Interventional cardiology

Corresponding Author:

Uma Mahesh R Avula
Department of Internal Medicine
Center for Arrhythmia Research, USA
E-mail: umamahes@med.umich.edu

Abstract

Introduction

The catheter based therapeutic approach to cure the anomalies related to heart disease is the theme of 'Interventional cardiology'. Such catheterization is having robust application specificity in respect to therapeutic intervention for cardiovascular biology. The founding stone of this medical study stream was established by Andreas Gruentzig, with the effective input from the concept of interventional radiology. Recent progress of medical science has showed promising health benefits in the surgical therapy for various cardiological implications. Present journal is devoted to aggregate all such precious information and also determined to provide them when it needs to any researcher without any pebble of availability through our open access window.

The journal ‘Interventional Cardiology’ in its recent release Volume 9, Issue 4, has ventured some impactful articles, which covers the key aspects of the studies in cardiology. Orscelik et al. [1] has described case of a 77-year old female patient, who had mobile thrombus extending from the distal segment of the left main coronary artery to the left anterior descending anterior artery. Marchioli [2] has reviewed the association of coronary risk factors and behaviours in old age. Papanikolaou et al. [3] described a critical case of discontinuation of prolonged dual antiplatelet therapy for a dental extraction. Martins et al. [4] presented a randomized CLEAR-CIN-PCI sub study on Rosuvastatin and contrast-induced nephropathy in elective percutaneous coronary intervention. Nigam and Chandra [5] communicated a letter to editor with a rational presentation of positive and negative false estimates of serum creatinine. Chye et al. [6] has explored the procedural safety and short outcome of magnesium bio-resorbable scaffold in Asian men. The brief description of each article is provided here for better understanding of the issue.

Patients have been reported to experience highest rate of death and recurrent ischemic events during the early period after an acute coronary syndrome. That's why such medical condition is fragile and risky to handle through in-home medications. Acute coronary syndromes characterized by thrombus formation in the left main coronary artery represent an uncommon form of atherosclerotic cardiac diseases. In the care report by Orscelik et al. [1], the authors have described a critical case of a 77-year old female patient, who had mobile thrombus extending from the distal segment of the left main coronary artery to the left anterior descending artery. The authors have stated that, the in such situation patients usually developed myocardial infarction due to thrombus formation in LMCA and/or LAD. However, no cases have been reported before with a loose thrombus resulting in obstruction of the distal bed after partial detachment. Therefore, therapeutic strategies are not clearly known.

In another article by Marchioli [2] has reviewed all the aspects related to risk factor analysis in coronary heart diseases profile and also added a valued note on the effect of age on the pathobiology. Cardiovascular risk factors and behaviours usually interact during adulthood with the negative health result, which further drags individual disabilities and death. Identification and treatment of such risk factors in childhood and adolescence have been suggested by the authors as most crucial, which further act in the effective cardiovascular prevention. The author also suggested that, wider studies are the urgent need of time in order to determine whether control of the risk factors at earlier ages could help persons reach an older biological age in a good psychological and physical state.

In another case report Papanikolaou et al. [3] has reported a case of 66-year-old hypertensive man, with an acute anterior ST-elevation myocardial infarction (STEMI) and ensuing cardiogenic shock, five years after implantation of three drug-eluting (DES) stents in proximal left anterior descending (LAD), proximal first diagonal branch and circumflex artery (LCX) (Figures 1A-1D) for stable ischemic heart disease. The patient was asymptomatic since then; however, three days before his admission, he was advised to temporarily discontinue aspirin-clopidogrel DAPT for a minimal dental procedure (tooth extraction), and receive low molecular weight heparin (LMWH) as a five-day bridging therapy regimen.

