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Recurrent drug-eluting stent restenosis (DES ISR) can be challenging to treat. Vascular brachytherapy (VBT) has been used with encouraging results. We report the long-term outcomes of patients with recurrent DES ISR treated with VBT from January 2014 to September 2018 [target lesion failure (TLF)

Background Bioabsorbable cardiac matrix (BCM) is a novel device that attenuates adverse left ventricular (LV) remodeling after large myocardial infarctions in experimental models. Objectives This study aimed to analyze whether BCM, compared with saline control, would result in less LV dilation and fewer adverse clinical events between baseline and 6 months. Methods In an international, randomized, double-blind, controlled trial, 303 subjects with large areas of infarction despite successful primary percutaneous coronary intervention (PCI) of ST-segment elevation myocardial infarction (STEMI) were randomized 2:1 to BCM or saline injected into the infarct-related artery 2 to 5 days after primary PCI. The primary outcome was mean change from baseline in LV end-diastolic volume index (LVEDVI) at 6 months. Secondary outcomes included change in Kansas City Cardiomyopathy Questionnaire score, 6-minute walk time, and New York Heart Association functional class at 6 months. The primary safety endpoint was a composite of cardiovascular death, recurrent MI, target-vessel revascularization, stent thrombosis, significant arrhythmia requiring therapy, or myocardial rupture through 6 months. Results In total, 201 subjects were assigned to BCM and 102 to saline control. There was no significant difference in change in LVEDVI from baseline to 6 months between the groups (mean change ± SD: BCM 14.1 ± 28.9 ml/m 2 vs. saline 11.7 ± 26.9 ml/m 2 ; p = 0.49). There was also no significant difference in the secondary endpoints. The rates of the primary safety outcome were similar between the 2 groups (BCM 11.6% vs. saline 9.1%; p = 0.37). Conclusions Intracoronary deployment of BCM 2 to 5 days after successful reperfusion in subjects with large myocardial infarction did not reduce adverse LV remodeling or cardiac clinical events at 6 months. (IK-5001 for the Prevention of Remodeling of the Ventricle and Congestive Heart Failure After Acute Myocardial Infarction [PRESERVATION I]; NCT01226563 )

Stem cell therapy shows promise in experimental ischemic cardiomyopathy (ICM), although results in clinical trials are variable. Growing data suggests that marked differences in stem cell regenerative potential contribute to differential effects. The CardiAMP Heart Failure Trial (CardiAMP-HF) is the

As the population ages, an increasing number of patients (pts) will develop refractory angina (RA) from severe myocardial ischemia not amenable for surgical or percutaneous revascularization (PCI). Despite significant limitations in their quality of life, pts have a relatively low mortality rate (

Interventional cardiologists are prone to suffer from sleep deprivation as they often have to perform emergent procedures at night, but the effects of sleep deprivation have received limited study. We examined the frequency, clinical characteristics, and outcomes of daytime percutaneous coronary

The burden and impact of sleep deprivation in cardiology has received limited study. Multidisciplinary, online-based survey on sleep health pattern and potential impact of sleep deprivation involving 44 closed-ended questions distributed via email list to cardiovascular providers, involving

Previous studies have shown PCI administered 12-24 hours (hrs) after onset of chest pain (CP) improves 12-month survival in STEMI patients (pts). Despite this, management of these pts continues to be controversial. Using a comprehensive prospective regional STEMI program database, we evaluated the

Phase I, II and prematurely terminated phase III trials of autologous CD34+ cell therapy provide consistent evidence for improving exercise time and trends towards reductions in mortality, but these studies were not individually powered to define efficacy. Exercise times were estimated across the

As the population ages and coronary artery disease mortality declines, an increasing number of patients have advanced coronary artery disease. Many of these patients are suboptimal candidates for further revascularization and have refractory angina (RA) despite optimal medical management. Dedicated

An increasing number of patients (pts) have refractory angina (RA) despite optimal medical management that is not amenable for revascularization. RA pts have a relatively low mortality rate (

Objectives. We sought to determine the importance of nitric oxide (NO) production in maintaining coronary blood flow during exercise in hearts with collateral-dependent myocardium.Background. Coronary collateral vessels demonstrate endothelium-mediated NO-dependent vasodilation in response to agonists such as acetylcholine. However, the contribution of endogenous NO production to maintaining vasodilation of coronary collateral vessels during exercise has not been previously studied.Methods. Collateral vessel growth was induced in 13 chronically instrumented dogs by intermittent 2-min occlusions, followed by permanent occlusion of the left anterior descending coronary artery (LAD). One week after permanent LAD occlusion, myocardial blood flow was measured with microspheres during rest and treadmill exercise at 6.4 km/h at a 15% grade. Measurements were then repeated after blockade of NO production with N-nitro-l-arginine (LNNA) (20 mg/kg body weight intravenously).Results. LNNA caused a 62 ± 4% (mean ± SEM) inhibition of the coronary vasodilation produced by acetylcholine. During rest conditions, LNNA caused a slight decrease in blood flow to the collateral region (p = NS), with no change in normal zone blood flow. During exercise, LNNA caused a decrease in mean blood flow to the collateral region (from 2.24 ± 0.19 to 1.78 ± 0.26 ml/min per g after LNNA, p < 0.05). This decrease resulted from a near doubling of the collateral vascular resistance (p < 0.05), with a trend toward an increase in small vessel resistance in the collateral zone. LNNA also reduced myocardial blood flow to the normal region during exercise (from 2.99 ± 0.24 to 2.45 ± 0.28 ml/min per g, p < 0.05) as the result of a 44 ± 13% increase in coronary vascular resistance (p < 0.05).Conclusions. NO contributes to the maintenance of coronary collateral blood flow during exercise. In contrast to the normal heart, endogenous NO production also maintains blood flow in remote myocardial regions during exercise. These results suggest that control of blood flow during exercise in normal myocardium is altered by the presence of an occluded coronary artery.