Optical coherence tomography for guiding wire into a side branch coronary artery with flush total occlusion.

We report a case of flush occlusion, where a novel use of optical coherence tomography (OCT) helped in successful crossing and stenting of the lesion.

Serial gray scale intravascular ultrasound findings in late drug-eluting stent restenosis.

The primary aim of the present study was to assess the gray scale intravascular ultrasound (IVUS) findings that might be associated with late drug-eluting stent restenosis. The study included 47 patients (54 lesions) who had undergone either baseline IVUS-guided stent implantation or IVUS-guided repeat stenting to treat in-stent restenosis and then had IVUS follow-up data for ≥1.5 years afterward without any intervening procedures. The left anterior descending artery was the culprit in 59% of cases, and 50% of the lesions were at bifurcation sites. Quantitative and qualitative IVUS analyses showed a decreased minimum lumen area at follow-up from 6.0 ± 1.8 to 3.8 ± 1.4 mm(2) (p <0.0001) that was mainly due to neointimal hyperplasia with chronic stent recoil (defined as a >15% decrease in minimum stent area) in only 2 lesions and stent fracture in only 5 lesions. Calcified neointima appeared in 12 lesions, mostly in the form of macrocalcification, and was associated with increased calcium both behind the stent and in the reference segment. In conclusion, late drug-eluting stent restenosis showed neointimal calcification in 20% of cases, and chronic stent recoil was rare.

Impact of baseline thrombocytopenia on the early and late outcomes after ST-elevation myocardial infarction treated with primary angioplasty: analysis from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial.

BACKGROUND: Thrombocytopenia (TP) is a common abnormality in patients presenting with acute coronary syndrome. Whether baseline TP has any influence on the outcome of patients treated with primary angioplasty for acute myocardial infarction is unknown. METHODS: We sought to detect the impact of baseline TP on the early and late outcomes of patients with ST-elevation myocardial infarction in the HORIZONS-AMI trial that included a protocol of immediate angiography and primary percutaneous coronary intervention. RESULTS: Baseline TP was found in 4.2% of patients and was associated with a higher incidence of cardiovascular mortality, major bleeding, and major cardiovascular events at short- and long-term follow-up. The 30-day rates of death, major bleeding, major cardiac events, and major cardiac events plus major bleeding were 6.2%, 11.9%, 9.6%, and 18.5% in the TP group, respectively, compared with 2.1%, 7%, 5.2%, and 10.8% in those without TP (P < .05 for all). Similarly, event rates at 2 years were 11.3%, 12.7%, 24.7%, and 30.8% compared with 5.1%, 7.9%, 18.5%, and 23.3% (P < .05). By multivariate analysis, baseline TP was an independent predictor of 30-day net adverse clinical events but not of any 2-year events. CONCLUSIONS: We found that baseline TP in patients with ST-elevation myocardial infarction undergoing routine angiography and primary percutaneous coronary intervention is strongly associated with early adverse events and is a maker of late events, related to both ischemia and bleeding.