A prospective study evaluating efficacy of polymer free Pronova XR stent in treatment of denovo coronary artery stenosis.

BACKGROUND: Drug eluting stents have remarkably improved results of percutaneous coronary angioplasty. Most of the currently available drug eluting stents uses a durable polymer as drug carrier which has been implicated in local inflammatory response and continued incidence of late and very late stent thrombosis. The Pronova XR stent is one from those new generation polymer free sirolimus eluting stents in which pharmaceutical excipient is used for the timed release of sirolimus from the XR stent platform instead of a polymeric coating. METHODOLOGY: We consecutively recruited 121 patients undergoing elective or urgent PCI at our center. All the patients were followed up clinically and mandatory follow up angiogram at 6 months was done for one third of the total patients. An independent core lab analyzed paired angiograms. RESULTS: The primary efficacy endpoint was death, MI, TVR at 6 months which occurred in 6.66% patients. The QCA analysis showed reference vessel diameter of 2.5 + 0.44 mm at baseline and the minimal luminal diameter was 0.88 + 0.43 mm giving baseline diameter stenosis of 65.26 + 15.89%. The immediate post procedure in-segment diameter stenosis assessed was 23.68 + 8.96% which increased to 36.02 + 24.48% at follow up with a late lumen loss of 0.25 + 0.76 mm at mean of 191 days. CONCLUSION: Coronary angioplasty with polymer free Pronova XR stents results in acceptable late lumen loss and very low target lesion revascularisation at short and intermediate term in unselected patients.

Stress echo for evaluation of valvular heart disease.

Resting echocardiography is the most important tool for diagnosing valvular heart disease. However, treatment planning in valvular heart diseases may require additional information in some patients, particularly asymptomatic patients with severe valve disease or symptomatic patients with moderate disease. Stress echocardiography provides invaluable information in these situations and aids decision making. Stress echocardiography is performed using either physical stress or dobutamine stress and various valve parameters are monitored during the stress. Further, the ventricular performance, which is an important determinant of outcome in valve disease is also closely monitored during stress which helps immensely in planning the intervention. Lastly, possibility of associated coronary artery disease can also be evaluated, especially in the elderly. This article discusses the role of stress evaluation in assessment of valve disease in the commonly encountered clinical situations.

Safety and efficacy of bivalirudin with glycoprotein IIb/IIIa for high-risk percutaneous coronary intervention.

AIMS: The aim of the study was to assess the safety and efficacy of bivalirudin + glycoprotein (Gp) IIb/IIIa inhibitor as compared to unfractionated heparin (UFH) + Gp IIb/IIIa inhibitor in high risk patients undergoing elective percutaneous coronary intervention (PCI). The primary end point was time to sheath removal and ambulation where as peri-procedure myocardial damage, access site bleeding and major adverse cardiac events (MACE) rates were secondary end points. METHODS: One hundred and one high risk patients undergoing elective PCI were randomly assigned to either bivalirudin + GpIIb/IIIa inhibitor or UFH + Gp IIb/IIIa inhibitor. PCI was performed by standard technique and activated clotting time was monitored immediately on arrival to recovery area and every 60 min thereafter. Sheath were pulled out once ACT was below 150 seconds and patients were mobilized 6hrs after sheath were removed. Peri-procedure myocardial damage was assessed by serial Trop I levels. RESULTS: Patient assigned to bivalirudin + tirofiban has significantly reduced time to sheath removal and ambulation as compared to those who received UFH + tirofiban (p < 0.0001) although peak Act did not differ in the groups. Peak Trop I levels were significantly lower in bivalirudin + tirofiban group (p = 0.023) and peri-procedure Trop I elevation occurred in significantly lower number of patients treated with bivalirudin + tirofiban (p = 0.029). CONCLUSIONS: The combination of bivalirudin + tirofiban was safe and effective as compared to UFH + tirofiban in high risk patients undergoing elective PCI.

Changing management of acute MI--perspectives from India.

Management of acute myocardial infarction (AMI) in India essentially rests on the established reperfusion strategies with unique adaptations compelled by the socioeconomic structure of the country. Due to limited availability of trained interventionists coupled with financial limitations, thrombolysis remains the most utilised reperfusion therapy for AMI. Patient education through the active participation of physicians concerning the early detection of symptoms suggestive of AMI can enhance the impact of thrombolysis on the outcomes by narrowing the door-to-needle time. This article discusses some of these unique issues and possible solutions in the emerging economies to optimise outcomes in AMI.

Recent advances in the management of acute myocardial infarction.

Recently the reperfusion therapy in the form of Primary Percutaneous Coronary intervention (PPCI) has become the gold standard for the treatment of Acute Myocardial Infarction. In spite of rapid revascularization either with PPCI or thrombolytic therapy, the significant number of patients develops decreased left ventricular function leading to heart failure which can increase long-term mortality and morbidity. The number of strategies are being evolved and evaluated to reduce this post infarct heart failure. They are being developed at the level of optimizing the outcomes of PPCI, protection against the reperfusion injury, and novel therapies like cardiac repair and regeneration and sonothrombolysis. Thrombus aspiration using simple aspiration catheters during PPCI are getting established as a useful adjunct tool to reduce distal embolisation and consequently improving myocardial salvage. The newer antiplatelet drugs like Prasugrel and Ticagrelor may replace the Clopidogrel to reduce ischemic complications. The reduction in reperfusion injury using drugs has shown mixed results. The newer modalities like cardiac repair and regeneration using stem cell therapy looks promising but are yet to be established.