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Find video protocols related to scientific articles indexed in Pubmed.
Fractional flow reserve and the index of microvascular resistance in patients with acute coronary syndromes.
EuroIntervention
PUBLISHED: 09-27-2014
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The aim of this article is to review what is currently known about fractional flow reserve (FFR) and related coronary physiological indices in patients with acute coronary syndrome (ACS) including non-ST-elevation (NSTEMI) and ST-elevation myocardial infarction (STEMI) with a view to making recommendations for daily practice.
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Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction: the British Heart Foundation FAMOUS-NSTEMI randomized trial.
Eur. Heart J.
PUBLISHED: 09-01-2014
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We assessed the management and outcomes of non-ST segment elevation myocardial infarction (NSTEMI) patients randomly assigned to fractional flow reserve (FFR)-guided management or angiography-guided standard care.
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Fractional flow reserve-guided PCI for stable coronary artery disease.
N. Engl. J. Med.
PUBLISHED: 09-01-2014
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We hypothesized that in patients with stable coronary artery disease and stenosis, percutaneous coronary intervention (PCI) performed on the basis of the fractional flow reserve (FFR) would be superior to medical therapy.
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Impact of left ventricular function in relation to procedural outcomes following percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society.
Eur. Heart J.
PUBLISHED: 08-28-2014
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Between 10 and 30% of patients undergoing percutaneous coronary intervention (PCI) have left ventricular (LV) dysfunction. We investigate the association between LV function on early and late mortality outcomes in a national 'real-world' cohort undergoing PCI in the elective and acute coronary syndrome setting through analysis of the British Cardiovascular Intervention Society (BCIS) data set.
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Fractional flow reserve derived from coronary CT angiography: variation of repeated analyses.
J Cardiovasc Comput Tomogr
PUBLISHED: 07-11-2014
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Fractional flow reserve (FFR) is the standard of reference for assessing the hemodynamic significance of coronary stenoses in patients with stable coronary artery disease. Noninvasive FFR derived from coronary CT angiography (FFRCT) is a promising new noninvasive method for assessing the physiologic significance of epicardial stenoses. The reproducibility of FFRCT has not yet been established.
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High-bolus dose tirofiban compared with abciximab in primary percutaneous coronary intervention: a propensity score-matched outcome study.
EuroIntervention
PUBLISHED: 05-17-2014
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Aims: The objective of this study was to analyse the outcomes of patients treated with high-bolus dose (HBD) tirofiban compared with abciximab at the time of primary PCI (PPCI) for ST-elevation myocardial infarction (STEMI). Methods and results: Data from two large UK tertiary centres, with differing protocols for glycoprotein IIb/IIIa inhibitor use during PPCI, were pooled. Propensity scores were calculated based on important covariates, and HBD tirofiban-treated patients were matched to abciximab-treated controls on a one-to-one basis. This resulted in 942 well matched pairs. Survival analysis demonstrated no significant difference in mortality between HBD tirofiban and abciximab either at 30 days (HBD tirofiban 3.7% vs. abciximab 3.2%; HR 1.01 [95% CI: 0.92-1.10], p=0.96) or at three years (HBD tirofiban 9.4% vs. abciximab 9.3%; HR 1.15 [95% CI: 0.79-1.67], p=0.45). Rates of stent thrombosis at 30 days were also similar (HBD tirofiban 12 [1.3%] vs. abciximab 8 [0.8%], p=0.50) but thrombocytopaenia was more common with abciximab (HBD tirofiban 3 [0.3%] vs. abciximab 17 [1.8%], p=0.001). Conclusions: In this observational study of adjunctive GP IIb/IIIa inhibitor treatment in PPCI, we found no difference in survival between HBD tirofiban-treated patients compared with propensity score-matched abciximab-treated controls up to three-year follow-up.
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Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain?: the RIPCORD study.
Circ Cardiovasc Interv
PUBLISHED: 03-18-2014
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The use of coronary angiography (CA) for diagnosis and management of chest pain (CP) has several flaws. The assessment of coronary artery disease using fractional flow reserve (FFR) is a well-validated technique for describing lesion-level ischemia and improves clinical outcome in the context of percutaneous coronary intervention. The impact of routine FFR at the time of diagnostic CA on patient management has not been determined.
