- Email: [email protected]
Directed proximal magnetic resonance coronary angiography compared with conventional contrast coronary angiography
LITERATURE REVIEW Linda Shore-Lesserson, MD Section Editor
SCIENTIFIC ARTICLES
Coronary Revascularization
Topoi E J, Ferguson J J, Weisman HF, et al: Longterm protection from myocardial ischemic events in a randomized trial of brief integrin 133 blockade with percutaneous coronary intervention. JAMA 278:479484, 1997 This study reports on the long-term outcome of patients who were enrolled into a randomized, prospective, controlled trial using the cqM53-receptor antagonist, abciximab, in angioplasty patients. The original report, published in 1994, showed a 23% reduction in coronary restenoses after 6 months. Three-year follow-up was conducted and the primary endpoints of death, myocardial infarction (MI), and need for coronary revascularization were evaluated. The composite of adverse endpoints was significandy lower at 1, 2, and 3 years in the bolus plus infusion group as compared with the placebo group; however, individual endpoint occurrences did not differ. In a subgroup of high-risk patients (those with evolving MI), mortality was reduced at 3 years in the drug group compared with the placebo group.
Donovan CL, Landolfo KP, Lowe JE, et ah Improvement in inducible ischemia during dobutamine stress echocardiography after transmyocardial laser revascularization in patients with refractory angina pectoris. J Am Coil Cardio130:607-612, 1997 In patients with severe coronary artery disease not amenable to surgery or angioplasty, 12 patients underwent transmyocardial laser revascularization. Dobutamine echocardiography was performed at baseline and at 3 and 6 months after the procedure. Wall motion score index at rest was not improved after laser revascularization; however, during stress echocardiography there was significantly improved wall motion. Improved wall motion in the lased segments was the factor primarily responsible. One patient died perioperatively. Ten of 11 patients had improvement in their angina of at least one functional class. Transmyocardial laser revascularization provides direct regional blood flow to ischemic myocardium and may prove to be a viable option for patients not candidates for other revascularization procedures.
plasty. Patients assigned to the Palmaz-Schatz stent group had a higher rate of reduction in stenosis without significant cardiac complications. Additionally, there was a significantly better outcome (as measured by MI, reoperation, and death) at 6 months in this group (73% v 58%; p = 0.03). Furthermore, the stent group had an increase in luminal diameter immediately after the procedure and at 6 months. Angiography revealed a restenosis rate of 37% in the stem group compared with 46% in the angioplasty group (p = 0.24). Although stenting of selected saphenous vein bypass grafts resulted in apparently better short-term results, there was no significant improvement in the angiographic restenosis rate.
Yoshino H, Toshiaki N, Kachi E, et ah Directed proximal magnetic resonance coronary angiography compared with conventional contrast coronary angiography. Am J Cardiol 80:514-518, 1997 Recent advances in magnetic resonance imaging (MRI) technology have allowed better visualization of the coronary arteries noninvasively and without the use of contrast materials. In this study, 36 patients with only proximal or midportion coronary artery disease underwent MRI coronary angiography 1 week after conventional angiography. Affected right and left proximal coronary arteries were adequately visualized in 31 of 36 patients (86%). Images that were poor in quality were because of the inability of patients to hold their breath for 17 seconds, and a tortuous coronary anatomy.
Academic~Economic Issues
Rosenthal GE, Harper DL, Quinn LM, Cooper GS: Severity-adjusted mortality and length of stay in teaching and nonteaching hospitals. Results of a regional study. JAMA 278:485-490, 1997
Savage MP, Douglas JS, Fischman DL, et al: Stent placement compared with balloon angioplasty for obstructed coronary bypass grafts. N Engl J Med 337:740-746, 1997
The perception that major teaching hospitals are expensive, inefficient, and vulnerable to market forces prompted this comparison in which > 89,000 cases admitted to either major teaching, minor teaching, or nonteaching hospitals were followed up until discharge. Patients admitted with one of six specific diagnostic codes were compared with respect to length of stay and mortality, with adjustment made for comorbid conditions and severity of illness. The analyses controlled for patients discharged to other care facilities and for different discharge practices among clinicians by using covariate statistical models. The observed mortality was lowest in major teaching hospitals, as was the observed and the adjusted length of stay. This was a regional study; however, extrapolation nationally could have a major impact on the viability of academic medical centers.
