STEMI patients with CKD have significantly higher rates of death and major bleeding compared with those without CKD. In patients with CKD, there appears to be no benefit of bivalirudin compared with heparin + GPI, or DES versus BMS during primary PCI in improving clinical outcomes.

MethodsStandard methods for DNA isolation and analyses were used and are described in the expanded Methods section, available in the Online Data Supplement at http://circres.ahajournals.org. ResultsThirty-four of 1414 (2.4%) consecutive unrelated HCM probands who underwent genetic testing (Supplement Methods), harbored the MYBPC3 Arg502Trp variant. MYBPC3 residue 502 has been highly conserved during evolution (Online Figure I). Insertion of tryptophan at position 502 substitutes a nonpolar hydrophobic residue for the polar uncharged residue arginine.MYBPC3 Arg502Trp cosegregated with HCM in families harboring only this sarcomere protein gene variant (Online Figure II). MYBPC3 Arg502Trp was absent in 545 healthy control subjects (nϭ95, this study; nϭ150 1 ; nϭ100 white Americans and nϭ100 African Americans 8 ; nϭ100 11 ). The combined calculated LOD score for HCM in MYBPC3 Arg502Trp familiesϭ4.04 (ϭ0, assuming penetranceϭ85% in subjects Ն20 years of age, and allele frequencyϭ0.001); the likelihood that MYBPC3 Arg502Trp and HCM cosegregated by random chance was less than 1/11 000. We conclude that MYBPC3 Arg502Trp is a pathogenic HCM mutation.Haplotype analyses were performed in 17 of the 34 MYBPC3 Arg502Trp families (Online Methods and Online Figure II) to determine whether a founding mutation in a common ancestor accounted for its high prevalence, or if MYBPC3 Arg502Trp arose repeatedly in unrelated HCM families. Haplotypes were assessed using short tandem repeat sequences that flank MYBPC3, 102 kb downstream and 188 kb upstream. Four unique haplotypes were identified (Table) with the most frequent haplotype, designated 4,5, seen in 13 families.Forty-three of 56 at-risk relatives in 34 families carried the MYBPC3 Arg502Trp mutation. Clinical information was available for 58 of 77 subjects (probands and family members) with the MYBPC3 Arg502Trp mutation (Online Table I). Fortyfive of 58 mutation carriers (78%) had clinical evidence of HCM, including hypertrophy, sudden cardiac death, or implanted cardioverter defibrillators (ICDs).The age of HCM diagnosis for Arg502Trp carriers relative to MYBPC3 truncation mutations and to MYH7 Arg719Trp, a mutation that causes severe HCM, carriers was compared (Figure, A). There was no significant difference in ages at diagnosis for 48 subjects who carried only the MYBPC3 Arg502Trp mutation versus carriers of MYBPC3 truncation mutations (Pϭ0.5). However, the age at diagnosis of HCM in carriers of MYH7 Arg719Trp was significantly earlier than for carriers of MYBPC3 Arg502Trp (PϽ0.0001). Whereas overt disease was recognized in nearly all carriers of MYH7 Arg719Trp by age 30, Ϸ50% of MYBPC3 Arg502Trp carriers lacked clinical evidence of HCM until after age 45 (Figure, A).Eight HCM subjects harbored both MYBPC3 Arg502Trp and another sarcomere protein gene mutation (Online Table III; Online Figure II, B). Based on patient age at the time of a significant adverse event (eg, age at sudden cardiac death, ICD implantation, myectomy, or cardiac transplantation), the clinical course of s...

The NCDR CAS score, comprising 6 clinical variables, predicts in-hospital S/D after CAS. This tool may be useful to assist clinicians in evaluating optimal management, share more accurate pre-procedural risks with patients, and improve patient selection for CAS.

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Use of a transverse cavitation therapeutic wire is feasible and well tolerated acutely in the normal porcine coronary. At 60 and 90 days, no angiographically apparent damage, no clinically significant pathologic changes, and no adverse events were seen. This technology may be safely used during percutaneous coronary intervention. Further studies are justified to evaluate its efficacy for intracoronary thrombus ablation.

Angioscopy allows direct visualization of the coronary artery lumen and provides detailed information regarding the surface characteristics of the vessel wall and specific lesions causing acute coronary syndromes. Disruption of a plaque, ulceration, tears, fissures, lipid-rich or fibrous lesions, and luminal or mural thrombus can be readily detected in vivo. Characterization of culprit lesions in various coronary syndromes reveals the different mechanisms of ischemia. The predominant lesion in acute myocardial infarction is an ulcerated, yellow plaque with thrombus. In unstable angina, different substrates can be seen, from the lipid-rich lesion with thrombus to the fibrous smooth plaque, reflecting a varied physiopathology. Because of its ability to detect superficial lipid pools, angioscopy may be valuable for the detection of vulnerable plaques.

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