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Adenosine: physiology, pharmacology, and clinical applications.
JACC Cardiovasc Interv
PUBLISHED: 02-10-2014
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Adenosine is a ubiquitous extracellular signaling molecule with essential functions in human physiology. Due to the widespread expression of adenosine receptors, it has far-reaching effects across many different organ systems. With a prominent role in the cardiovascular system, it has been extensively studied for both its therapeutic and diagnostic abilities. One of the key areas of use is in the coronary circulation whereby adenosine produces a hyperemic response. An important target of adenosine is the coronary microcirculation whereby adenosine acts as a prominent vasodilator with many of the beneficial effects of adenosine reflected in its capacity to affect the microvessels. Adenosine also has an important role in the pre-conditioned state and also in the attenuation of ischemia-reperfusion injury. This review examines the physiology, pharmacology, and therapeutic applications of adenosine in the human cardiovascular system and provides a brief overview of important aspects of the adenosine-cardiac interaction. It also examines the role of adenosine in the coronary hyperemic response and discusses the use of adenosine for this purpose. After recent concerns about the use of adenosine, a discussion regarding safety of this drug is provided. A brief review of novel agents used to initiate coronary hyperemia is also provided.
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Outcomes in patients with ST-segment elevation acute myocardial infarction treated with clopidogrel versus prasugrel (from the INFUSE-AMI trial).
Am. J. Cardiol.
PUBLISHED: 02-04-2014
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Prasugrel is more potent than clopidogrel, but it is not known whether this translates into clinical benefit in patients undergoing primary percutaneous coronary intervention (PCI) with bivalirudin for ST elevation myocardial infarction. In the Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction trial, 452 patients with anterior STEMI undergoing primary PCI with bivalirudin were randomized to intralesional abciximab or placebo and to thrombus aspiration or no aspiration. Clopidogrel or prasugrel were administered at physician discretion. The primary end point was infarct size at 30 days by cardiac magnetic resonance imaging. Clinical events at 30 days and 1 year were independently adjudicated. Propensity score was used to adjust for nonrandom allocation of the drugs. Prasugrel and clopidogrel were administered to 155 patients (34.3%) and 297 patients (65.7%), respectively. Patients receiving prasugrel were younger with higher left ventricular ejection fraction and greater use of drug-eluting stents. Prasugrel-treated patients had higher rates of procedural success (94% vs 89%, p = 0.03), Thrombolysis In Myocardial Infarction (TIMI) 3 flow (95% vs 90%, p = 0.06), and lower corrected TIMI frame counts (21 ± 6 vs 23 ± 11, p = 0.008). At 30 days, infarct size was marginally lower in the prasugrel group (median [interquartile range] = 16.4% [6.5 to 20.0] vs 17.6% [8.1 to 25.7], p = 0.06). At 1 year, prasugrel group had significantly fewer deaths (1.3% vs 8.3%, p = 0.004) and fewer episodes of severe heart failure (2.0% vs 7.7%, p = 0.02). These findings persisted after propensity score adjustment. There were no significant differences in major bleeding. Stent thrombosis was 0% versus 2.5%, respectively, p = 0.054. We conclude that prasugrel was associated with improved efficacy and similar safety compared with clopidogrel in patients undergoing primary PCI with bivalirudin.
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A randomized trial of deferred stenting versus immediate stenting to prevent no- or slow-reflow in acute ST-segment elevation myocardial infarction (DEFER-STEMI).
J. Am. Coll. Cardiol.
PUBLISHED: 01-31-2014
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The aim of this study was to assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
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Variation in thromboxane B2 concentrations in serum and plasma in patients taking regular aspirin before and after clopidogrel therapy.
