Facilitated advancement of the Palmaz-Schatz stent delivery system with the use of an adjacent 0.018′ stiff wire

The 5.0 French Palmaz-Schatz stent delivery system is a relatively bulky, stiff system which can be advanced only over a 0.014′ wire. Although crossing failure is rare, advancement of the delivery system through tortuous, rigid vessels may be unsuccessful. We report on four consecutive cases in which the initial advancement of the Palmaz-Schatz stent delivery system was unsuccessful due to vessel tortuosity or vessel angulation. The use of a 0.018′ stiff wirer adjacent to the Palmaz-Schatz delivery system, to “straighten” the vessels and to give additional guide catheter support, allowed for the successful advancement and delivery of coronary stents in all four cases. © 1996 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/38223/1/24_ftp.pd

SAFETY OF TRANSRADIAL CARDIAC CATHETERIZATION IN PATIENTS WITH END-STAGE LIVER DISEASE

The current study adopted McAdams’ multilayer framework as the basis to develop a psychological portrait of an elite athlete who was identified as being particularly “mentally tough.” The aim was to use this single case as an exemplar to demonstrate the utility of McAdams’ framework for understanding the complexity of sport performers across three domains of personality: dispositional traits, characteristic adaptations, and narrative identity. We operationalised these domains through the development of specific research questions and, subsequently, the collection and integration of the participant’s Big Five traits, personal strivings, coping strategies, and response to a life story interview. The results offered a comprehensive insight into the nature of one athlete’s personality that, in turn, informed conceptual perspectives of mental toughness in sport psychology literature and qualitatively supported emerging evidence of the validity of a three-layer framework in personality psychology. Specifically, the study’s design showed how a holistic approach to personality analysis can lead to a more complete psychological representation of competitors in sport, and people generally. It demonstrated how motivational, sociocultural, and meaning-making aspects of personality can complement a trait profile to achieving a satisfying assessment of the whole person

Temporal Trends in the Use of Drug-eluting Stents for Approved and Off-label Indications: A Longitudinal Analysis of a Large Multicenter Percutaneous Coronary Intervention Registry

Background We sought to examine the temporal variations in the rate of both bare-metal stent (BMS) and drug-eluting stent (DES) use for off-label indications after the reports of an increased risk of very late stent thrombosis in patients with DES at the 2006 meeting of the European Society of Cardiology (ESC). Hypothesis To determine whether the decrease in use of DES has affected both on and off-label indications. Methods The study cohort included patients undergoing coronary intervention in a large regional registry, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Patient demographic and clinical characteristics for patients with DES in the third quarter of 2006 (pre-ESC) were compared to those from the fourth quarter of 2008 (post-guideline changes). Use of DES for off-label indications, such as ST-segment elevation myocardial infarction (STEMI), in-stent restenosis (ISR), and saphenous vein graft (SVG) interventions, were evaluated. Results The overall deployment of DES fell sharply from 83% pre-ESC to a plateau of 58% in the first quarter of 2008. This corresponded to a rise in BMS use, while angioplasty procedures stayed the same. The STEMI subgroup showed the most dramatic change, from 78% to only 36%. Off-label use in SVGs showed a similar trend, from 74% to 43%. Drug-eluting stent deployment for ISR was less affected, though it also fell 25% (from 79%–56%). Conclusions The use of DES has fallen dramatically from June 2006 to December 2008, particularly for nonapproved indications. Our study provides a real-world assessment of contemporary change in DES use in response to the presentation of negative observational studies. Copyright © 2010 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65057/1/20717_ftp.pd

Prevalence and significance of Exit Block During Arrhythmias Arising in Pulmonary Veins

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74819/1/j.1540-8167.2000.tb00332.x.pd

Relationship Between Operator Volume and Adverse Outcome in Contemporary Percutaneous Coronary Intervention Practice An Analysis of a Quality-Controlled Multicenter Percutaneous Coronary Intervention Clinical Database

ObjectivesThe aim of our study was to evaluate the volume-outcome relationship in a large, quality-controlled, contemporary percutaneous coronary interventions (PCI) database.BackgroundWhether the relationship between physician volume of PCI and outcomes still exists in the era of coronary stents is unclear.MethodsData on 18,504 consecutive PCIs performed by 165 operators in calendar year 2002 were prospectively collected in a regional consortium. Operators' volume was divided into quintiles (1 to 33, 34 to 89, 90 to 139, 140 to 206, and 207 to 582 procedures/year). The primary end point was a composite of major adverse cardiovascular events (MACE) including death, coronary artery bypass grafting, stroke or transient ischemic attack, myocardial infarction, and repeat PCI at the same site during the index hospital stay.ResultsThe unadjusted MACE rate was significantly higher in quintiles one and two of operator volume when compared with quintile five (7.38% and 6.13% vs. 4.15%, p = 0.002 and p = 0.0001, respectively). A similar trend was observed for in-hospital death. After adjustment for comorbidities, patients treated by low volume operators had a 63% increased odds of MACE (adjusted odds ratio [OR] 1.63, 95% confidence interval [CI] 1.29 to 2.06, p < 0.0001 for quintile [Q]1; adjusted OR 1.63, 95% CI 1.34 to 1.90, p < 0.0001 for Q2 vs. Q5), but not of in-hospital death. Overall, high volume operators had better outcomes than low volume operators in low-risk and high-risk patients.ConclusionsAlthough the relationship between operator volume and in-hospital mortality is no longer significant, the relationship between volume and any adverse outcome is still present. Technological advancements have not yet completely offset the influence of procedural volume on proficiency of PCIs

Development of a Multicenter Interventional Cardiology Database: The Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Experience

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72219/1/j.1540-8183.2002.tb01072.x.pd

The Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Collaborative Quality Improvement Initiative in Percutaneous Coronary Interventions

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72388/1/j.1540-8183.2002.tb01071.x.pd