Jeffrey Snell

CORONARY REVASCULARIZATION IN MULTIVESSEL DISEASE Which is better, stents or surgery? Findings to date on important, practical differences between percutaneous coronary intervention and coronary artery bypass grafting.

Coronary artery disease (CAD) remains the major cardiovascular health issue in contemporary clinical practice. Treatment options for multivessel CAD include medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). Here, the authors review the most recent data that compare intracoronary stenting to CABG in multivessel disease. They address therapeutic issues surrounding proper selection of the optimal revascularization strategy and give special consideration to high-risk populations, such as patients with diabetes.

Impact of a novel interventional platform and hospital design on the door-to-balloon time in patients presenting with ST-segment elevation myocardial infarction.

INTRODUCTION Reducing door-to-balloon (DTB) time in ST-segment elevation myocardial infarction improves outcomes. Several hospital factors can delay DTB times and lead to increased morbidity and mortality. The effects of hospital design and an interventional platform (IP) on patient care, particularly on the DTB time, are unknown. METHODS We performed a retrospective analysis of consecutive patients presenting to the emergency department of a medical center from September 2010 to February 2014 who met criteria for a ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention. Patients were divided into 2 groups based on whether they presented before or after the opening of the IP in our new hospital on January 6, 2012. Total DTB time and separate systematic intervals were tabulated. RESULTS Fifty-two patients met our inclusion criteria, 21 pre-IP and 31 post-IP. Both groups had overall similar baseline characteristics. The mean DTB time significantly improved by 11.7 minutes after the opening of the IP (P = 0.016), and all cases had a DTB time 90 minutes or less as compared with 90.4% prior. Eighty-nine percent of the overall improvement in DTB happened before the patient reached the catheterization table. Important factors were the new emergency department (ED) design that facilitates rapid patient triage and the direct connection between the ED and cath lab. CONCLUSIONS This study showed that the new hospital design had significant effects on immediate patient care by improving the DTB time at our institution. Further study regarding the long-term impact of hospital designs on patient care is needed.

194. Deltavasc|[trade]| - Phase I Study of Intramuscular Administration of Plasmid Del-1 (Developmentally Regulated Endothelial Cell Locus |[ndash]|1) in Humans with Peripheral Arterial Disease (PAD)

Background: Del-1 (Developmentally regulated endothelial locus 1) is a novel angiomatrix protein that induces a potent angiogenic response. Preclinical studies using a plasmid expressing Del-1 in conjunction with a poloxamer (VLTS-589) have demonstrated functional improvements in lower extremity perfusion and exercise tolerance. The objective of this Phase I investigation was to obtain safety and preliminary efficacy data of such an approach in subjects with peripheral arterial disease (PAD).

877-3 Effect of percutaneous transluminal renal artery angioplasty with stenting on renal function in patients with atherosclerotic renal artery stenosis

An gi og ra ph y & In te rv en tio na l C ar di ol og y RESULTS: 69 patients (98% of total) completed a 12-months clinical follow up. MACE were: S: 4/36 (11%) and P: 8/33 (24%)(p<0.05). 61 patients (85%) had repeat catheterization at 11±7 months. Binary ISR was: S: 5/33 (14%) and P: 5/28 (18%)(p:NS). Minimal lumen area was: S: 5.7±1.4 and P: 6.1±2.2 mm2 (p::NS); neointimal volume index (=[stent-lumen volume]/stent length) was: S: 3.6±1.8 and P: 3.8±2.3 mm3/mm (p:NS); obstruction volume percent (=[stent-lumen volume]/stent volume%) was: S: 34±15 and P: 35±23% (p:NS). External plaque percent (=[vessel-stent volume]/vessel volume%) at stented site, at baseline and follow-up, was S: 53±10 and 39±9%, and P: 51±12 and 57±11% (p<0.05). External plaque volume index (=[vessel-stent volume]/stent length), at baseline and follow-up, was: S: 11.9±4.2 and 7.9±3.3 mm3/mm, and P: 10.9±4.0 and 11.6±3.5 mm3/mm (p<0.05). Total plaque percent (=[vessel-lumen volume]/vessel volume%) at non-stented sites, at baseline and follow-up, was: S: 49±8 and 39±7%, and P: 47±8 and 56±10% (p<0.05). Total plaque volume index (=[vessel-lumen volume]/segment length), at baseline and follow-up, was: S: 9.8±3.6 and 7.3±2.5 mm3/mm, and P: 8.8±2.9 and 9.8±3.1 mm3/mm (p<0.05). CONCLUSION: In normocholesterolemic patients, prolonged treatment with oral simvastatin shows no effect in preventing ISR and neointimal growth after coronary stenting. However, it reduces MACE and induces a diffuse regression of the atherosclerotic plaque burden.