Platelets
PUBLISHED: 01-18-2014
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Abstract Dual antiplatelet therapy with aspirin and a P2Y12 antagonist is widely prescribed for the prevention of thrombotic events in patients with an acute coronary syndrome or undergoing percutaneous coronary intervention (PCI). It is recognised that there is inter-individual variation in the antiplatelet effects of both drugs. Recent data also suggest that P2Y12 antagonists can affect the response to aspirin. A direct indicator of the effect of aspirin on platelets is their ability to generate thromboxane, which if measured as the difference between the level of thromboxane B2 in serum and plasma ([TxB2]S-P) avoids the confounding effect of endogenous TxB2 production from other cells. We therefore analysed [TxB2]S-P as a measure of aspirin response in a group of 123 patients undergoing elective PCI before and after the introduction of clopidogrel. In a subgroup of 40 patients taking aspirin alone, we compared [TxB2]S-P and VerifyNow Aspirin for the assessment of aspirin response. There was a wide variation in plasma and serum TxB2 concentrations both before and after clopidogrel therapy but only 3.5% of patients had residual serum concentration of TxB2 > 10?ng/ml. There was a strong correlation between the pre and post clopidogrel levels of TxB2 (r???0.78; p?=?0.001) and no significant difference in [TxB2]S-P. There was no correlation between the magnitude of response to clopidogrel response and the generation of thromboxane B2. Correlation between [TxB2]S-P and VerifyNow Aspirin was poor. We conclude that the use of a P2Y12 antagonist does not influence the effect of aspirin on the ability of platelets to generate thromboxane. Therefore, measurement of TxB2 levels in serum, after subtracting the contribution from plasma, provides a measure of the response to aspirin in patients taking dual antiplatelet therapy.
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Three-year results comparing platinum-chromium PROMUS element and cobalt-chromium XIENCE V everolimus-eluting stents in de novo coronary artery narrowing (from the PLATINUM Trial).
Am. J. Cardiol.
PUBLISHED: 01-14-2014
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In the randomized PLATINUM trial, the PROMUS Element platinum-chromium everolimus-eluting stent (PtCr-EES; Boston Scientific, Natick, Massachusetts) was noninferior to the XIENCE V cobalt-chromium everolimus-eluting stent (CoCr-EES; Boston Scientific and Abbott Vascular, Santa Clara, California) for the primary end point of 1-year target lesion failure. This study reports the 3-year outcomes. Patients (n=1,530) with 1 or 2 de novo native coronary artery lesions (baseline vessel diameter?2.50 mm to ?4.25 mm and length?24 mm) were randomized 1:1 to PtCr-EES versus CoCr-EES. Three-year follow-up was available in 93.9% (703 of 749) of patients with CoCr-EES and 96.7% (733 of 758) of patients with PtCr-EES. Comparing CoCr-EES with PtCr-EES, 3-year rates of death (4.3% vs 3.7%, hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.52 to 1.48, p=0.62), cardiac death (1.9% vs 1.2%, HR 0.63, 95% CI 0.27 to 1.45, p=0.27), myocardial infarction (2.5% vs 2.3%, HR 0.92, 95% CI 0.48 to 1.79, p=0.81), ischemia-driven target lesion revascularization (4.9% vs 3.5%, HR 0.72, 95% CI 0.43 to 1.20, p=0.21), and Academic Research Consortium definite or probable stent thrombosis (0.5% vs 0.7%, HR 1.23, 95% CI 0.33 to 4.57, p=0.76) were not significantly different. In conclusion, 3-year results of the PLATINUM randomized, controlled, clinical trial demonstrate comparable safety and efficacy outcomes of the PROMUS Element PtCr-EES and the XIENCE V CoCr-EES.
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Comprehensive dobutamine stress CMR versus echocardiography in LBBB and suspected coronary artery disease.
JACC Cardiovasc Imaging
PUBLISHED: 01-03-2014
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This study aimed to compare dobutamine stress cardiac magnetic resonance (DSCMR) with dobutamine stress echocardiography (DSE) in patients with left bundle branch block (LBBB) and suspected coronary artery disease (CAD).
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Randomized trial of preventive angioplasty in myocardial infarction.
N. Engl. J. Med.
PUBLISHED: 09-01-2013
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In acute ST-segment elevation myocardial infarction (STEMI), the use of percutaneous coronary intervention (PCI) to treat the artery responsible for the infarct (infarct, or culprit, artery) improves prognosis. The value of PCI in noninfarct coronary arteries with major stenoses (preventive PCI) is unknown.
