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Volume 11, No 2 - Spring 2010

Volume 11, No 2 - Spring 2010

Table of Contents

Safety and Efficacy of Drug-Eluting Stents Compared With Bare Metal Stents in ST-Elevation Myocardial Infarction Treatment Update
Drug-eluting stents (DES) reduce restenosis and the need for repeat revascularization, but patients with ST-segment elevation myocardial infarction (STEMI) were excluded from many of the trials that established the safety and efficacy of DES. Because of the unstable nature of lesions associated with STEMI, these patients are considered high risk, and often experience higher rates of adverse events. There is concern that DES may increase the risk of stent thrombosis, particularly late and very late stent thrombosis, in STEMI patients. Evidence also suggests that although DES reduce target vessel revascularization, this benefit may be lost after extended follow-up due to procedures necessitated by increased stent thrombosis. Several randomized trials, meta-analyses, and registry studies have been conducted to compare DES with bare metal stents in patients with STEMI, but many of the studies are not large scale and the length of follow-up has been limited in duration. This review summarizes the data comparing DES with bare metal stents in patients with STEMI. [Rev Cardiovasc Med. 2010;11(2):57-73 doi: 10.3909/ricm0517]
Management of Atrial Fibrillation: Focus on Catheter-Based Ablation Management Update
Atrial fibrillation (AF) contributes to considerable morbidity, with increasing risk of stroke, complications from anticoagulation, and exacerbation of heart failure. AF ablation has become a commonly performed procedure in many hospitals as the procedural techniques evolve rapidly with improved success. Here we discuss the interventional options of catheter-based AF ablation for rhythm control, which offers the benefit of mortality reduction associated with normal sinus rhythm but without medication complications. [Rev Cardiovasc Med. 2010;11(2):74-83 doi: 10.3909/ricm0520]
Recognition of Noncardiac Findings on Cardiac Computed Tomography Examination Diagnosis and Management Review
Multislice computed tomography (CT) is rapidly emerging as a novel technique for the evaluation of coronary artery disease. It is anticipated that with increasing acceptance of this imaging technique, CT for calcium scores and CT angiography will be performed in ever greater numbers. Thus, it is all but inevitable that clinicians will stumble upon incidental findings given the sheer number of vital organs and blood vessels that are imaged in the field of view. This article reviews the literature on incidental findings on cardiac CT with a focus on pulmonary nodules, ethical aspects of following up such findings, and cost implications. [Rev Cardiovasc Med. 2010;11(2):84-91 doi: 10.3909/ricm0521]
Left Ventricular Noncompaction Cardiomyopathy: What Do We Know? Disease State Review
Noncompaction is a rare and primary genetic cardiomyopathy affecting the left ventricle. The diagnosis is usually established by echocardiography, or, less frequently, by left ventriculography. Cardiac magnetic resonance and electrocardiography-gated multidetector computed tomography are evolving noninvasive modalities to image cardiac structures, and have the utility to detect noncompacted myocardium. Estimates of the frequency and incidence of left ventricular noncompaction (LVNC) are limited because of the controversy over whether LVNC is a discrete disease entity. There is considerable overlap with dilated cardiomyopathy, apical hypertrophy, and hypertrophic cardiomyopathy. Symptoms, diagnosis, and prognosis are variable because of the heterogeneous nature of these diseases, making treatment often empirical and mimicking the treatment of other cardiomyopathies. However, there are management issues that should be addressed in each patient with LVNC, including genetic testing and family screening, the need for implantable cardioverter defibrillator placement, the role of anticoagulation in prevention of thromboembolic complications, and prescriptions/restrictions for implementation of physical activity. [Rev Cardiovasc Med. 2010;11(2):92-99 doi: 10.3909/ricm0531]
TCT 2009: New Findings Pave the Way for Novel Approaches to Treating Cardiovascular Disease Meeting Review
Highlights From the 21st Annual Transcatheter Cardiovascular Therapeutics Scientific Symposium, September 21-25, 2009, San Francisco, CA [Rev Cardiovasc Med. 2010;11(2):103-111 doi: 10.3909/ricm0534]
Unstable Angina in a Patient With Anomalous Origin of the Left Main Coronary Artery From the Right Sinus of Valsalva Case Review
Anomalous coronary arteries are rare. Although most are not clinically significant, the most clinically important coronary anomaly is origin of the left main coronary artery from the right sinus of Valsalva, which can be associated with sudden death. We present a case of a 37-year-old man with unstable angina who underwent cardiac catheterization and was found to have this type of anomaly, which was later confirmed by coronary computed tomography angiography. Diagnosis and management of patients with this coronary anomaly are discussed. [Rev Cardiovasc Med. 2010;11(2):112-116 doi: 10.3909/ricm0525]