JACC. Cardiovascular interventions
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JACC Cardiovasc Interv · Nov 2013
Multicenter Study Comparative Study Observational StudyThe role of drug-eluting balloons alone or in combination with drug-eluting stents in the treatment of de novo diffuse coronary disease.
This study sought to investigate the role of drug-eluting balloons (DEB) alone or in combination with drug-eluting stents (DES) in the treatment of diffuse de novo coronary artery disease (CAD) (>25 mm). ⋯ DEB may have a role in the treatment of diffuse de novo CAD, either alone in smaller vessels or in combination with DES in very long disease.
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JACC Cardiovasc Interv · Nov 2013
ReviewSystematic use of transradial PCI in patients with ST-segment elevation myocardial infarction: a call to "arms".
A growing body of evidence now supports the use of transradial percutaneous intervention (TRI) as the preferred access site for the treatment of patients with ST-segment elevation myocardial infarction (STEMI). Historically, TRI has been avoided in the STEMI population due to concerns over longer procedure time, longer door-to-device time, higher crossover rates, and the experience level required with TRI compared with transfemoral access. However, in recent years, recognition of the impact of periprocedural bleeding on mortality in patients with acute coronary syndromes has garnered interest in the utility of TRI as an established method to reduce bleeding. ⋯ Additional benefits of TRI include enhanced patient comfort, reduced hospital length of stay, and reduced cost. Despite the evidence, trends in use of TRI in the United States have shown a slow adoption rate as a result of multiple barriers in clinical practice and doubts about the mechanism and causal relationship of mortality reduction with TRI. We summarize the current evidence and propose a call to action to foster training of TRI in cardiovascular fellowship programs and post-fellowship courses, and for more widespread implementation of TRI in STEMI patients.
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JACC Cardiovasc Interv · Nov 2013
ReviewResponse variability to P2Y12 receptor inhibitors: expectations and reality.
P2Y12 inhibitors are widely used in patients with acute coronary syndromes and in the secondary prevention of thrombotic events in vascular diseases. Within the past few years, several pharmacological, genetic, and clinical limitations of the second-generation thienopyridine clopidogrel have raised major concerns. High on-treatment platelet reactivity, which is common in clopidogrel-treated patients, and its clinical implications led to the development of the more effective platelet P2Y12 inhibitors prasugrel (a third-generation thienopyridine) and ticagrelor (a cyclopentyl-triazolo-pyrimidine). ⋯ Therefore, cardiologists might be facing a new challenge in the future: to individualize the level of platelet inhibition in order to decrease thrombotic events without increasing bleeding. The current review focuses on the use of platelet function testing and pharmacogenomic testing in order to identify patients who either do not respond to or are at risk of not responding sufficiently to P2Y12 inhibitors. Moreover, this paper discusses randomized trials, which so far have failed to show that tailored antiplatelet therapy improves clinical outcome, and treatment options for patients with high on-treatment platelet reactivity.
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JACC Cardiovasc Interv · Nov 2013
Observational StudyRisk score, causes, and clinical impact of failure of transradial approach for percutaneous coronary interventions.
To study the causes of and to develop a risk score for failure of transradial approach (TRA) for percutaneous coronary intervention (PCI). ⋯ In a high-volume radial center, 2.7% of patients undergoing PCI are excluded from initial TRA on clinical grounds, whereas crossover to femoral approach is required in only 1.8% of the cases. A new simple clinical risk score is developed to predict TRA-PCI failure.
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JACC Cardiovasc Interv · Nov 2013
Long-term experience and outcomes with transcatheter closure of patent foramen ovale.
This study sought to examine the frequency of indications for and the immediate and long-term clinical outcomes of transcatheter closure of patent foramen ovale (PFO). ⋯ Transcatheter PFO closure is safe and feasible in patients with several clinical indications. The long-term efficacy of this intervention in patients with paradoxical embolism appears superb in this observational study. Carefully selected patients with features suggestive of paradoxical embolism are the most likely to benefit from PFO closure and should be the focus of future investigation.