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Multicenter Core Laboratory Comparison of the Instantaneous Wave-Free Ratio and Resting Pd/Pa with Fractional Flow Reserve: The RESOLVE Study.
J. Am. Coll. Cardiol.
PUBLISHED: 07-08-2013
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We sought to examine the diagnostic accuracy between the instantaneous wave-free ratio (iFR) and resting Pd/Pa with respect to hyperemic fractional flow reserve (FFR) in a core laboratory-based multicenter collaborative study.
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Vasodilatory capacity of the coronary microcirculation is preserved in selected patients with non-ST-segment-elevation myocardial infarction.
Circ Cardiovasc Interv
PUBLISHED: 06-11-2013
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The use of fractional flow reserve in patients with non-ST-segment-elevation myocardial infarction (NSTEMI) is a controversial issue. We undertook a study to assess the vasodilatory capacity of the coronary microcirculation in patients with NSTEMI when compared with a model of preserved microcirculation (stable angina [SA] cohort: culprit and nonculprit vessel) and acute microcirculatory dysfunction (ST-segment-elevation myocardial infarction [STEMI] cohort). We hypothesized that the vasodilatory response of the microcirculation would be preserved in NSTEMI.
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Prognostic value of the Index of Microcirculatory Resistance measured after primary percutaneous coronary intervention.
Circulation
PUBLISHED: 05-16-2013
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Most methods for assessing microvascular function are not readily available in the cardiac catheterization laboratory. The aim of this study is to determine whether the Index of Microcirculatory Resistance (IMR), measured at the time of primary percutaneous coronary intervention, is predictive of death and rehospitalization for heart failure.
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Fractional flow reserve versus angiography in guiding management to optimize outcomes in non-ST-elevation myocardial infarction (FAMOUS-NSTEMI): rationale and design of a randomized controlled clinical trial.
Am. Heart J.
PUBLISHED: 04-17-2013
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In patients with acute non-ST-elevation myocardial infarction (NSTEMI), coronary arteriography is usually recommended; but visual interpretation of the angiogram is subjective. We hypothesized that functional assessment of coronary stenosis severity with a pressure-sensitive guide wire (fractional flow reserve [FFR]) would have additive diagnostic, clinical, and health economic utility as compared with angiography-guided standard care.
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Quality of life following percutaneous coronary interventions in octogenarians: a systematic review.
Heart
PUBLISHED: 03-06-2013
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Overall, percutaneous coronary intervention (PCI) can improve the symptoms and quality of life (QoL) of patients with coronary artery disease. Older patients account for an increasing number and proportion of PCIs, however they are more prone to adverse events. This study systematically reviews the QoL benefits in this sub-group.
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The impact of coronary bifurcation stenting strategy on health-related functional status: a quality-of-life analysis from the BBC One (British Bifurcation Coronary; Old, New, and Evolving Strategies) study.
JACC Cardiovasc Interv
PUBLISHED: 02-23-2013
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This study sought to assess the impact of coronary bifurcation stenting on health-related functional status, using the Seattle Angina Questionnaire (SAQ), for participants in the BBC ONE (British Bifurcation Coronary; Old, New, and Evolving Strategies) trial and to compare simple versus complex bifurcation stenting strategies in this regard.
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Relationship between myocardial reperfusion, infarct size, and mortality: the INFUSE-AMI (Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction) trial.
JACC Cardiovasc Interv
PUBLISHED: 02-08-2013
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This study sought to compare infarct size (IS) measured by magnetic resonance imaging in patients with successful (myocardial blush grade [MBG] 2/3) versus unsuccessful (MBG 0/1) microcirculatory reperfusion in the INFUSE-AMI (Intracoronary Abciximab and Aspiration Thrombectomy in Patients With Large Anterior Myocardial Infarction) trial.
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VERIFY (VERification of Instantaneous Wave-Free Ratio and Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis Severity in EverydaY Practice): a multicenter study in consecutive patients.
J. Am. Coll. Cardiol.
PUBLISHED: 02-06-2013
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This study sought to compare fractional flow reserve (FFR) with the instantaneous wave-free ratio (iFR) in patients with coronary artery disease and also to determine whether the iFR is independent of hyperemia.