Martins et al. [4] presented a randomized CLEAR-CIN- PCI sub-study on Rosuvastatin and contrastinduced nephropathy in elective percutaneous coronary intervention. This study sought to determine whether PCI realized within the time of Rosuvastatin peak concentration was associated with reduced inhospital CIN compared with standard clinical practice. This single-center prospective, randomized, open-label, non-blinded clinical trial evaluated stable coronary artery disease patients taking chronic statin undergoing PCI. Patients were randomized to receive a loading dose of Rosuvastatin (40 mg within 2 to 6 h before angioplasty) or to standard practice (without load dose of Rosuvastatin). The pre-specified primary endpoint was the occurrence of CIN defined as an increase in the serum creatinine by 0.3 mg/dl within 24 h after intervention. However, the result does not support the initiation of Rosuvastatin before elective PCI to prevent CIN in patients taking chronic statin therapy.

Accurate and precise measurement of serum creatinine is very important for assessment of kidney function. However, false estimates of serum creatinine have been found due to interference by both exogenous and endogenous substances, which have been attributed to factors such as decreased or inhibited tubular secretion of creatinine, interference with serum creatinine assays and increased production of creatinine. Several drugs cause positive and negative interference through these mechanisms resulting in false positive and negative estimates of serum creatinine which may affect glomerular filtration rate (GFR) calculation also. Endogenous substances also affect the creatinine assay systems resulting in false estimate of serum creatinine concentration. Therefore, the awareness about the drug-induced or endogenous substance-induced false estimates of serum creatinine and pre-analytical errors in blood sampling is important. With such novel intention Nigam and Chandra [5] have communicated a letter to editor, which is having immense importance.

Chye et al. [6] has explored the procedural safety and short outcome of magnesium bio-resorbable scaffold in Asian men. In their experiment, 7 male patients (46±9) were enrolled. Ethnicity breakdown showed 5 Malays, 1 Chinese, and 1 Indian. Cardiovascular risk assessment revealed 85.7% diabetes mellitus, 42.9% smokers, 28.6% hypertension and 28.6% dyslipidaemia. Target vessels treated were 6 left anterior descending (LAD) and 1 right coronary artery (RCA). Out of the 7 patients, 28.6% were type A lesions, 42.8% were type B, and 28.5% were type C. Among those lesions, 3 involved LAD-D1 bifurcations, and 2 were total occlusions. The lesions were prepared with semi-compliant balloons in 5 cases and non-compliant balloons in 2 cases. The balloon-to- stent ratios were 1:1 (n=1), 0.92:1 (n=1), 0.85:1 (n=4) and 0.83:1 (n=1). The magnesium BRS diameters used were 3.5 mm (n=4) and 3.0 mm (n=3) with length of 15 mm (n=1), 20 mm (n=4) and 25 mm (n=2). Post-dilatation in one patient was carried out with non-compliant balloon of equal diameter to the stent, while the rest had upsizing with +0.5 mm larger non- compliant balloon. Procedural outcome was 100% successful. At three-month follow-up, there were no symptoms, MACE or TLR. The authors have suggested that, a larger cohort and longer-term outcome would better delineate the safety and efficacy of this new technology in treating coronary artery disease.

Together, all the articles published in the present issue contain the merit of novelty and could contribute in the futuristic progress in cardiovascular research.

References

1. Orscelik O, Ozkan B, Sahin EE, et al. Mobile thrombus extending from the distal segment of the left main coronary artery to the left anterior descending artery. Interv. Cardiol. 9: 123-124 (2017).
2. Marchioli CAP. Association of coronary risk factors and behaviours in old age. Interv. Cardiol. 9: 125-131 (2017).
3. Papanikolaou J, Platogiannis N, Gkekas D, Barmpatzas N, Spathoulas K, Platogiannis D. Discontinuation of prolonged dual antiplatelet therapy for a dental extraction; A nearly-fatal decision. Interv. Cardiol. 9: 133-135 (2017).
4. Martins KBA, de Oliveira MS, Mattos LA. Rosuvastatin and contrast-induced nephropathy in elective percutaneous coronary intervention: The randomized CLEAR-CIN-PCI sub study. Interv. Cardiol. 9: 137-146 (2017).
5. Nigam PK, Chandra A. Positive and negative false estimates of serum creatinine. Interv. Cardiol. 9: 157-160 (2017).
6. Chye NCY, Arshad MKM, Khir RN, et al. Procedural safety and short-term outcome in asian men treated with magnesium bio-resorbable scaffold. Interv. Cardiol. 9: 147-156 (2017).