OBJECTIVES: The purpose of this research was to perform a feasibility study of prophylactic coronary revascularization in patients with preoperative extensive stress-induced ischemia. BACKGROUND: Prophylactic coronary revascularization in vascular surgery patients with coronary artery disease does not improve postoperative outcome. If a beneficial effect is to be expected, then at ...

Myocardial infarction and ischemic heart disease are among the most common causes of morbidity and mortality in the industrial world. Surgical and percutaneous intravascular approaches are commonly used to treat these diseases. Regrettably, a significant number of patients are either ineligible or demonstrate suboptimal responses to these therapies. In an ...

Coronary artery disease is the most common underlying cause of heart failure, yet there is little consensus on the role of revascularization in the management of patients with ischemic cardiomyopathy. The concept of recovery of dysfunctional but viable myocardium forms the pathophysiologic basis for the benefit of revascularization. Data from ...

AIM: Minimally invasive direct coronary artery bypass (MIDCAB) is a reliable method to revascularize the left anterior descending (LAD) coronary artery. However, a more consistent body of knowledge is needed to assess factors influencing long-term outcome. With this study, we retrospectively investigated the long-term determinants of survival and freedom from ...

Coronary revascularization procedures by means of percutaneous coronary interventions or coronary artery bypass graft surgeries are performed worldwide daily for the symptomatic treatment of patients with myocardial ischaemia. Nevertheless, angina remains a significant clinical problem. Management of angina recurring or persisting after coronary revascularization is particularly challenging. This review attempts ...

Coronary heart disease is the most common cause of death in the general population and in patients with ESRD. The principles of cardiovascular risk assessment and management apply to both populations. Advances in noninvasive coronary artery imaging have improved early detection of subclinical disease. The goals of medical management of ...

Transmyocardial laser revascularization is a technique for the treatment of patients with chronic angina pectoris that is refractory to medical therapy and who are not eligible for surgical intervention. Percutaneous myocardial revascularization is a less-invasive catheter-based procedure that has been adapted from transmyocardial laser revascularization. Six prospective randomized clinical trials ...

We present a 79-year-old woman with coronary heart disease who underwent complete revascularization by using a No-React bovine internal mammary artery seeded with autologous endothelial cells. Her postoperative course was uneventful, and the patient was recently in New York Heart Association functional class I. Multislice computed tomography imaging showed patent ...

BACKGROUND: The Coronary Artery Revascularization (CARE) study is a multicenter observational registry of coronary revascularization by percutaneous and surgical techniques. As a substudy of this registry, we analyzed the current practice and outcomes of on-pump and off-pump coronary artery bypass graft (CABG) surgery. METHODS: Procedural and outcomes data were prospectively ...

Clinical investigations designed to contrast the efficacy of carotid endarterectomy (CEA) versus best medical therapy and CEA versus carotid artery stenting (CAS) in patients with carotid artery stenosis have been based on the traditional endpoints of stroke, myocardial infarction, and death. Cognitive function is being increasingly recognized as an important ...

AIMS: To determine whether revascularization within 14 days reduces 1-year mortality in patients with a previous CABG admitted for non-ST-elevation ACS. Current guidelines for patients with acute coronary syndrome (ACS) include early revascularization. The evidence is derived from studies, in which patients with previous coronary artery by-pass graft (CABG) surgery ...

More patients are both suffering and surviving acute coronary syndromes. After hospital discharge, a host of interventions, including medications, therapeutic lifestyle changes, revascularization, and electrophysiologic devices improve quality of life and survival. Evidence-based management requires the general internist to have a working knowledge of these interventions and to identify patients ...

Percutaneous coronary balloon angioplasty was pioneered by Andreas Gruentzig who designed and assembled balloon dilatation catheters in his own kitchen. In 1976, he reported the successful application in canine coronary experiments. He performed the first successful coronary angioplasty in a patient in September 1977 in Zurich. The dilation catheter consisted ...

Percutaneous revascularization strategies for bifurcation disease of the left main are complex and carry significant risk. These risks are magnified in the setting of a left main which trifurcates. In a patient with complex ostial disease of two of the three limbs of a left main trifurcation, turned down for ...

PURPOSE: To assess the effects of socioeconomic status on mortality in patients with acute myocardial infarction. MATERIAL AND METHODS: We studied a retrospective cohort of 5622 patients who presented to a hospital emergency department with an initial episode of acute myocardial infarction between April 1998 and March 2002 in the ...

In patients with chronic ischemic myocardial dysfunction, late gadolinium enhancement CMR (LGE-CMR) accurately depicts the regional extent of fibrosis and predicts functional recovery after revascularization. We hypothesized that the predictive accuracy of LGE-CMR could be optimized by not only taking into account the transmural extent of hyperenhancement but also the ...

Hybrid coronary revascularization is a combination of minimally invasive coronary artery bypass grafting and percutaneous coronary intervention in patients with multivessel coronary artery disease. The concept is now 10 years old. Implementation was slow, but major developments have taken place. The surgical part of the procedure can be performed in ...