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Bright-blood T2-weighted MRI has higher diagnostic accuracy than dark-blood short tau inversion recovery MRI for detection of acute myocardial infarction and for assessment of the ischemic area at risk and myocardial salvage.
Circ Cardiovasc Imaging
PUBLISHED: 03-22-2011
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T2-Weighted MRI reveals myocardial edema and enables estimation of the ischemic area at risk and myocardial salvage in patients with acute myocardial infarction (MI). We compared the diagnostic accuracy of a new bright-blood T2-weighted with a standard black blood T2-weighted MRI in patients with acute MI.
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Clinical value of antiplatelet therapy in patients with acute coronary syndromes and in percutaneous coronary intervention.
Biomark Med
PUBLISHED: 02-16-2011
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Dual antiplatelet therapy with aspirin and clopidogrel is recommended in all patients who have had an acute coronary syndrome or who undergo percutaneous coronary intervention to prevent further ischemic events. Resistance or reduced responsiveness to aspirin and/or clopidogrel has been associated with adverse cardiovascular outcomes, including stent thrombosis. There have been significant advances in this field, which aim to overcome antiplatelet resistance, including the development of new antiplatelet agents. The rationale for dual antiplatelet therapy, the impact of suboptimal efficacy and the potential ways of overcoming resistance or variability in response to antiplatelet agents will be reviewed in this article.
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Perioperative and long-term outcomes following aortic valve replacement: a population cohort study of 4124 consecutive patients.
Eur J Cardiothorac Surg
PUBLISHED: 01-19-2011
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Because of increasing life expectancy, more patients require valve replacement for aortic stenosis. We aimed to determine perioperative and long-term outcomes, the factors associated with these and whether they have changed over time.
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Simple or complex stenting for bifurcation coronary lesions: a patient-level pooled-analysis of the Nordic Bifurcation Study and the British Bifurcation Coronary Study.
Circ Cardiovasc Interv
PUBLISHED: 01-04-2011
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Controversy persists regarding the correct strategy for bifurcation lesions. Therefore, we combined the patient-level data from 2 large trials with similar methodology: the NORDIC Bifurcation Study (NORDIC I) and the British Bifurcation Coronary Study (BBC ONE).
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Percutaneous coronary intervention in the elderly: changes in case-mix and periprocedural outcomes in 31,758 patients treated between 2000 and 2007.
Circ Cardiovasc Interv
PUBLISHED: 07-06-2010
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The elderly account for an increasing proportion of the population and have a high prevalence of coronary heart disease. Percutaneous coronary intervention (PCI) is the most common method of revascularization in the elderly. We examined whether the risk of periprocedural complications after PCI was higher among elderly (age > or =75 years) patients and whether it has changed over time.
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Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation.
J. Am. Coll. Cardiol.
PUBLISHED: 06-29-2010
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The purpose of this study was to investigate the relationship between angiographic and functional severity of coronary artery stenoses in the FAME (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation) study.
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The index of microcirculatory resistance measured acutely predicts the extent and severity of myocardial infarction in patients with ST-segment elevation myocardial infarction.
JACC Cardiovasc Interv
PUBLISHED: 03-09-2010
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This study investigated the relationship between the index of microcirculatory resistance (IMR) with myocardial injury and microvascular obstruction (MVO) assessed by contrast-enhanced cardiac magnetic resonance (ceCMR) imaging in a broad range of ST-segment elevation myocardial infarction (STEMI) patients undergoing emergency percutaneous coronary intervention (PCI).
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Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions: the British Bifurcation Coronary Study: old, new, and evolving strategies.
Circulation
PUBLISHED: 03-01-2010
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The optimal strategy for treating coronary bifurcation lesions remains a subject of debate. With bare-metal stents, single-stent approaches appear to be superior to systematic 2-stent strategies. Drug-eluting stents, however, have low rates of restenosis and might offer improved outcomes with complex stenting techniques.
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Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients. 1-year results of the CARDia (Coronary Artery Revascularization in Diabetes) trial.
