AimsWe investigated whether routine T-stenting reduces restenosis of the side branch as compared with provisional T-stenting in patients with de novo coronary bifurcation lesions.Methods and resultsOur randomized study assigned 101 patients with a coronary bifurcation lesion to routine T-stenting with sirolimus-eluting stents (SES) in both branches and 101 patients to provisional T-stenting with SES placement in the main branch followed by kissing-balloon angioplasty and provisional SES placement in the side branch only for inadequate results. Primary endpoint was per cent diameter stenosis of the side branch at 9 month angiographic follow-up. Angiographic follow-up in 192 (95%) patients revealed a per cent stenosis of the side branch of 23.0 ± 20.2% after provisional T-stenting (19% with side-branch stent) and of 27.7 ± 24.8% (P = 0.15) after routine T-stenting (98.2% with side-branch stent). The corresponding binary restenosis rates were 9.4 and 12.5% (P = 0.32), prompting re-intervention in 5.0 and 7.9% (P = 0.39), respectively. In the main branch, binary restenosis rates were 7.3% after provisional and 3.1% after routine T-stenting (P = 0.17). The overall 1 year incidence of target lesion re-intervention was 10.9% after provisional and 8.9% after routine T-stenting (P = 0.64).ConclusionsRoutine T-stenting with SES did not improve the angiographic outcome of percutaneous coronary intervention of coronary bifurcation lesions as compared with stenting of the main branch followed by kissing-balloon angioplasty and provisional side-branch stenting.

Background-In acute myocardial infarction, distal embolization of debris during primary percutaneous catheter intervention may curtail microvascular reperfusion of the infarct region. Our randomized trial investigated whether distal protection with a filter device can improve microvascular perfusion and reduce infarct size after primary percutaneous catheter intervention. Methods and Results-We enrolled 200 patients who had angina within 48 hours after onset of pain plus at least 1 of 3 additional criteria: ST-segment elevation, elevated myocardial marker proteins, and angiographic evidence of thrombotic occlusion. Among the patients included (83% men; mean age, 62Ϯ12 years), 100 were randomly assigned to the filter-wire group and 100 to the control group. The primary end point was the maximal adenosine-induced Doppler flow velocity in the recanalized infarct artery; the secondary end point was infarct size estimated by the volume of delayed enhancement on nuclear MRI. ST-segment elevation myocardial infarction was present in 68.5% of the patients; the median time from onset of pain was 6.9 hours. In the filter-wire group, maximal adenosine-induced flow velocity was 34Ϯ17 compared with 36Ϯ20 cm/s in the control group (Pϭ0.46). Infarct sizes, assessed in 82 patients in the filter-wire group and 78 patients in the control group, were 11.8Ϯ9.3% of the left ventricular mass in the filter-wire group and 10.4Ϯ9.4% in the control group (Pϭ0.33). Thirty-day mortality was 2% in filter-wire group and 3% in the control group. Conclusions-The filter wire as an adjunct to primary percutaneous catheter intervention in myocardial infarction with and without ST-segment elevation did not improve reperfusion or reduce infarct size.

No benefit was seen for CTO PCI in terms of the primary endpoint, SWT, or other indexes of left ventricular function. CTO PCI resulted in clinical benefit over no CTO PCI, as evidenced by reduced major adverse coronary event rates at 12 months.

Obesity is associated with improved outcome after UA/NSTEMI treated with early revascularization.

No abstract

During five-year follow-up, routine T-stenting offered no advantage over provisional T-stenting with respect to TLR or MACE. ClinicalTrials.gov Identifier: NCT00288535

More-than-mild AR after TAVI was more frequent with MCV than with ESV. This finding deserves consideration, as more-than-mild AR was associated with higher mortality at 1 year.

A 50-year-old nonsmoker with paroxysmal atrial fibrillation was referred to our hospital for pulmonary vein isolation (PVI). He had a known 1-vessel coronary artery disease. Because of stable angina, a drug-eluting stent had been implanted into the midportion of the left anterior descending artery in 2010. Otherwise he was healthy. His medical treatment included warfarin, sotalol, an angiotensin-converting enzyme-inhibitor and a statin. Cryoballoon-PVI (Arctic Front Advance 28 mm; Medtronic) was scheduled under general anesthesia (international normalized ratio, 2-9; minimal activated clotting time, 300 s). After transseptal access, the left PV were targeted first, followed by the right inferior PV and right superior PV, respectively. PVI of all PVs could be visualized in real-time and gained within 40 s. Two freezethaw cycles were used for each PV, except for the left superior PV, which had to be treated 3×, because of an initially ineffective freeze (Table I in the Data Supplement ). The procedure had been uneventful, until a sudden blood pressure drop occurred (70/40 mm Hg), immediately after the second right superior PV-freeze. Cardiac tamponade was excluded. Twelve-lead ECG revealed global ST-depression and progressive ST-elevation in aVR, consistent with coronary main stem occlusion ( Figure 1). Pulseless electric activity developed rapidly, necessitating cardiopulmonary resuscitation. Coronary angiography showed a severe spasm of the left coronary main stem, without evidence for air-or thromboembolism (Figure 2A), which could be completely reverted by balloon dilatation and intracoronary nitroglycerine administration ( Figure 2B). The right coronary artery showed a less severe spasm, which was treated by nitroglycerine alone (Figure 3A and 3B). Immediately after coronary reperfusion, ventricular fibrillation occurred, affording several direct current shocks. Because of severe global myocardial stunning, without effective myocardial contractions, an extracorporeal cardiac life support system (veno-arterial extracorporeal cardiac life support system) had to be implanted. Myocardial stunning reverted completely during the following 5 days, and the patient could be weaned from the extracorporeal cardiac life support system. He survived without any major focal neurologic deficit, but impairment of short-term memory was apparent during follow-up. Predischarge echocardiography showed normal biventricular function without wall motion abnormalities. About the used cryoballoon device, the manufacturer excluded a technical malfunction. DiscussionIn this case report, to date, we describe an unreported serious complication of a near-fatal coronary artery main stem spasm during cryoballoon-PVI. We suspect cryoenergy-induced blood cooling, as the most likely trigger, rather than a direct ablation effect, given the distance between the pulmonary veins and the left main stem ( Figure I in the Data Supplement). Further evidence for this theory is provided in Figure 1, which retrospectively showed progressive development of...