Coronary interventions in patients with bleeding and bleeding tendency

In general, percutaneous coronary intervention (PCI)is contra-indicated in patients with bleeding and those that are easy to bleed because during PCI the patients need full anticoagulation to counter any thrombotic formation caused by introduction and manipulation of devices in the vascular system.……

Evidence based medicine:clinical trials that guide the management of ST-elevation myocardial infarction of elderly patients

Cardiovascular disease is the most frequent diagnosis in elderly people and is the leading cause of death in both men and women older than 65 years. Every year in the United States more than 700,000 patients arrive at the emergency room with ST-segment elevation myocardial infarction(STEMI). About 60 percent of hospital admissions for AMI are of people older than 65 years. Their in-hospital, 1-month,and 1-year mortality is high. 1 In this article, we will provide a review on clinical trials that guide the management of STelevation myocardial infarction of the elderly patients.……

Prevalence of metabolic syndrome in adults in Khanh Hoa,Viet Nam

Background The metabolic syndrome (MS) is characterized by a specific clustering of risk factors, including dyslipidemia, central adiposity, systemic hypertension, insulin resistance, and dysglycemia. It is associated with an increased risk of developing cardiovascular disease (CVD). Accurate data on prevalence and characteristics of MS will facilitate the development of preventive strategies for CVD. Objective To estimate accurately the prevalence of MS among Vietnamese adults with the usual criteria or with the criteria modified for Asian populations. Design and methods We studied a representative, cross-sectional, population-based sample of 856 subjects (mean age 52.82 ± 16.36) classified in three age groups from 15-34 years, 35-54 years and ＞ 54 years of age, living in Khanh Hoa Province, Viet Nam. MS was diagnosed according to the criteria defined by the Third Report of the National Cholesterol Education Program Expect Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel Ⅲ) (NCEP-ATP Ⅲ) and by the modified criteria for some Asian populations in which the waist circumference (WC) is considered abnormal if it is ＞ 90 cm for males and ＞ 80 cm for females.Results Using the NCEP-ATP Ⅲ criteria, the prevalence of MS in the studied population was 10.0％ (CI 95 ％:8.1-12.3). It was 2.4 ％ in the 15-34 age group (men 4.5％ and women 1.2％),5.2％ (men 6.3％,women 4.5％ ) in 35-54 age group and 15.8％ (men 9.7％, women 21.7％) in over 54 age group, respectively. And it was more common in women than in men (11.7％ vs 8.0％, P ＜0.001). Using 2001 population census data of the whole province over 15 years (695 218 habitants) we estimated that about 35 193 people suffered from the MS.The WC was the least common feature of MS (2.1％ for men and in 6.1％ for women).Overall,45.2 ％ of the studied population had one feature of MS, 23.1％ had two features, 8.2％ had three features, 1.6％ had four features, and 0.2％ had all five features. No feature of MS was identified in 21.7％.Using the modified criteria,the prevalence of MS in the studied population was 15.7％. It was 4.0％ in the 15-34 age group, 12.5％ in the 35-54 age group and 21.5％ in the＞54 age group. Prevalence of modified WC feature was 10.9％ for men and 23.6％ for women.Conclusions MS is more accurately identified among Vietnamese adults using the modified criterion of the WC for some Asian populations. Its prevalence is similar to that in the developed countries. ( J Geriatr Cardiol 2004;1(2) :95-100.)

A glimpse of the future:optical coherence tomography in the real world

In vivo visualization of the coronary arteries is the most elegant way to confirm or refute any iatrogenic or pathological lesions and their association with any short- and long-term positive or negative results. ……

A new Screening Tool for Detecting Early Atheroslerosis

In a study published in the current issue of the Journal of Geriatric Cardiology, Ang and co-investigators used the highresolution 64-slice CT coronary angiography to detect coronary lesions in a group of patients with atypical angina.1 The clinical data of these patients were also used to calculate their risk according the Framingham and PROCAM scoring system.2,3 As the cohort is composed with a majority of low risk patients with atypical angina, only a small minority of the patients were classified as having medium and high risk. The results showed that MDCT uncovered 18% either significant lesions (＞50% stenosis) or calcifications (＞400Agatston units)in the low risk patients and 33% in the medium and high risk subgroups.……

Lessons learned from the TIMI trials in rescue interventions for elderly patients after failed fibrinolytic therapy:look beyond the TIMI flow

In ST-segment elevation myocardial infarction (STEMI), acute reperfusion of the infarct-related artery (IRA)is the main goal in the early minutes after the patient seeks medical attention. Fibrinolytic therapy (FT) and/or primary coronary intervention (PCI) were proven to be effective in opening the IRA.