Patients with the combination of coronary artery disease and peripheral vascular disease have multiple risk factors and manifest widespread vascular disease. Although indications of combined coronary and femoral revascularization are rare, a combined procedure is useful in selected patients. We report a patient who underwent a successful combined coronary and ...

BACKGROUND: The proximal left anterior descending artery (LAD) is a challenging area for percutaneous interventions; therefore, coronary artery bypass grafting is often considered and sometimes performed even in patients with single-vessel disease involving the proximal LAD. This study compares mid-term results of LAD revascularization using drug-eluting stents (Cypher) with minimally ...

OBJECTIVES: The purpose of this study was to determine the relative benefit of intensive medical therapy compared with coronary revascularization for suppressing scintigraphic ischemia. BACKGROUND: Although medical therapies can reduce myocardial ischemia and improve patient survival after acute myocardial infarction, the relative benefit of medical therapy versus coronary revascularization for ...

BACKGROUND: Coronary microcirculatory damage is an important factor for the prognosis for acute myocardial infarction (MI) after revascularization. The myocardial enhancement area with contrast media infused during coronary revascularization therapy, detected by computed tomography (CT) just after revascularization, has been reported to correspond to the area of hemorrhagic infarction. The ...

The purpose of this paper is to review what is known regarding the anatomy of the coronary venous system, and the commonly used techniques for its selective catheterization. This is with regard to new innovative percutaneous techniques that have led to a burgeoning interest in methods of access to the ...

BACKGROUND: We hypothesized that ejection fraction (EF) best predicts cardiovascular death but only measures of ischemia predict relative survival benefit from revascularization compared with medical therapy. METHODS AND RESULTS: We followed up 5366 consecutive patients without prior revascularization who underwent stress electrocardiography-gated myocardial perfusion single photon emission computed tomography (MPS) ...

PURPOSE OF REVIEW: The aim of this article is to review the current status of optimal revascularization strategies in patients presenting with multivessel coronary artery disease. RECENT FINDINGS: Coronary artery bypass surgery is the gold standard for patients with multivessel disease. Recent developments in the interventional field, like drug-eluting stents, ...

Some of the confusion surrounding the role of coronary revascularization in women relates to differences in study design, the large number of reported end points, and the multitude of comparisons. This article presents current results from randomized coronary revascularization trials as well as contemporary observational data from a large regional ...

BACKGROUND: The aim of this retrospective study was to evaluate the safety and efficacy of left anterior small thoracotomy for treatment of isolated chronic total occlusion of the left anterior descending artery. METHODS: From November 21, 1994, to December 31, 2002, 143 patients with isolated left anterior descending artery chronic ...

BACKGROUND: Stress gated myocardial perfusion single photon emission computed tomography (gSPECT) is increasingly used before and after intercurrent therapeutic intervention and is the basis for ongoing evaluation in the Department of Veterans Affairs clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial. METHODS AND RESULTS: The COURAGE trial is ...

OBJECTIVES: This study was designed to evaluate biomarkers for selection of patients with non-ST-segment elevation acute coronary syndromes (ACS) that derive mortality benefit from revascularization. BACKGROUND: Biomarkers are essential for identification of patients at increased risk, which may be reduced by revascularization. METHODS: During the initial 30 days, 2,340 patients ...

AIMS: The aim of this study was to document the early outcome of coronary-like revascularization for atherosclerotic renal artery stenosis (ARAS). METHODS AND RESULTS: A total of 181 consecutive patient, 102 men, mean age 66.1 (+/- 9.2) years and 79 females, mean age 68.4 (+/- 9.2) years and 198 lesions ...

BACKGROUND: Although practice guidelines recommend coronary revascularization for patients with heart failure, the evidence to support this recommendation is weak. The objective of our study was to determine the association of coronary revascularization with survival in patients who have had heart failure. METHODS: Data were obtained from the Alberta Provincial ...

Cardiac complications are the leading cause of peri-operative morbidity and mortality of patients undergoing vascular surgery. This high incidence of cardiac complications is related to the presence of underlying coronary artery disease. The optimal treatment strategy for these high-risk patients, including the use of pre-operative coronary revascularization for the purpose ...

INTRODUCTION: Female gender has been associated with worse clinical outcomes following coronary revascularization. Whether a gender-specific difference in vessel size is contributing to this finding remains controversial. We sought to better define the relationship between gender and coronary artery size. METHODS: Baseline characteristics were obtained and quantitative coronary angiography was ...

Racial/ethnic and sex disparities in coronary heart disease treatment exist. We previously reported that physicians perceive non-clinical variables, such as a patient's desire for a second opinion, as affecting revascularization decisions. The results of that study are further examined here, using factor analysis to identify significant interrelationships among the non-clinical ...

We describe the first use of totally endoscopic, off-pump, robot-assisted transmyocardial laser revascularization in a 58-year-old man with refractory rest angina who had undergone two prior coronary bypass operations. Preoperative testing revealed reversible ischemia of the left ventricular apex with diffuse coronary atherosclerotic disease not suitable for further treatment by ...

