
This edition first published 2011, © 2011 by Ever D. Grech
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 |