J. Am. Coll. Cardiol.
PUBLISHED: 02-02-2010
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The purpose of this study was to compare the safety and efficacy of percutaneous coronary intervention (PCI) with stenting against coronary artery bypass grafting (CABG) in patients with diabetes and symptomatic multivessel coronary artery disease.
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Low serum cortisol predicts early death after acute myocardial infarction.
Crit. Care Med.
PUBLISHED: 01-19-2010
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To determine whether low serum cortisol concentrations are associated with adverse prognosis in patients with acute myocardial infarction. Low serum cortisol concentrations have been associated with adverse prognosis in critical illness of diverse etiology.
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Validation of magnetic resonance myocardial perfusion imaging with fractional flow reserve for the detection of significant coronary heart disease.
Circulation
PUBLISHED: 11-16-2009
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Magnetic resonance myocardial perfusion imaging (MRMPI) has a number of advantages over the other noninvasive tests used to detect reversible myocardial ischemia. The majority of previous studies have generally used quantitative coronary angiography as the gold standard to assess the accuracy of MRMPI; however, only an approximate relationship exists between stenosis severity and functional significance. Pressure wire-derived fractional flow reserve (FFR) values <0.75 correlate closely with objective evidence of reversible ischemia. Accordingly, we have compared MRMPI with FFR.
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Obesity paradox in a cohort of 4880 consecutive patients undergoing percutaneous coronary intervention.
Eur. Heart J.
PUBLISHED: 08-17-2009
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We sought to investigate the impact of body mass index (BMI) on long-term all-cause mortality in patients following first-time elective percutaneous coronary intervention (PCI).
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Effect of clopidogrel discontinuation at 1 year after drug eluting stent placement on soluble CD40L, P-selectin and C-reactive protein levels: DECADES (Discontinuation Effect of Clopidogrel After Drug Eluting Stent): a multicenter, open-label study.
J. Thromb. Thrombolysis
PUBLISHED: 06-09-2009
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Antiplatelet therapy with clopidogrel has been shown to reduce major adverse cardiac events in acute coronary syndromes and after percutaneous interventions. This effect is not only due to its anti-platelet effect but also possibly due to an anti-inflammatory effect. The effect of clopidogrel cessation after one year of therapy on markers of inflammation has been investigated in diabetics and showed an increase in platelet aggregation as well as hsCRP and surface P-selectin levels. This was an exploratory multicenter prospective open-label single arm study of 98 non-diabetic patients who had received one or more drug eluting stents and were coming to the end of their 12 months course of clopidogrel therapy. The effect of clopidogrel cessation on expression of biomarkers: sCD40L, soluble P-selectin and hsCRP was measured right before clopidogrel cessation (day 0), and subsequently at 1, 2, 3 and 4 weeks after drug withdrawal. A median increase in sCD40L expression from 224 to 324.5 pg/ml was observed between baseline and 4 weeks after clopidogrel cessation, which corresponded to a 39% mean percent change based on an ANCOVA model (P < 0.001). Over the 4 weeks observation period the change in sCD40L expression correlated weakly with soluble P-selectin levels (at 4 weeks Spearmans correlation coefficient = 0.32; P = 0.0024). Increase in P-selectin expression from baseline was statistically significant at week 1 and 2. Conversely, hsCRP level decreased by 21% at 1 week (P = 0.008) and was still reduced by 18% by 4 weeks (P = 0.062). The change in sCD40L expression appeared to vary with the type of drug eluting stent. Patients treated with drug eluting stents at 1 year after implantation display significant increase in sCD40L and decrease in hsCRP after clopidogrel cessation. Further studies should elucidate if this increase in sCD40L levels reflects solely the removal of the inhibitory effects of clopidogrel on platelet activity or rather an increase in pro-inflammatory state. The latter hypothesis may be less likely given decrease in hsCRP levels. Randomized studies are urgently needed to establish potential link of clopidogrel discontinuation and vascular outcomes.
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Radial versus femoral approach for high-speed rotational atherectomy.
Catheter Cardiovasc Interv
PUBLISHED: 05-13-2009
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The aim of this study was to compare in-hospital outcomes for patients undergoing high-speed rotational atherectomy (HSRA) via the radial and femoral route.