About half of all saphenous-vein bypass grafts become severely atherosclerotic within 10 years after coronary bypass surgery. The management of these patients poses a particular problem because reoperation entails a substantial risk and the results of conventional angioplasty have been disappointing. This study assigned a total of 220 patients who presented with stenosis of saphenous vein grafts to receive either placement of a Palmaz-Schatz stent or standard balloon angio-
Pilon CS, Leathley M, London R, et al: Practice guidelines for arterial blood gas measurement in the intensive care unit decreases numbers and increases appropriateness of tests. Crit Care Med 25:1308-1313, 1997
Journal of Cardiothoracic and Vascular Anesthesia, Vol 12, No 2 (April), 1998: pp 233-235
233
SCIENTIFIC ARTICLES
Coronary Revascularization
Topoi E J, Ferguson J J, Weisman HF, et al: Longterm protection from myocardial ischemic events in a randomized trial of brief integrin 133 blockade with percutaneous coronary intervention. JAMA 278:479484, 1997 This study reports on the long-term outcome of patients who were enrolled into a randomized, prospective, controlled trial using the cqM53-receptor antagonist, abciximab, in angioplasty patients. The original report, published in 1994, showed a 23% reduction in coronary restenoses after 6 months. Three-year follow-up was conducted and the primary endpoints of death, myocardial infarction (MI), and need for coronary revascularization were evaluated. The composite of adverse endpoints was significandy lower at 1, 2, and 3 years in the bolus plus infusion group as compared with the placebo group; however, individual endpoint occurrences did not differ. In a subgroup of high-risk patients (those with evolving MI), mortality was reduced at 3 years in the drug group compared with the placebo group.
Donovan CL, Landolfo KP, Lowe JE, et ah Improvement in inducible ischemia during dobutamine stress echocardiography after transmyocardial laser revascularization in patients with refractory angina pectoris. J Am Coil Cardio130:607-612, 1997 In patients with severe coronary artery disease not amenable to surgery or angioplasty, 12 patients underwent transmyocardial laser revascularization. Dobutamine echocardiography was performed at baseline and at 3 and 6 months after the procedure. Wall motion score index at rest was not improved after laser revascularization; however, during stress echocardiography there was significantly improved wall motion. Improved wall motion in the lased segments was the factor primarily responsible. One patient died perioperatively. Ten of 11 patients had improvement in their angina of at least one functional class. Transmyocardial laser revascularization provides direct regional blood flow to ischemic myocardium and may prove to be a viable option for patients not candidates for other revascularization procedures.
plasty. Patients assigned to the Palmaz-Schatz stent group had a higher rate of reduction in stenosis without significant cardiac complications. Additionally, there was a significantly better outcome (as measured by MI, reoperation, and death) at 6 months in this group (73% v 58%; p = 0.03). Furthermore, the stent group had an increase in luminal diameter immediately after the procedure and at 6 months. Angiography revealed a restenosis rate of 37% in the stem group compared with 46% in the angioplasty group (p = 0.24). Although stenting of selected saphenous vein bypass grafts resulted in apparently better short-term results, there was no significant improvement in the angiographic restenosis rate.
Yoshino H, Toshiaki N, Kachi E, et ah Directed proximal magnetic resonance coronary angiography compared with conventional contrast coronary angiography. Am J Cardiol 80:514-518, 1997 Recent advances in magnetic resonance imaging (MRI) technology have allowed better visualization of the coronary arteries noninvasively and without the use of contrast materials. In this study, 36 patients with only proximal or midportion coronary artery disease underwent MRI coronary angiography 1 week after conventional angiography. Affected right and left proximal coronary arteries were adequately visualized in 31 of 36 patients (86%). Images that were poor in quality were because of the inability of patients to hold their breath for 17 seconds, and a tortuous coronary anatomy.
Academic~Economic Issues
Rosenthal GE, Harper DL, Quinn LM, Cooper GS: Severity-adjusted mortality and length of stay in teaching and nonteaching hospitals. Results of a regional study. JAMA 278:485-490, 1997
Savage MP, Douglas JS, Fischman DL, et al: Stent placement compared with balloon angioplasty for obstructed coronary bypass grafts. N Engl J Med 337:740-746, 1997
The perception that major teaching hospitals are expensive, inefficient, and vulnerable to market forces prompted this comparison in which > 89,000 cases admitted to either major teaching, minor teaching, or nonteaching hospitals were followed up until discharge. Patients admitted with one of six specific diagnostic codes were compared with respect to length of stay and mortality, with adjustment made for comorbid conditions and severity of illness. The analyses controlled for patients discharged to other care facilities and for different discharge practices among clinicians by using covariate statistical models. The observed mortality was lowest in major teaching hospitals, as was the observed and the adjusted length of stay. This was a regional study; however, extrapolation nationally could have a major impact on the viability of academic medical centers.
About half of all saphenous-vein bypass grafts become severely atherosclerotic within 10 years after coronary bypass surgery. The management of these patients poses a particular problem because reoperation entails a substantial risk and the results of conventional angioplasty have been disappointing. This study assigned a total of 220 patients who presented with stenosis of saphenous vein grafts to receive either placement of a Palmaz-Schatz stent or standard balloon angio-
Pilon CS, Leathley M, London R, et al: Practice guidelines for arterial blood gas measurement in the intensive care unit decreases numbers and increases appropriateness of tests. Crit Care Med 25:1308-1313, 1997
Journal of Cardiothoracic and Vascular Anesthesia, Vol 12, No 2 (April), 1998: pp 233-235
233