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We sought to evaluate the restoration of microcirculatory patency after primary percutaneous coronary intervention (PCI) in an unselected cohort of patients at a tertiary center. We retrospectively evaluated distributions of the Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grade (TMPG) and the myocardial blush grade (MBG) in all primary PCI procedures performed at our institution during 2008. We defined optimal microvascular perfusion as simultaneous TMPG 3 and MBG 3 at procedure's end. Ninety-nine patients (mean age, 61.5 ± 12.7 yr; 64 men) underwent primary PCI. Microvascular perfusion was optimal in 69 patients (69.7%) and was associated with lower peaks of enzymes than those occurring in patients with suboptimal perfusion. When optimal microvascular perfusion was achieved, early spontaneous recanalization was more frequently observed, as expressed by a higher frequency of TIMI-3 flow (34.8% vs 10%; P =0.006), TMPG 3 (26% vs 3.3%; P =0.004), and MBG 3 (24.6% vs 3.3%; P=0.004) on the initial angiogram before primary PCI. A higher frequency of MBG 3 (50% vs 20%; P=0.005) was seen after initial recanalization in patients with optimal microvascular perfusion. Multiple regression analysis showed that MBG after initial recanalization and the use of drug-eluting stents were associated with optimal perfusion. Despite successful recanalization of the culprit coronary artery, optimal microvascular perfusion was achieved in less than 75% of the patients. Restoration of the microvasculature was associated with smaller infarcts. Procedure-related variables associated with suboptimal perfusion were unlikely to be causative. [ABSTRACT FROM AUTHOR]

We studied the effect of the dose of bone marrow mononuclear cells, delivered via transendocardial injection, upon capillary density and fibrosis in pigs with chronic ischemic heart disease. Pigs (n=16) that had undergone ameroid constrictor placement (left circumflex coronary artery) to induce chronic ischemia were divided equally into 4 groups on the basis of bone marrow mononuclear cell dose: control (saline injection) and 50, 100, or 200 x 106 bone marrow mononuclear cells. Thirty days after ameroid placement, each pig received 13 transendocardial NOGA-guided injections. An implantable loop recorder monitored possible arrhythmias caused by cell transplantation. Thirty days later, the pigs were killed, and their hearts were evaluated histopathologically for fibrosis and capillary density; the number of cells per segment was correlated with fibrosis and capillary density. No adverse events, arrhythmias, or cardiac inflammatory reactions were associated with cell therapy. Less fibrosis was seen in pigs that received 100 x 106 cells than in control pigs. A trend toward higher capillary density was seen with higher cell concentrations. Segments injected with more than 20 x 106 million cells had the highest capillary density and the least amount of fibrosis (P <0.05 vs controls). In conclusion, transendocardial injections (up to 200 x 106 bone marrow mononuclear cells) were safe. Analyses of individual injected segments suggest potential benefit from higher cell concentrations per segment. [ABSTRACT FROM AUTHOR]

Endovascular treatment of peripheral artery occlusive disease has suboptimal long-term patency rates. The addition of cryoplasty to balloon angioplasty, which involves the application of cold thermal energy to atherosclerotic plaque, might improve outcomes and decrease the need for reintervention. At a single tertiary center, we retrospectively analyzed data from the angiograms and medical records of unselected patients who underwent cryoplasty for peripheral artery disease from January 2004 through November 2006. We calculated rates of freedom from amputation, freedom from intervention, and freedom from death and examined the data using the Kaplan-Meier method. Paired t tests were used to compare the ankle--brachial indices before and after cryoplasty. The study population comprised 99 patients who received treatment for 132 atherosclerotic lesions, including 62 lesions in the superficial femoral artery, 28 in the popliteal artery, and 25 in arteries below the knee; 71 patients completed follow-up (64 ± 57 wk). Short-term periprocedural success was achieved in 98.5% of the interventions. Dissections occurred in 12.2% of patients treated successfully without bail-out stenting or additional balloon inflations. At 6 months, more than 88% of the patients were alive and had not had an amputation. However, reintervention was required for 42% of patients. Mean ankle--brachial indices improved significantly after treatment (P <0.0001). Our results show that cryoplasty for treatment of peripheral artery disease is safe and has a high rate of periprocedural success. However, long-term efficacy is compromised because of the frequent need for reintervention. [ABSTRACT FROM AUTHOR]

Left ventricular electromechanical mapping (LVEM) is a method for mapping the left ventricular cavity in 3 dimensions by use of a catheter that samples points on the endocardial surface. These points provide data on unipolar voltage and linear local shortening, which can then be used to evaluate myocardial ischemia and viability. The new QwikStar multielectrode catheter, which acquires data from multiple points simultaneously, potentially improves map quality and decreases mapping time in comparison with the single-point NogaStar catheter. Our study sought to validate the QwikStar catheter's LVEM capabilities in a porcine model of chronic ischemia. Eight pigs underwent ameroid placement over the proximal left circumflex artery, to induce chronic ischemia. In 60 days, LVEM was performed on each animal with the Noga-Star and QwikStar catheters. Unipolar voltage and linear local shortening results were displayed in 9-segment polar maps. The unipolar voltage data from both maps were then correlated by means of linear regression. There were no adverse events during LVEM. Mapping time was similar for both groups (QwikStar, 44.6 ± 25.62 min; NogaStar, 65.75 ± 25.33 min; P=0.13). Results of mean unipolar voltage maps acquired with the 2 catheters showed a moderate correlation (r =0.59, P <0.001). Selecting segments with more than 6 point samples increased the Pearson coefficient to 0.69 (P <0.001). Our findings show that the QwikStar catheter enables the reproducible performance of LVEM by sampling fewer points, which shortens procedure time, decreases manipulation of the left ventricular cavity, and might increase procedural safety. [ABSTRACT FROM AUTHOR]

The article focuses on the use of combined electrocardiography (ECG)-guided percutaneous coronary intervention (PCI) and a contralateral angiogram in patients with ST-elevation myocardial infarction (STEMI). In a study by Dib and associates published in this journal, the combined approach minimized the door-to-balloon (DTB) time in primary PCI. The authors used the guidelines from the American College of Cardiology/American Heart Association in assessing STEMI and non-STEMI patients.