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Three-year clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimus-eluting stent: insights from the Arterial Revascularisation Therapies Study, part II (ARTS II).
EuroIntervention
PUBLISHED: 04-14-2009
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The long-term impact of treating bifurcation lesions on the overall outcome of patients with multivessel coronary disease treated percutaneously with drug-eluting stents is unknown. This analysis determined the influence of bifurcation treatment using sirolimus-eluting stents on 3-year clinical outcomes.
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Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.
N. Engl. J. Med.
PUBLISHED: 01-16-2009
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In patients with multivessel coronary artery disease who are undergoing percutaneous coronary intervention (PCI), coronary angiography is the standard method for guiding the placement of the stent. It is unclear whether routine measurement of fractional flow reserve (FFR; the ratio of maximal blood flow in a stenotic artery to normal maximal flow), in addition to angiography, improves outcomes.
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Drug-eluting stents: a study of international practice.
Am. Heart J.
PUBLISHED: 01-12-2009
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We aimed to analyze trends in drug-eluting stents (DES) use in four international health care and regulatory settings.
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The role of cardiac magnetic resonance imaging (MRI) in acute myocardial infarction (AMI).
Heart Lung Circ
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Acute myocardial infarction (AMI) is a leading cause of mortality and morbidity in the world, despite the rate having significantly declined over the past decade. The aim of this review is to consider the emerging diagnostic and clinical utility of cardiac MRI in patients with recent AMI. Cardiac MRI has high reproducibility and accuracy, allowing detailed functional assessment and characterisation of myocardial tissue. In addition to traditional measures including infarct size (IS), transmural extent of necrosis and microvascular obstruction (MVO), other infarct characteristics can now be identified using innovative MRI techniques. These novel pathologies include myocardial oedema and myocardial haemorrhage which also have functional and prognostic implications for patients. In addition to its diagnostic utility in ordinary clinical practice, cardiac MRI has been increasingly used to provide information on surrogate outcome measures, such as left ventricular ejection fraction (LVEF) and volumes, in clinical trials. MRI is becoming more available in secondary care, however, the potential clinical utility and cost effectiveness of MRI in post-MI patients remains uncertain. Cardiac MRI is most likely to be useful in high risk patients with risk factors for heart failure (HF). This includes individuals with early signs of pump failure and risk factors for adverse remodelling, such as MVO. This review focuses on the role of cardiac MRI in the assessment of patients with AMI.
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Microvascular Resistance Predicts Myocardial Salvage and Infarct Characteristics in ST-Elevation Myocardial Infarction.
J Am Heart Assoc
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The pathophysiology of myocardial injury and repair in patients with ST-elevation myocardial infarction is incompletely understood. We investigated the relationships among culprit artery microvascular resistance, myocardial salvage, and ventricular function.
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Usefulness of fractional flow reserve to improve diagnostic efficiency in patients with non-ST elevation myocardial infarction.
Am. J. Cardiol.
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Myocardial fractional flow reserve (FFR) has emerging clinical utility and prognostic value in medically stabilized patients with non-ST-segment elevation myocardial infarction (NSTEMI). The aim of this study was to investigate whether measurement of FFR compared to coronary angiography alone improves diagnostic efficiency in patients with NSTEMIs. One hundred consecutive patients with NSTEMIs who had previously undergone clinically indicated FFR measurements were included. In a simulated decision exercise, 5 interventional cardiologists retrospectively and independently reviewed the clinical history and coronary angiogram of each patient and then made a treatment decision. FFR results were then disclosed, and the same cardiologists were asked to review their initial treatment decisions. A p value <0.05 indicates a difference between cardiologists. The proportion of patients allocated to each treatment option initially differed among the 5 cardiologists (p = 0.0061). Forty-two percent of all FFR measurements were made in culprit lesions. After FFR disclosure, the number of patients in whom the treatment decisions made by each cardiologist independently conformed (and so represented the majority with ? 3 of the 5 cardiologists) increased from 65% to 91% (p = 0.0094). After FFR disclosure, the cardiologists changed their initial treatment plans in 46% of patients (p = 0.0016). Changes in favor of medical therapy occurred in 24% of patients (p = 0.0016), and this increase was associated with reductions in "deferred" management (p = 0.0067), single-vessel percutaneous coronary intervention (p = 0.0052), and multivessel percutaneous coronary intervention (p = 0.046). In conclusion, FFR measurement reduced diagnostic variability and changed cardiologists treatment decisions for patients with NSTEMIs.
