ABC of Interventional Cardiology

Previous edition: 2003

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Library of Congress Cataloging-in-Publication Data

ABC of interventional cardiology / Ever D. Grech. – 2nd ed.

p.; cm.

Includes bibliographical references and index.

ISBN 978-1-4051-7067-3 (pbk.: alk. paper)

1. Heart – Diseases – Treatment. 2. Coronary heart disease – Surgery. I. Grech, Ever D.

[DNLM: 1. Cardiovascular Diseases – therapy. WG 120]

RC683.8.A33 2010

616.1′2-dc22

2010039150

ISBN: 978-1-4051-7067-3

List of Contributors

Abdallah Al-Mohammad

Consultant Cardiologist, South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK

Kevin S. Channer

Professor of Cardiovascular Medicine, Royal Hallamshire Hospital, Sheffield, UK

Ever D. Grech

Consultant Cardiologist, South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK

Julian Gunn

Senior Lecturer and Honorary Consultant Cardiologist, University of Sheffield, Sheffield, UK

Gerald C. Kaye

Consultant Cardiac Interventional Electrophysiologist, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia

Damien Kenny

Specialist Registrar in Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK

Laurence O’Toole

Consultant Cardiologist, South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK

Jonathan Sahu

Consultant Cardiologist, South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, UK

Robert F. Storey

Reader and Honorary Consultant Cardiologist, University of Sheffield, Sheffield, UK

Kevin P. Walsh

Consultant Paediatric Cardiologist, Our Lady’s Hospital for Sick Children, Dublin, UK

Preface

It is only 33 years since the first percutaneous transluminal coronary angioplasty (PTCA) was carried out by the pioneering Swiss radiologist Andreas Greuntzig in Zurich, heralding the dawn of interventional cardiology. In this short time, interventional cardiology has overcome many limitations and undergone major evolutionary changes – most notably the development of the intracoronary stent and more explicitly the drug-eluting stent. Across the world, many thousands of patients now safely undergo percutaneous coronary intervention everyday and the numbers continue to grow. In many countries, the numbers far exceed surgical bypass operations.

Although at first, PTCA was indicated only as treatment for chronic stable angina caused by a discrete, easily accessible lesion in a single coronary artery, this has now progressed enormously to encompass complex multi-lesion and multi-vessel disease. Moreover, percutaneous coronary intervention has now become widely used in the management of acute coronary syndromes (which principally include ‘heart attacks’) with definite benefits in terms of morbidity and mortality. The effectiveness and safety of these procedures has undoubtedly been enhanced by the adjunctive use of new anti-platelet and anti-thrombotic agents, and newer drugs are being evaluated. As drug-eluting stents address the Achilles’ heel of angioplasty and stents – restenosis – the huge increase in percutaneous coronary procedures seen over recent years is likely to continue.

As the indications increase and more patients are treated, so inevitably do the demands on healthcare budgets. Although percutaneous intervention is expensive, this burden must be weighed against bypass surgery which is significantly more costly and multi-drug therapy which would be required over many years.

Although percutaneous coronary intervention has held centre stage in cardiology, major in-roads have also been made in non-coronary areas. Transcatheter valvular treatments – including actual new valve implantation, closure devices and ethanol septal ablation – have become effective and safe alternatives to surgery, as have paediatric interventional procedures. A greater understanding of cardiac electrophysiology and heart failure has led to important advances in the treatment of arrhythmias and resynchronisation therapy. Pacemakers, implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT) are benefiting ever larger numbers of patients both in terms of life quality and mortality.

Where are we heading? This is perhaps the biggest question in the minds of many interventional cardiologists. New ideas and technology generated by industry, coupled with high levels of expertise, are fuelling advances in almost all areas of interventional cardiology. The next decade promises many new (and possibly unexpected) developments in this exciting and restless field of medicine.

In writing this book, I have endeavoured to present broad (and sometimes complex) aspects of interventional cardiology in a clear, concise and balanced manner. To this end, I have concentrated on an easy-to-read style of text, avoiding jargon and exhaustive detail where possible and supplemented with many images and graphics.

Ever D. Grech

Sheffield

Acknowledgements

I have many people to thank for their help in developing and producing this book. I am very grateful to my co-authors who have all willingly contributed their time and expertise. I would also like to recognise the positive efforts and invaluable assistance of the editors and publishers at Wiley-Blackwell. These include Laura Quigley, Adam Gilbert, Carla Hodge and Karen Moore. My thanks also to Dhanya Ramesh at Laserwords.

Finally, my enduring gratitude goes to my wife Lisa and our children Alexander and Frances for their unfailing encouragement, patience and love.

