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Background: Prolonged dual antiplatelet therapy (DAPT) after percutaneous coronary intervention is associated with increased bleeding, despite a reduced incidence of ischemic events. The SYNERGY everolimus-eluting stent is a thin-strut platinum-chromium stent that elutes everolimus from a thin abluminal layer of bioabsorbable polymer. These design elements may facilitate rapid endothelialization and enable shorter-duration DAPT. Methods: EVOLVE Short DAPT prospectively evaluated the safety of 3-month DAPT in high bleeding risk patients treated with the SYNERGY everolimus-eluting stent, enrolling 2009 patients at 110 global sites. Patients with acute myocardial infarction or complex lesions were excluded. After percutaneous coronary intervention, patients were required to take DAPT (aspirin+P2Y 12 inhibitor) for 3 months, except those on chronic anticoagulation in whom aspirin was optional. Patients free of events (stroke, myocardial infarction, revascularization, and stent thrombosis) who discontinued P2Y 12 inhibitor at 3 months, but continued aspirin, and had at least 1 year of follow-up or an end point event were included in the primary analysis. Two powered coprimary end points were (1) death/myocardial infarction compared with a historical control and (2) study stent-related definite/probable stent thrombosis compared to a performance goal. Results: The analysis population consisted of 1487 patients. The adjusted rate of death/myocardial infarction between 3 and 15 months was 5.6% among patients receiving 3-month DAPT versus 5.7% patients in the 12-month DAPT control (propensity adjusted difference=−0.12%; 97.5% upper bound=1.63% which was less than the prespecified margin of 2.52; P non-inferiority =0.0016). The rate of study stent-related stent thrombosis between 3-15 months was 0.2% in the 3-month DAPT group (97.5% upper bound=0.63%; P =0.0005 for comparison to 1% performance goal). Conclusions: Favorable rates of ischemic outcomes were observed among selected high bleeding risk patients undergoing percutaneous coronary intervention with the SYNERGY everolimus-eluting stent who tolerated 3 months of P2Y 12 inhibitor and then discontinued it, supporting the safety of abbreviated DAPT with this stent platform. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02605447.

SYNERGY stent was designed to improve arterial healing and reduce the risk of stent thrombosis (ST) with thin struts and abluminal everolimus-eluting bioabsorbable polymer. Safety and efficacy of SYNERGY has been established in normal bleeding risk patients treated with standard duration DAPT.

A 57-year-old male former smoker presented to the Emergency Department (ED) with blurry vision, headache, and generalized weakness. He was hypoxic on room air and ECG showed sinus tachycardia. A CT pulmonary angiogram was ordered in the ED and revealed no pulmonary embolism but incidentally noted a likely significant stenosis in the proximal LAD. Subsequent cardiac catheterization revealed a 90% stenotic lesion with percutaneous coronary intervention leading to symptom resolution. Unlike coronary CTA, CTPA is performed with non-ECG gated helical scanning and generates motion artifacts associated with myocardial contraction. However, the timing of vascular contrast opacification during CTPA often allows for at least partial evaluation of the coronary arteries, especially ostial and proximal segments. Physicians ordering and evaluating noncardiac-focused CT chest studies, particularly in the ED, should remain cognizant of the radiographic appearance of underlying CAD, particularly life-threatening incidental coronary pathologies to allow for timely management and intervention.

The SYNERGY stent (Boston Scientific) is a thin-strut platinum chromium metal alloy platform eluting everolimus from an ultrathin abluminal layer of poly(DL-lactide-co-glycolide) bioabsorbable polymer. Drug release and polymer degradation are complete within 4 months of implantation. These design

Filtered back-projection (FBP) has been a standard in SPECT imaging. Newer iterative reconstruction algorithms have been shown to improve image quality and shorten acquisition time by taking into account statistical nature of raw data and using resolution recovery (RR). Wide-beam reconstruction (WBR) is an iterative algorithm with RR and adaptive noise control. We prospectively investigated outcome of WBR half-time SPECT on diagnostic certainty, accuracy and normalcy by quantitative perfusion analysis in comparison to full-time FBP images. 434 patients underwent rest 201Tl/stress 99mTc-sestamibi full-time (20 s/stop, FBP) followed by a half-time (10 s/stop, WBR) SPECT. 34 patients underwent an angiogram within 90 days of SPECT. Diagnostic certainty was based on summed stress scores (SSS, 5-point/17 segments): normal if SSS ≤ 1, equivocal if SSS = 2-3, and abnormal if SSS ≥ 4. Perfusion defects were normalized to a percent of total myocardium, and expressed as %LV = defect SSS/maximal SSS × 100% with maximal SSS of 28 for left anterior descending (LAD), and of 20 for right coronary (RCA) and left circumflex (LCX). Change in %LV (Δ%LV = %LV FBP − %LV WBR) was evaluated for diagnostically discordant versus concordant scans. SSS and %LV demonstrated very good correlation. There were significantly fewer equivocal scans with WBR (38 vs 151 FBP, P

Compression of the left main coronary artery (LMCA) has been reported with pulmonary artery enlargement but rarely from aortic pathology. A 75-year-old man with history of mechanical aortic valve replacement (AVR) with aortic conduit for severe aortic insufficiency underwent routine screening

Nuclear stress testing remains the most common non-invasive means to assess for obstructive coronary artery disease (CAD). Despite the prognostic utility of the test, equivocal results are common. The significance of ischemic electrocardiographic changes in the presence of normal myocardial

Biventricular pacing for the treatment of congestive heart failure is now one of the forefront therapies for symptomatic heart failure patients who are receiving maximal medical therapy. Recent advances in lead technology and delivery systems have improved the success rates of left ventricular (LV) lead implantation. A major difficulty in LV lead implantation, however, occurs in patients with coronary vein stenoses, insufficient coronary vein caliber, or significant variations in coronary venous anatomy, in terms of left ventricular lead implantation. We sought to examine whether cardiac vein angioplasty and/or stenting would allow for the proper placement of the LV lead in these patients.

Primary tumors of the heart are rare with an incidence of 0.0017% to 0.19% in unselected patients at autopsy. Of those tumors, cardiac myxomas are the most commonly seen and account for about 50% of primary cardiac tumors. About 75% to 85% of myxomas originate in the left atrium, 15% to 20% in the right atrium, and only rare cases have been reported of myxomas originating in the left and right ventricles (5%). We present 3 cases in which right-sided myxomas were diagnosed echocardiographically and review the literature on primary cardiac myxomas.