As patients with coronary artery disease live longer and more often reach the stage where further myocardial revascularization procedures can no longer be performed, efficacious and well-tolerated antianginal medications are needed. Metabolic agents offer the advantage of controlling symptoms without untoward hemodynamic effects. This article reviews the epidemiology of stable ...

BACKGROUND: Using the ischemic myocardial cell as a paradigm, competitive coronary revascularization technologies will be analyzed for their potential in causing additional myocardial cell damage during the course of therapeutic procedures. METHODS AND RESULTS: Percutaneous coronary intervention (PCI) using balloon and/or stent (bare metal or coated) approaches may be associated ...

BACKGROUND: Correct assessment of the significance of left main stem lesions is of pivotal importance to the patient with coronary artery disease. On the basis of clinical and angiographic information alone, this evaluation often cannot be done reliably. Limited data suggest that coronary pressure-derived fractional flow reserve (FFR) supports decision ...

BACKGROUND: Off-pump coronary artery bypass is commonly performed through a full median sternotomy; however, the tendency to reduce surgical trauma has stimulated cardiac surgeons to use less invasive techniques for single-vessel disease. The use of thoracotomy for reoperative and valvular surgery has also been reported, but its application in primary ...

To determine the perioperative mortality, myocardial infarction rate, and long-term survival of patients with critical limb ischemia (CLI) compared with those with intermittent claudication (IC) within a cohort selected for significant coronary artery disease, a secondary analysis was conducted of a prospective, randomized, multicenter trial of Coronary Artery Revascularization Prophylaxis ...

OBJECTIVES: Recently off-pump coronary artery bypass grafting (CABG) is being widely used for coronary revascularization. However, there is some evidence that off-pump surgery increases the risk of recurrent angina and the need for reintervention, suggesting poor graft quality or incomplete revascularization. We describe our experience to demonstrate the feasibility of ...

CONTEXT: Certificate of need regulations were enacted to control health care costs by limiting unnecessary expansion of services. While many states have repealed certificate of need regulations in recent years, few analyses have examined relationships between certificate of need regulations and outcomes of care. OBJECTIVE: To compare rates of coronary ...

An ever-growing number of patients are being referred for coronary revascularization in an attempt to reduce morbidity or to reduce mortality. Multiple randomized trials comparing percutaneous and surgical coronary revascularization have been performed. The decision to proceed with percutaneous or surgical revascularization should be based ona thorough understanding of the ...

The pressure-derived fractional flow reserve (FFR) is a valuable and well validated index for assessing the ischemic significance of coronary lesions. The 0.75 cutoff value of FFR discriminates between lesions with and without ischemic potential, helps decision making as to whether to revascularize a coronary stenosis and assists in evaluating ...

We present a female Jehovah's Witness patient with concomitant severe left main and left anterior descending coronary artery disease and pheochromocytoma who underwent successful off-pump myocardial revascularization. Perioperative management of this patient included alpha-blockade with Doxazosin followed by beta-blockade with Metoprolol. A short-acting Phentolamine was used for alpha-blockade before surgery. ...

AIMS: To examine the relationship between revascularization within 7 days and 1-year mortality among ST-elevation myocardial infarction patients enrolled in GUSTO-V trial (n=13 451). To examine the relative contribution of system and patient level factors to the variation in international revascularization rates, and their impact on mortality outcomes. METHODS AND ...

Transmyocardial revascularization, using the US FDA-approved holmium: yttrium-aluminum-garnet (Ho:YAG) laser system, is a surgical option for patients with debilitating angina caused by diffuse coronary artery disease in areas of the heart not amenable to complete revascularization using conventional treatments. Increased utilization of this therapy is warranted, in parallel with continuing ...

Recent studies show that bisphosphonates can decrease the development of femoral head deformity following ischemic osteonecrosis by inhibiting osteoclast-mediated bone resorption. Given the potential new indication, improved understanding of pharmacokinetics of bisphosphonates as it applies to the infarcted head would be beneficial. The purpose of this study was to investigate ...

Coronary artery disease is one of the most important causes of death in Western society. Attempts to revascularize the coronary artery by myocardial retroperfusion, direct revascularization from the left ventricle, and bypass surgery have finally led to percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) as standard ...

BACKGROUND: The clinical value of revascularization and other procedures in patients with severe systolic heart failure is unclear. It has been suggested that assessing ischemia and viability by positron emission tomography (PET) with fluorodeoxyglucose (FDG) imaging may identify patients for whom revascularization may lead to improved survival. We performed a ...

BACKGROUND: Randomized clinical trials showed the benefit of pharmacological and revascularization treatments in secondary prevention of myocardial infarction (MI), in selected population with highly controlled interventions. The objective of this study is to measure these treatments' impact on the cardiovascular (CV) mortality rate among patients receiving usual care in the ...