Percutaneous transluminal coronary rotary ablation with rotablator (European experience)

This study reports the results from 3 European centers using rotary ablation with Rotablator, a device that is inserted into the coronary artery and removes atheroma by grinding it into millions of tiny fragments. Rotary ablation was performed in 129 patients. Primary success (reduction in percent luminal narrowing greater than 20%, residual stenosis less than 50%, without complications) was achieved by rotary angioplasty alone in 73 patients (57%). An additional 38 patients (29%) had successful adjunctive balloon angioplasty. Thus primary success was achieved in 111 patients (86%) at the end of the procedure. Acute occlusion occurred in 10 patients (7.7%). Recanalization was achieved by balloon angioplasty in 7: urgent bypass grafting was undertaken in 2. Q-wave and non-Q-wave myocardial infarction occurred in 3 and 7 patients, respectively. No deaths occurred. Follow-up angiography was performed in 74 patients (60%). Restenosis, defined as the recurrence of significant luminal narrowing (greater than 50%) occurred in 17 of 37 patients (46%) who underwent rotary ablation alone, and 11 of 37 patients (30%) who had adjunctive balloon angioplasty. The overall angiographic restenosis rate was 37.8%. In conclusion, rotary ablation is technically feasible, and relatively safe i

P-Selectin as a new gender associated biomarker in patients with metabolic syndrome

[No abstract available

751-6 Multiple Repeat Coronary Angioplasty for Final Lesion Patency

To demonstrate that multiple repeat coronary angioplasty can be solely utilized to achieve final lesion patency after restenosis, such a protocol was prospectively applied for restenosis since 1983. Bypass surgery was only considered for 1) new left main trunk lesions, 2) symptomatic restenosis where angioplasty was either unsuccessful or unsuitable, and 3) patient preference. Between 1983 and 1992, 1455 lesions (acute myocardial infarction or total occlusion excluded) were successfully dilated for the first time. Although only 941 (68%) of the 1385 lesions studied showed satisfactory patency (≤ 70% stenosis) after the first procedure, 93% (1248/1345 studied) showed satisfactory patency after repeating angioplasty up to 3 times and 94% (1268/1354 studied) after repetition up to 6 times. Only 23 lesions 11.6%) required 4 or more procedures and 20 of them showed final patency. Disease aggravation (either impossible or failed repeat angioplasty, acute infarction, or sudden death) occurred in 43 lesions (3.2%). Bypass grafts were done for 11 lesions of 7 patients, mostly due to disease progression at the left main trunk.Dilatation (stenosis)Patent (0–50%)Mild (55-70%)Re-do(75%-)Grafts(75%-)Medical(75%-)Aggravated#WithdrawalCumulative0–70%No*1st87467384916327394113822nd221229706731118413513rd5311230136124813454th11181010126113455th3320000126713456th100100012681345*:1763- ∑ Withdrawal#:sudden death. acute infarction or irreversible occlusionConclusionThese findings indicate that 1) repeat angioplasty can be the main treatment strategy for restenosis, 2) multiple repeat angioplasties (up to 6 times) can be effective and rarely aggravate coronary anatomy and 3) disease aggravation must be prevented to improve the final patency rate of repeat ang ioplasty

Percutaneous coronary intervention in Europe 1992-2003

peer reviewedAims: The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer revascularization approaches and its distribution in different regions in Europe. We report the data of the year 2003 and give an overview of the development of coronary interventions since 1992, when the first data collection was performed. Methods and results: Questionnaires were distributed yearly to delegates of all national societies of cardiology represented in the European Society of Cardiology to collect the case numbers of all local institutions and operators. The overall numbers of coronary angiographies increased from 1992 to 2003 from 684,000 to 1,993,000 (from 1,250 to 3,500 per million inhabitants). The respective numbers for percutaneous coronary interventions (PCI-coronary angioplasty) and coronary stenting procedures increased from 184,000 to 733,000 (from 335 to 1,300) and from 3,000 to 610,000 (from 5 to 1,100), respectively. Germany has been the most active country for the past years with 653,000 angiographies (7,800), 222,000 angioplasties (2,500), and 180,000 stenting procedures (2,200) in 2003. The indication has shifted towards acute coronary syndromes, as demonstrated by raising rates of interventions for acute myocardial infarction over the last decade. The procedures are more readily performed and safer, as shown by increasing rate of “ad hoc” PCI and decreasing need for emergency coronary artery bypass surgery (CABG). In 2003, use of drug-eluting stents had further increased. However, an enormous variability is reported with the highest rate in Portugal (55%). Conclusion: Interventional cardiology in Europe is still expanding, mainly but not exclusively due to rapid growth in the eastern European countries. A number of new coronary revascularization procedures introduced over the years have all but disappeared. Only stenting has experienced an exponential growth. The same can be forecast for drug-eluting stenting

021: Clopidogrel low response and correlation between the different tests: light transmission aggregometry, VerifyNow-P2Y12 and V ASP