Bioresorbable Vascular Scaffold in the Midportion of the Left Anterior Descending Artery for Cardiac Allograft Vasculopathy in a Cardiac Transplant Patient

In an era when cardiac transplant patients are surviving more immediate issues of rejection and infection,the prevalence of more chronic issues such as cardiac allograft vasculopathy(CAV)is rising.This case describes a man 20 years after cardiac transplant with his first presentation of CAV.Acute myocardial infarction was diagnosed on the basis of symptoms and biochemical markers and on coronary angiography,and he was found to have a critical stenosis of the midportion of the left anterior descending artery.It was elected to treat this percutaneously with a fully bioresorbable vascular scaffold(BVS)because of the diffuse nature of the disease process.This was successfully performed with optical coherence tomography guidance.The use of BVS in CAV has not been well studied.This is one of few case reports describing the use of BVS in CAV.

Inflammation and vascular disease: the role of C-reactive protein

Inflammation is an important component of active atherosclerotic disease. C-reactive protein (CRP)is a non-specific inflammatory marker that is increased in inflammatory conditions. Newer more sensitive assays (high sensitivity CRP) can detect the low levels of inflammation associated with vascular disease. CRP levels can give further risk assessment to individuals beyond predictions from traditional risk factors. This measurement is most useful in helping to discriminate risk in intermediate risk patients such as metabolic syndrome patients. Exercise and weight loss have been shown to significantly lower CRP levels. Lipid lowering therapies, especially with the statin class of medications, also lower CRP levels. A reduction in inflammation may be an important component of plaque stabilization and contribute to cardiovascular risk reduction.

How to duplicate the procedural success of coronary interventions by the radial approach:tips and tricks in the selection and manipulations of guides

In this issue of the Journal of Geriatric Cardiology;Jing et al. showed off their near perfect results of percutaneous coronary interventions (PCI) through transfemoral approach (TFA) and transradial approach (TRA) in the elderly Chinese patients. All patients were older.than 60years of age, with an average of 67.……

Same fur,different animals

Slow flow is not an uncommon phenomenon for cardiologists. It can happen in many clinical scenarios, requires different tools of investigation and responds to various modalities of treatment.……

Stepping through a new door in La Porte IN

In this issue of the Journal of Geriatric Cardiology,Yang et al.1 studied the effects of arotinolol, a beta-blocker (BB), on the right ventricular (RV) function.……

Understanding and clinical application of acute dilation of the left ventricle on ventricular arrhythmias

In this issue of the Journal of Geriatric Cardiology,Yin et al discussed the effects of calcium preconditioning (CPC) and streptomycin (S) on acute dilation of the left ventricle.……

Apolipoprotein E and coronary artery disease:the debate is still on

Apolipoprotein E (Apo E) is quite a fascinating lipoprotein. As reported by Zou et al. 1 in this issue of the Journal of Geriatric Cardiology, Apo E has three isoforms,ε2, ε3, and ε4, differing from each other by the polymorphisms found in the amino acid residues at sites 112 and 158. Apo E and its three isoforms, with ε3 being the most common, is like a Pandora's box of sorts, where upon investigation, interesting correlations to some very prominent modem diseases have been found. For example, there was evidence that the presence of one ε4 allele in their Apo E gene increased the risk for type-2Alzheimer's disease and two ε4 alleles would increase further this risk. Also intriguing is the subject of this paper by Zou et al.: the relationship between Apo E isoform ε2 and the presence of coronary artery disease (CAD).……

Fly boyz,hybrid artists or cool guys:testing the boundaries of imagination

In the early years of coronary interventions,when a single lesion was found,the question then was asked whether it was feasible and safe to dilate right away the lesion with plain old balloon angioplasty (ad hoc POBA) or to call in a senior interventional cardiologist to do POBA on a later date.If lesions were found in more than one coronary artery territories,then the interventional cardiologists had to pull his or her hair and asked whether it was feasible and safe to dilate right away the other lesion(s) at the same session.More than 20 years later,at this present time,with nearly perfect outcomes due to stent availability and high level of experiences from operators,the question of multiple coronary stenting in one session is neither problematic nor relevant.However,if not all lesions are taken care immediately or in near future sessions,the question would be whether the patient receives standard of care as there is no complete revascularization.

Peripheral vascular bifurcation： features and techniques

The systemic nature of vascular atherosclerosis involves all vascular territories.. As interventional cardiologists, we are familiar with coronary artery bifurcation treatment. In other parts of the human body, the vascular tree develops similar bifurcation in the carotid, renal, aortoiliac and tibio-peroneal segments. Even with some differences depending on specific vascular wall composition, the atherosclerotic process affects all such bifurcations in a similar way.