Circulation. 2006;113:1045
(Circulation. 2006;113:1045.)
© 2006 American Heart Association, Inc.
Issue Highlights
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ACHIEVING RAPID DOOR-TO-BALLOON TIMES: HOW TOP HOSPITALS IMPROVE COMPLEX CLINICAL SYSTEMS, by Bradley et al.
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Guidelines currently recommend rapid door-to-balloon times (<90
min) for reperfusion with percutaneous coronary revascularization
in ST-elevation myocardial infarction (STEMI). In this issue
of
Circulation, Bradley and colleagues report on a qualitative
study using in-depth interviews with clinical and administrative
staff at 11 hospitals that experienced outstanding improvement
in door-to-balloon times from 1999 to 2002. The experiences
of these hospitals suggest that innovative program development
within interdisciplinary teams that includes specific goals,
engages senior management, and provides detailed data feedback
with a nonblaming, patient-focused approach can serve as a foundation
for efforts to improve door-to-balloon times. See p
1079.
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MAGNETIC RESONANCE IMAGING–GUIDED BALLOON ANGIOPLASTY OF COARCTATION OF THE AORTA: A PILOT STUDY, by Krueger et al.
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Percutaneous intervention for congenital heart disease has become
a major component of reparative therapies for many congenital
cardiovascular abnormalities. These procedures are often long
and repeated and have high radiation exposure. Magnetic resonance
imaging (MRI) is a major imaging modality for preprocedure and
postprocedure evaluation. In this issue, Krueger et al, in a
small pilot study, describe successful interactive real-time
MRI-guided percutaneous aortic coarctation intervention in 5
patients. The technique, results, safety requirements, and proximity
to the traditional catheterization laboratory are detailed.
The potential for interactive real-time MRI to guide invasive
procedures is an important advance in this field. It should
allow continuous monitoring of soft tissue structures during
the intervention and significantly reduce radiation exposure.
Further validation of this approach will be important to substantiate
its role in percutaneous interventions. See p
1093.
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CORRELATES AND LONG-TERM OUTCOMES OF ANGIOGRAPHICALLY PROVEN STENT THROMBOSIS WITH SIROLIMUS- AND PACLITAXEL-ELUTING STENTS, by Kuchulakanti et al.
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In the drug-eluting stent era, stent thrombosis remains a serious
procedural complication with significant adverse sequelae. It
has been suggested that, as compared with bare metal stents,
drug-eluting stents pose a greater risk of stent thrombosis
owing to delayed reendothelialization as well as inherent thrombogenicity
despite optimal oral anticoagulation. Furthermore, stent thrombosis
associated with drug-eluting stent implantation has been shown
to occur both subacutely (
30 days) and late (>30 days), thereby
shifting the time frame for which clinicians should maintain
a heightened state of awareness for this complication. Patients
who develop stent thrombosis frequently require repeat revascularization
procedures and have an increased incidence of Q-wave and non—Q-wave
myocardial infarction. In this issue of
Circulation, Kuchulakanti
et al analyze the clinical and procedural characteristics of
patients with angiographically proven stent thrombosis and the
influence of this complication on outcome at 6 months. See p
1108.
Visit http://circ.ahajournals.org:
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Clinician Update
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Inflammatory Biomarkers in Acute Coronary Syndromes: Part III:
Biomarkers of Oxidative Stress and Angiogenic Growth Factors.
See p
e289.
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Images in Cardiovascular Medicine
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Untreated Tetralogy of Fallot With Pulmonary Atresia: Giant
Aneurysm of an Aortopulmonary Collateral Artery Demonstrated
by Magnetic Resonance Imaging. See p
e293.
Pulmonary Embolization of Acrylic Cement During Vertebroplasty. See p e295.
Giant Aortic Aneurysm After Patch Repair of Coarctation. See p e297.
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Correspondence
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See p
e299.
Related Articles:
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Inflammatory Biomarkers in Acute Coronary Syndromes: Part III: Biomarkers of Oxidative Stress and Angiogenic Growth Factors
- Ehrin J. Armstrong, David A. Morrow, and Marc S. Sabatine
Circulation 2006 113: e289-e292.
[Full Text]
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Untreated Tetralogy of Fallot With Pulmonary Atresia: Giant Aneurysm of an Aortopulmonary Collateral Artery Demonstrated by Magnetic Resonance Imaging
- Clerio F. Azevedo, Marcelo S. Hadlich, Denilson C. Albuquerque, and Jorge N. Moll
Circulation 2006 113: e293-e294.
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Pulmonary Embolization of Acrylic Cement During Vertebroplasty
- Nancy Quesada and Gökhan M. Mutlu
Circulation 2006 113: e295-e296.
[Full Text]
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Giant Aortic Aneurysm After Patch Repair of Coarctation
- Norbert Augustin, Harald Kaemmerer, Michael Pörner, Gabriel Meinhardt, John Hess, and Rüdiger Lange
Circulation 2006 113: e297-e298.
[Full Text]
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Letter Regarding Article by Ruttmann et al, "
-Glutamyltransferase as a Risk Factor for Cardiovascular Disease Mortality: An Epidemiological Investigation in a Cohort of 163 944 Austrian Adults"
- Philippe Giral, Vlad Ratziu, John C. Chapman, Elfriede Ruttmann, Hanno Ulmer, Larry J. Brant, Hans Concin, Günter Diem, and Kilian Rapp
Circulation 2006 113: e299-e300.
[Full Text]
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Magnetic Resonance Imaging–Guided Balloon Angioplasty of Coarctation of the Aorta: A Pilot Study
- Julia J. Krueger, Peter Ewert, Sevim Yilmaz, Dinah Gelernter, Björn Peters, Klaus Pietzner, Axel Bornstedt, Bernhard Schnackenburg, Hashim Abdul-Khaliq, Eckart Fleck, Eike Nagel, Felix Berger, and Titus Kuehne
Circulation 2006 113: 1093-1100.
[Abstract]
[Full Text]
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Achieving Rapid Door-To-Balloon Times: How Top Hospitals Improve Complex Clinical Systems
- Elizabeth H. Bradley, Leslie A. Curry, Tashonna R. Webster, Jennifer A. Mattera, Sarah A. Roumanis, Martha J. Radford, Robert L. McNamara, Barbara A. Barton, David N. Berg, and Harlan M. Krumholz
Circulation 2006 113: 1079-1085.
[Abstract]
[Full Text]
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Correlates and Long-Term Outcomes of Angiographically Proven Stent Thrombosis With Sirolimus- and Paclitaxel-Eluting Stents
- Pramod K. Kuchulakanti, William W. Chu, Rebecca Torguson, Patrick Ohlmann, Seung-Woon Rha, Leonardo C. Clavijo, Sang-Wook Kim, Ahn Bui, Natalie Gevorkian, Zhenyi Xue, Kimberly Smith, Jana Fournadjieva, William O. Suddath, Lowell F. Satler, Augusto D. Pichard, Kenneth M. Kent, and Ron Waksman
Circulation 2006 113: 1108-1113.
[Abstract]
[Full Text]
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ACHIEVING RAPID DOOR-TO-BALLOON...
MAGNETIC RESONANCE IMAGING...