Skip to main content

Commencing Volume 19, Issue 1, MedReviews has ceased the publication of this journal. Reviews in Cardiovascular Medicine will continue to be published by IMRPress, Ltd. (www.imrpress.com)

Volume 2, No 4 - Fall 2001

Volume 2, No 4 - Fall 2001

Table of Contents

Catheter-Based Revascularization Strategies for Acute Coronary Syndromes in Women Treatment Update
Women with acute coronary syndromes who present for percutaneous revascularization have clinical characteristics that place them at higher risk for adverse events. These women are older with an increased incidence of hypertension, diabetes, and congestive heart failure. At angiography, women with epicardial coronary disease tend to have smaller diameter vessels, which predict an increase in procedural complications. Recent observations suggest that in the new device era, women with unstable angina/ non-Q myocardial infarction may have clinical outcomes similar to their male counterparts; however, women who present with acute ST-elevation myocardial infarction and undergo catheter-based revascularization procedures remain at increased risk for adverse events. Although adjunctive glycoprotein IIb/IIIa antagonists may improve procedural outcomes, women undergoing catheter-based revascularization procedures are at increased risk for hemorrhagic complications. Despite these high-risk features, catheter-based reperfusion therapies remain an effective treatment strategy in women with acute coronary syndromes. [Rev Cardiovasc Med. 2001;2(4):181–189]
The Drug-Eluting Stent: Is It the Holy Grail? Treatment Update
Although the restenosis rate of coronary stenting is generally 10% to 20%, it can go as high as 60% in patients with diabetes or complex lesions. Currently, the only effective treatment for restenosis is brachytherapy. Drug-eluting stents may be the way to prevent restenosis that cardiologists have been seeking: the drug-coated stents are simple to use and help prevent negative remodeling and the intimal hyperplasia caused by stenting. In studies comparing sirolimus-coated and bare-metal stents, the sirolimus-coated stents resulted in less smooth muscle cell colonization, minimal intimal hyperplasia, and no edge effect; moreover, no adverse clinical events were reported. Currently ongoing, multicenter clinical trials of drug-eluting stents may soon come up with the answers that cardiologists have been hoping for. [Rev Cardiovasc Med. 2001;2(4):190–196]
Primary and Secondary Prevention of Sudden Cardiac Death: The Role of the Implantable Cardioverter Defibrillator Treatment Review
Sudden cardiac death (SCD) affects nearly 300,000 people each year in the U.S., and out-of-hospital rates for survival range from only 2% to 25%. A substantial reduction in SCD requires primary prevention through risk-stratification and secondary prevention of sustained ventricular tachycardia (VT-S) and ventricular fibrillation (VF). Because frequent premature ventricular complexes (PVCs) appeared to be associated with an increased risk for SCD in patients with significant ventricular dysfunction, it was thought that suppression of PVCs would prevent SCD. The implantable cardioverter defibrillator (ICD) electrically treats life-threatening VT-S and VF, and it can be implanted readily in the pectoral area. Two randomized, prospective, controlled trials demonstrated conclusively that the ICD is the treatment of choice in the primary prevention of SCD in patients with a previous MI. In addition, three randomized, controlled trials found the ICD to be superior to antiarrhythmic drugs in the secondary prevention of SCD. Physicians should learn to recognize patients who are candidates for the ICD and refer them to an electrophysiologist so that they can get this life-saving therapy. [Rev Cardiovasc Med. 2001;2(4)197–205]
Takayasu Arteritis
Takayasu arteritis is a severe inflammatory vascular disorder that can involve the thoracic or abdominal aorta and their branches as well as the pulmonary artery. It has a much higher incidence in women than in men, and is most frequently found in Asia, although known in North America, Europe, Africa, and the Middle East. Clinical presentation depends on the location and severity of the aortic branch lesions. Diagnosis is difficult, and treatment options include corticosteroids, percutaneous transluminal angioplasty, or surgical bypass. The case of an Indian woman requiring bypass surgery is presented here, with indications for diagnostic and treatment strategy in other patients. [Rev Cardiovasc Med. 2001;2(4);211–214]
Acute Coronary Syndrome Caused by Coronary Artery Dissection Mimicking Acute Plaque Rupture
When a middle-aged, nonpregnant female patient with no coronary risk factors presents with chest pain, what are the red flags for unusual causes? This case report provides important diagnostic clues as well as progressive therapeutic steps to solving a potentially life-threatening problem. [Rev Cardiovasc Med. 2001;2(4):215–219]