BackgroundClopidogrel low response correlates with poor prognosis after percutaneous coronary intervention (PCI). Many biological tests are currently available to test the clopidogrel response. However, the presence of any correlation between the different tests is today poorly reported.MethodsIn this prospective study, clopidogrel response was assessed in 100 consecutive patients. All patients were tested between 18h and 24h after a600mg clopidogrel loading dose using 3 different tests: light transmission aggregometry with 10μmol ADP (LTA, results expressed as platelet inhibition percentage), VerifyNow-P2Y12 (VN, results expressed as PRU) and vasodilatator stimulated phosphoprotein (VASP, results expressed as IRP). Patients under chronic clopidogrel therapy were excluded.ResultsThe mean platelet inhibition percentage, PRU value and IRP value were 38.5±13% by LTA, 178±89 PRU by VN and 52±21% by VASP. When results were analyzed as continuous variables, there was a good correlation between the different tests: LTA/VN (R2=0,642, p<0,001), LTA/VASP (R2=0,409, p<0,001) and VN/VASP (R2=0,616, p<0,001). However, when results were analyzed as pre-specified cut-off points to define patients as “low or good responders” (according to the literature: 50% for LTA, 235 PRU for VN and 50% IRP for VASP), only 47% of the patients were defined as “good” or “low responders” by the 3 tests. Altogether, 33% of the patients were defined as “low responders” by only 1 test, 20% by 2 tests and only 16% by the 3 tests.ConclusionIf the correlation between the different tests is good when results are analyzed as continuous variables, each individual is rarely (less than 50%) defined as “low or good responder” by all the 3 tests when recognized cut-off values are used. In that way, a sole test might not be sufficient to manage antiplatelet therapy in an individual patient

020: Impact of anti-platelets dose fractionation on platelet inhibition in type 2 diabetes mellitus

ObjectiveThe hypothesis of the study was that increased drug administration frequency [twice daily versus once daily] may provide more effective platelet inhibition in patients with type 2 diabetes mellitus.MethodsTwenty patients with type 2 diabetes mellitus with stable coronary artery disease were prospectively recruited. All the patients received once daily 150mg of aspirin and clopidogrel for two weeks. Then patients were switched to aspirin and clopidogrel 75mg twice daily for two weeks. Pharmacodynamic assessment was performed by VerifyNow system accumetrics at fifteen and thirty days.ResultsThere was no difference between the antiplatelet effect produced by 150mg of aspirin given once daily and 75mg of aspirin given twice daily. A twice-daily dose of 75mg of clopidogrel is associated with significantly more effective platelet inhibition on the residual assay: PRU=38.2% once daily vs 53.8% twice daily (p= 0.001) and PRU=187 once daily vs 147 twice daily (p=0.005).ConclusionsIncreasing the frequency of clopidogrel administration to twice daily in patients with type 2 diabetes mellitus is significantly associated with more effective platelet inhibition. But our data do not support a twice-daily dose of aspirin to improve platelet response

Percutaneous coronary interventions in Europe 1992-2001

Aims The purpose of this registry is to collect data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in newer re-vascularisation approaches and its distribution in different regions in Europe. We report the data of the year 2001 and give an overview of the development of coronary interventions since 1992, when the first data collection was performed. Methods and Results Questionnaires were distributed to delegates of the individual national societies of cardiology represented in the European Society of Cardiology. These were completed by the local institutions and operators and showed that 1,806,238 angiograms and 617,176 percutaneous transluminal coronary angioplasties (PTCAs) were performed in 2001. This is an increase of 10% and 17%, respectively, compared with the year 2000. The population-adjusted PTCA rate rose from nearly 800 procedures per 106 inhabitants in the year 2000 to approximately 990 procedures per 106 inhabitants in 2001. Coronary stenting increased by 25% to about 488,900 stents implanted in 2001. Complication rates remained unchanged, and the need for emergency coronary artery bypass grafting is still at 0.2% per percutaneous intervention. Conclusion Interventional cardiology in Europe is still expanding, mainly due to rapid growth in countries with lower socio-economical levels. Most central European countries reported only minor increases in procedures performed. Coronary stenting remains the only noteworthy adjunctive strategy to balloon angioplast

934-28 Sensitivity and Specificity of Angiographic Markers for Thrombus: A Prospective Comparison with Angioscopy

The limitations of angiography for the detection of intracoronary thrombus are well recognized. Between November 1991 and July 1994, we performed 402 angioscopy procedures in 225 vessels in 202 patients, with the Image-Cath (Baxter).We performed a prospective study in 190 of these patients, who had an interpretable angioscopy performed just before PTCA to determine the sensitivity and specificity of predetermined angiographic criteria that are considered to be indicative of the presence of intracoronary thrombus. Angiographically verified thrombus was used as the gold standard for comparison. Lesions were classified on angiography (2 orthogonal views) by independent observers. The presence of an intraluminal filling defect, of overhanging edges, of haziness, or of ulceration were noted. The characteristic ulceration was not mutually exclusive of the other 3 characteristics.Of 15 filling defects on angiography 14 (93%) had thrombus on angiography; in the 23 lesions with overhanging edges 19 (83%) had thrombus on angioscopy; in the 27 ulcerated lesions 21 (78%) had angioscopic thrombus; in the 6 lesions that were hazy on angiography 5 had angioscopic thrombus.AngioscopyThrombus+Thrombus-AngiographyThrombus+4512Thrombus-4093In our model, using 5 prespecified angiographic characteristics, angiography had high specificity (89%) but relatively low sensitivity (53%) for the detection of thrombus compared to angioscopy

Intracoronary Brachytherapy, a Promising Treatment Option for Diabetic Patients: Results from a European Multicenter Registry (RENO)

Despite advances in the interventional treatment of coronary disease, diabetics still have double the case fatality rate as nondiabetics. The purpose of this an