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Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease.
N. Engl. J. Med.
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The preferred initial treatment for patients with stable coronary artery disease is the best available medical therapy. We hypothesized that in patients with functionally significant stenoses, as determined by measurement of fractional flow reserve (FFR), percutaneous coronary intervention (PCI) plus the best available medical therapy would be superior to the best available medical therapy alone.
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Use of troponin to diagnose periprocedural myocardial infarction: effect on composite endpoints in the British Bifurcation Coronary Study (BBC ONE).
Heart
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Periprocedural myocardial infarction (PMI; ESC/ACC type 4a) is diagnosed on the basis of elevation of cardiac enzymes more than three times the 99th centile upper reference limit. Recent guidelines recommend the use of troponin instead of creatine kinase (CK) to diagnose PMI, but this assay increases diagnostic sensitivity, while the clinical significance of small increases in troponin remains undetermined. We examined the effects of using the new definition on the incidence of a composite endpoint (previously defined by CK) in a contemporary clinical randomised trial-the British Bifurcation Coronary Study (BBC ONE).
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Prevention of coronary in-stent restenosis and vein graft failure: does vascular gene therapy have a role?
Pharmacol. Ther.
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Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), including stent insertion, are established therapies in both acute coronary syndromes (ACS) and symptomatic chronic coronary artery disease refractory to pharmacological therapy. These continually advancing treatments remain limited by failure of conduit grafts in CABG and by restenosis or thrombosis of stented vessel segments in PCI caused by neointimal hyperplasia, impaired endothelialisation and accelerated atherosclerosis. While pharmacological and technological advancements have improved patient outcomes following both procedures, when grafts or stents fail these result in significant health burdens. In this review we discuss the pathophysiology of vein graft disease and in-stent restenosis, gene therapy vector development and design, and translation from pre-clinical animal models through human clinical trials. We identify the key issues that are currently preventing vascular gene therapy from interfacing with clinical use and introduce the areas of research attempting to overcome these.
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Succinobucol-eluting stents increase neointimal thickening and peri-strut inflammation in a porcine coronary model.
Catheter Cardiovasc Interv
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The aim of this study was to assess the efficacy of stent-based delivery of succinobucol alone and in combination with rapamycin in a porcine coronary model. Background: Current drugs and polymers used to coat coronary stents remain suboptimal in terms of long term efficacy and safety. Succinobucol is a novel derivative of probucol with improved antioxidant and anti-inflammatory properties.
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The effect of reactive oxygen species on whole blood aggregation and the endothelial cell-platelet interaction in patients with coronary heart disease.
Thromb. Res.
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The effect of reactive oxygen species (ROS) on platelet function in coronary heart disease (CHD) is complex and poorly defined. Platelet aggregation studies in healthy volunteers have demonstrated contrasting results when platelets are exposed to ROS. We investigated the effect of ROS on whole blood aggregation (WBA) and the endothelial cell-platelet interaction in patients with CHD.
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Primary endpoint results of the EVOLVE trial: a randomized evaluation of a novel bioabsorbable polymer-coated, everolimus-eluting coronary stent.
J. Am. Coll. Cardiol.
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This study sought to compare the safety and efficacy of 2 dose formulations of SYNERGY, a novel bioabsorbable polymer everolimus-eluting stent (EES) (Boston Scientific Corp., Natick, Massachusetts) compared with the durable polymer PROMUS Element EES (Boston Scientific Corp.).
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Clinical outcomes following radial versus femoral artery access in primary or rescue percutaneous coronary intervention in Scotland: retrospective cohort study of 4534 patients.
Heart
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To assess short-term and medium-term outcomes following radial and femoral artery access for primary or rescue percutaneous coronary intervention (PCI).
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.