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It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management,

/pdf/acc-aha-2006-guidelines-for-the-management-of-patients-with-27qfh9fc7i.pdf

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).

/pdf/2015-esc-guidelines-for-the-management-of-acute-coronary-6did6h5nxk.pdf

2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)

2018 ESC/EACTS Guidelines on myocardial revascularization.

We conducted a randomized trial involving 2287 patients who had objective evidence of myocardial ischemia and significant coronary artery disease at 50 U.S. and Canadian centers. Between 1999 and 2004, we assigned 1149 patients to undergo PCI with optimal medical therapy (PCI group) and 1138 to receive optimal medical therapy alone (medical-therapy group). The primary outcome was death from any cause and nonfatal myocardial infarction during a follow-up period of 2.5 to 7.0 years (median, 4.6). Results There were 211 primary events in the PCI group and 202 events in the medicaltherapy group. The 4.6-year cumulative primary-event rates were 19.0% in the PCI group and 18.5% in the medical-therapy group (hazard ratio for the PCI group, 1.05; 95% confidence interval [CI], 0.87 to 1.27; P = 0.62). There were no significant differences between the PCI group and the medical-therapy group in the composite of death, myocardial infarction, and stroke (20.0% vs. 19.5%; hazard ratio, 1.05; 95% CI, 0.87 to 1.27; P = 0.62); hospitalization for acute coronary syndrome (12.4% vs. 11.8%; hazard ratio, 1.07; 95% CI, 0.84 to 1.37; P = 0.56); or myocardial infarction (13.2% vs. 12.3%; hazard ratio, 1.13; 95% CI, 0.89 to 1.43; P = 0.33). Conclusions As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy. (ClinicalTrials.gov number, NCT00007657.)

https://www.medpagetoday.com/upload/2007/4/25/COURAGE1.pdf

Optimal Medical Therapy with or without PCI for Stable Coronary Disease

Chronic kidney disease1 (CKD) is a worldwide public health problem. In the United States, there is a rising incidence and prevalence of kidney failure, with poor outcomes and high cost. The number of individuals with kidney failure treated by dialysis and transplantation exceeded 320 000 in 1998 and is expected to surpass 650 000 by 2010.1,2 There is an even higher prevalence of earlier stages of CKD (Table 1).1,3 Kidney failure requiring treatment with dialysis or transplantation is the most visible outcome of CKD. However, cardiovascular disease (CVD) is also frequently associated with CKD, which is important because individuals with CKD are more likely to die of CVD than to develop kidney failure,4 CVD in CKD is treatable and potentially preventable, and CKD appears to be a risk factor for CVD. In 1998, the National Kidney Foundation (NKF) Task Force on Cardiovascular Disease in Chronic Renal Disease issued a report emphasizing the high risk of CVD in CKD.5 This report showed that there was a high prevalence of CVD in CKD and that mortality due to CVD was 10 to 30 times higher in dialysis patients than in the general population (Figure 1 and Table 2).6–18 The task force recommended that patients with CKD be considered in the “highest risk group” for subsequent CVD events and that treatment recommendations based on CVD risk stratification should take into account the highest-risk status of patients with CKD. 

View this table:

TABLE 1. Stages of CKD 





Figure 1. Cardiovascular mortality defined by death due to arrhythmias, cardiomyopathy, cardiac arrest, myocardial infarction, atherosclerotic heart disease, and pulmonary edema in general population (GP; National Center for Health Statistics [NCHS] multiple cause of mortality data files International Classification of Diseases, 9th Revision [ICD 9] codes 402, 404, 410 to 414, and …

Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention.

Optical Coherence Tomography in Cardiology

Cigarette smoking is known to be deleterious to patients with coronary artery disease; however, the effect of smoking on vascular responses after coronary drug-eluting stent implantation is unknown. We sought to examine vascular response after sirolimus-eluting stent implantation in patients with ongoing smoking using optical coherence tomography, compared with former smokers and nonsmokers. We identified 181 sirolimus-eluting stents in 140 subjects who underwent follow-up optical coherence tomography imaging. Subjects were divided into 3 groups: current smokers (n = 28), former smokers (n = 35), and nonsmokers (n = 77). Stent strut coverage, neointimal characteristics, and strut malapposition were evaluated. The incidence of uncovered stent struts was significantly higher in nonsmokers compared with current smokers (13.3 ± 13.3% vs 6.7 ± 8.3%; p = 0.001). On qualitative evaluation of neointimal morphology, the prevalence of heterogeneous neointima was higher in current smokers (71.9%) than in former smokers (36.0%) or nonsmokers (10.1%) (p = 0.004 and p

Optical coherence tomographic evaluation of the effect of cigarette smoking on vascular healing after sirolimus-eluting stent implantation

Biomarkers associated with coronary high-risk plaques

Expanded use of thrombolytic therapy.

It has been 40 years since the first balloon coronary angioplasty procedure was performed. Since then, development of treatment devices such as bare metal stents, drug-eluting stents, and bioresorbable vascular scaffolds has dramatically changed the management of patients with coronary artery disease. Intracoronary imaging modalities such as intravascular ultrasound (IVUS), developed in the late 1980s and utilized in clinical practice since the 1990s, and coronary angioscopy (CAS), developed in the early 1990s, have been used to enrich our understanding of in vivo pathology of coronary atherosclerosis as well as to improve the outcomes of percutaneous coronary intervention (PCI). Optical coherence tomography (OCT) was first developed for ex vivo imaging of the atherosclerotic plaque in the 1990s. After ex vivo validation by autopsy specimen, the first-in-man study was conducted at the Massachusetts General Hospital to evaluate the feasibility of OCT to visualize plaque components in the coronary arteries. The first-generation time-domain OCT became commercially available in 2002. The second-generation frequency-domain (Fourier-domain) OCT was introduced in 2010 with occlusion-free imaging, improved pull-back speed with higher frame rate, and increased axial scan density for improved image quality. The latest model of OCT (C8 ILUMIEN OPTIS PCI Optimization System, St. Jude Medical, Inc., St. Paul, MN, USA) provides imaging with a faster pull-back speed of 18-36 mm/s (180 frames/s), greater pull-back length of 54-75 mm, and real-time three-dimensional image reconstruction.

Ik-Kyung Jang

Papers

Optical Coherence Tomography in Cardiology

Optical coherence tomographic evaluation of the effect of cigarette smoking on vascular healing after sirolimus-eluting stent implantation

Biomarkers associated with coronary high-risk plaques

Expanded use of thrombolytic therapy.

Optical Coherence Tomography for Study of In Vivo Pathobiology and for Optimization of Percutaneous Coronary Intervention