List of Abbreviations

CTO	Chronic total occlusion
HRT	Hormone replacement therapy
IVUS	Intravascular ultrasound
LAD	Left anterior descending (artery)
LCx	Left circumflex (artery)
Non-STEMI Non-ST	segment elevation myocardial infarction
PCI	Percutaneous coronary intervention
RCA	Right coronary artery
STEMI ST	segment elevation myocardial infarction

List of Trial Abbreviations

ACE	Abciximab and Carbostent Evaluation
ADMIRAL	Abciximab before Direct Angioplasty and Stenting in Myocardial Infarction Regarding Acute and Long-Term Follow-up
ASSENT-4	Assessment of the Safety and Efficacy of a New Treatment Strategy for Acute Myocardial Infarction
BARI	Bypass Angioplasty Revascularisation Investigation
CADILLAC	Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications
CAPITAL-AMI	Combined Angioplasty and Pharmacological Intervention Versus Thrombolytics Alone in Acute Myocardial Infarction
CAPTURE C7E3	Antiplatelet Therapy in Unstable Refractory Angina
CARDia	Coronary Artery Revascularisation in Diabetes
CARE-HF	Cardiac Resynchronization – Heart Failure
CARESS-in-AMI	Combined Abciximab REteplase Stent Study in Acute Myocardial Infarction
CHAMPION	Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition
CHARISMA	Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization Management and Avoidance
CLARITY	Clopidogrel as Adjunctive Reperfusion Therapy
COMMIT	Clopidogrel and Metoprolol in Myocardial Infarction Trial
COMPANION	Comparison of Medical Therapy, Pacing, and Defibrillation in Chronic Heart Failure
COURAGE	Clinical Outcomes Utilising Revascularisation and Aggressive Drug Evaluation
CREDO	Clopidogrel for the Reduction of Events during Observation
CURE	Clopidogrel in Unstable Angina to Prevent Recurrent Events
ECSG	European Cooperative Study Group
EPIC	Evaluation of C7E3 for Prevention of Ischemic Complications
EPILOG	Evaluation in PICA to Improve Long-Term Outcome with Abciximab Glycoprotein IIb/IIIa Blockade
EPISTENT	Evaluation of Platelet IIb/IIIa Inhibitor for Stenting
ESPRIT	Enhanced Suppression of the Platelet Glycoprotein IIb/IIIa Receptor Using Integrilin Therapy
EUROPA	European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease
EVEREST	Endovascular Valve Edge-to-Edge Repair Study
FAME FFR	Versus Angiography for Multivessel Evaluation
FINESSE	Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events
FREEDOM	Future Revascularisation Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease
FRISC II	Fast Revascularisation during Instability in Coronary Artery Disease
GISSI	Gruppo Italiano per to Studio della Sopravvivenza nell’infarto miocardico
GUSTO	Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries
GUSTO	IV ACS Global Use of Strategies to Open Occluded Arteries IV in Acute Coronary Syndrome
HOPE	Heart Outcomes Prevention Evaluation
HORIZONS-AMI	Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction
ICTUS	Invasive Versus Conservative Treatment in Unstable Coronary Syndromes Investigators
IMPACT II	Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis
ISAR-COOL	Intracoronary Stenting with Antithrombotic Regimen Cooling Off
ISAR-REACT 2	Intracoronary Stenting and Antithrombotic Regimen – Rapid Early Action for Coronary Treatment 3
ISIS-2	Second International Study of Infarct Survival
JUPITER	Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin
MADIT I and II	Multicenter Automatic Defibrillator Implantation Trials. The Use of Defibrillators in Primary Prevention
MIST	Migraine Intervention with Starflex Technology
MUSTT	Multicenter Unsustained Tachycardia Trial
On-TIME 2	Ongoing Tirofiban in Myocardial Infarction Evaluation
PARAGON	Platelet IIb/IIIa Antagonism for the Reduction of Acute Coronary Syndrome Events in the Global Organization Network
PEACE	Prevention of Events with Angiotensin-Converting Enzyme Inhibition
PLATO	Platelet Inhibition and Patient Outcomes
PRISM	Platelet Receptor Inhibition in Ischemic Syndrome Management
PRISM-PLUS	Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms
PROSPECT	Predictors of Response to Cardiac Resynchronization Therapy
PURSUIT	Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy
RAPPORT	Reopro and Primary PTCA Organization and Randomized Trial
RAVEL	Randomised Study with the Sirolimus-Eluting Velocity Balloon-Expandable Stent in the Treatment of Patients with De Novo Native Coronary Artery Lesions
RESTORE	Randomized Efficacy Study of Tirofiban for Outcomes and Restenosis
RITA 3	Randomised Intervention Treatment of Angina
SCD-Heft	Sudden Cardiac Death in Patients with Heart Failure
SHOCK	Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock
SIRIUS	Sirolimus-Coated Velocity Stent in Treatment of Patients with De Novo Coronary Artery Lesions Trial
Stent-PAMI	Stent Primary Angioplasty in Myocardial Infarction
SYNTAX	Synergy between PCI with Taxus and Cardiac Surgery
TACTICS-TIMI 18	Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy– Thrombolysis in Myocardial Infarction TAMI Thrombolysis and Angioplasty in Myocardial Infarction
TIMIIIIB	Thrombolysis in Myocardial Infarction IIIB
TRANSFER-AMI	Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction
TRITON-TIMI 38	Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel – Thrombolysis in Myocardial Infarction
TRUCS	Treatment of Refractory Unstable Angina in Geographically Isolated Areas without Cardiac Surgery
VANQWISH	Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital
VINO	Value of First Day Coronary Angiography/Angioplasty in Evolving Non-ST Segment Elevation Myocardial Infarction
WHO MONICA	World Health Organisation: Monitoring Trends and Determinants in Cardiovascular Disease