or chronic kidney disease.
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JACC Cardiovasc Interv · Nov 2013
ReviewTransradial versus transfemoral percutaneous coronary intervention in acute coronary syndromes: re-evaluation of the current body of evidence.
Recent literature has argued the superiority of radial access compared with femoral access for percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). Three particular trials-RIVAL (Radial Versus Femoral Access for Coronary Intervention), RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome), and STEMI-RADIAL (ST Elevation Myocardial Infarction Treated by Radial or Femoral Approach-Randomized Multicenter Study Comparing Radial Versus Femoral Approach in Primary PCI)-demonstrated lower rates of bleeding and vascular complications with the transradial approach. Bleeding is a major independent predictor of negative long-term outcomes including death, predisposes patients to transfusions, and attenuates the ability to administer cardioprotective post-procedural anticoagulation. ⋯ These are important considerations especially for high-risk and ACS patients, in whom the negative implications of major bleeding are even greater. Without an optimized design, the applications of the trial findings are uncertain. Ultimately, a trial comparing femoral versus radial access in patients on bivalirudin, potent oral antiplatelet medication, and without adjunctive glycoprotein IIb/IIIa inhibitors is needed to assess outcomes based on access site alone.
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JACC Cardiovasc Interv · Nov 2013
Randomized Controlled Trial Multicenter Study Comparative StudyClinical outcome after crush versus culotte stenting of coronary artery bifurcation lesions: the Nordic Stent Technique Study 36-month follow-up results.
The aim of the study was to compare long-term follow-up results of crush versus culotte stent techniques in coronary bifurcation lesions. ⋯ At 36-month follow-up, the clinical outcomes were similar for patients with coronary bifurcation lesions treated with the culotte or the crush stent technique. (Nordic Bifurcation Study. How to Use Drug Eluting Stents [DES] in Bifurcation Lesions? NCT00376571).
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JACC Cardiovasc Interv · Nov 2013
Randomized Controlled Trial Comparative StudyA randomized comparison of the transradial and transfemoral approaches for coronary artery bypass graft angiography and intervention: the RADIAL-CABG Trial (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention).
This study sought to compare and contrast use and radiation exposure using radial versus femoral access during cardiac catheterization of patients who had previously undergone coronary artery bypass graft (CABG) surgery. ⋯ In patients who had previously undergone CABG surgery, transradial diagnostic coronary angiography was associated with greater contrast use, longer procedure time, and greater access crossover and operator radiation exposure compared with transfemoral angiography. (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention [RADIAL-CABG] Trial; NCT01446263).