Editor`s Message (November 2002)

Dear Readers, This issue of the Journal of Invasive Cardiology includes original research articles, case reports, an editorial, brief reviews, the session V discussion from this year’s International Andreas Gruentzig Society Meeting, proceedings from the TCT meeting this year in Washington, DC, and articles from the Journal special sections “Acute Coronary Syndromes", and “Clinical Decision Making". The first research article, submitted by Dr. John Gresham and associates from Eastern Virginia Medical School in Norfolk, Virginia describes the experience of a community hospital performing primary angioplasty for acute myocardial infarction in a setting without surgical backup. They showed that this is a feasible approach and also compared primary angioplasty results with matched thrombolytic patients, showing long-term improvement in cardiac function. In the second research article, Dr. Toshiya Muramatsu and colleagues from the Division of Cardiology at the Kawasaki Social Insurance Hospital in Kawasaki, Japan demonstrate the usefulness in evaluating fractional flow reserve in guiding percutaneous coronary intervention in patients presenting with acute myocardial infarction. They showed that patients with higher fractional flow reserve could be treated with primary angioplasty alone, and had similar clinical results but lower cost compared to a control group treated with stenting. Dr. Steven Goldberg from the University of Washington in Seattle has provided a commentary on the Muramatsu et al. article in which he reviews trials that have been done comparing angioplasty versus stenting in acute myocardial infarction, suggesting that there may be improved ways to approach this challenging clinical situation. The next research article, submitted by Dr. Ronald Caputo and collaborators from St. Joseph’s Hospital in Syracuse, Hospital Privat Francais in Paraguay, SUNY Upstate Medical University in Syracuse and Lahey Clinic in Burlington, Massachusetts, describes a new closure device for percutaneous femoral arteriotomy repair. This staple technology demonstrated a high success rate in closing femoral arteriotomies. The last original research report, submitted by Dr. Roby Rakhit and colleagues from the Swiss Cardiovascular Center at the University Hospital in Bern, Switzerland presents their study comparing efficacy, safety and outcome between 5 French versus 6 French catheters for percutaneous coronary intervention. They show that in selected cases, 5 French technology yields comparable results and results in decreased use of contrast and fluoroscopy time. This issue also includes an editorial, which was submitted by Dr. Elad I. Levy and colleagues from the Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, and the Department of Cardiology, The Sanger Clinic, Charlotte, North Carolina. In the editorial, they question whether there is a sufficient number of trained physicians available today to treat stroke patients. They discuss in detail the training necessary to allow interventional cardiologists to treat ischemic strokes. This issue of the Journal also includes four interesting case reports representing unusual clinical presentations and two case reports with brief reviews of the literature. In the first case report, submitted by Drs. Ferreira, Eton and de Marchena, the authors describe a late clinical presentation of a femoral artery occlusion following the use of the angioseal closure device, showing that complications can occur up to 4 weeks after the initial deployment. The second case report, submitted by Drs. Boulmier, Ecke and Verhoye from the Departments of Cardiology, Vascular Medicine and Cardiothoracic Surgery in Rennes, France, presents an unusual case in which recurrent myocardial infarction occurs due to obstruction of the right coronary ostium by an aortic papillary fibroelastoma. In another unusual case, Drs. Kay, Kwok and Chow from the Division of Cardiology at the University of Hong Kong, Grantham Hospital in Hong Kong describe their successful approach to treating a long calcified lesion with rotational atherectomy and stenting in a patient with dextrocardia and situs inversus. Two other case reports are included that contain brief reviews of the literature in addition to the case report. In the first, submitted by Dr. Sami Aldoboni and colleagues from the National Iranian Oil Company, Central Hospital in Tehran, Iran, the authors describe their approach to treating a spontaneous dissection of a coronary artery with stenting in a patient with Systemic Lupus Erythematosus. Finally, Drs. Balan, Kobayashi and Moses from the Cardiovascular Research Foundation at the Lenox Hill Heart and Vascular Institute in New York present an unusual situation in which they successfully opened an underexpanded stent through the struts of a previously implanted stent utilizing cutting balloon angioplasty. Two of our special clinical sections are featured in this issue of the Journal. In the first special section, Acute Coronary Syndromes, edited by Dr. Lloyd Klein from the Section of Cardiology, Rush Heart Institute at Rush-Presbyterian-St. Luke’s Medical Center in Chicago Illinois, Dr. Klein has included two papers in this section. In the first, submitted by Dr. James Choi and Dr. Charles Davidson from the Departments of Medicine and Cardiology at Northwestern University Medical School in Chicago, Illinois, the authors describe a case of spontaneous multivessel coronary artery dissection in a long-distance runner that was successfully treated with oral antiplatelet therapy. In addition, they have also provided an excellent review of the literature on this topic. The second article in the ACS section is from Dr. Klein and 2 collaborators from his institution, Drs. Todd Kerwin and Neal Ruggie. They have provided a case report showing their approach to management of a patient who presented with spontaneous coronary dissection after a low-intensity blunt chest trauma. They have also provided a review of the literature on current treatment options for this clinical presentation. In the second special section, Clinical Decision Making, edited by Dr. Michael Sketch from Duke University Medical Center in Durham, North Carolina, Dr. Sketch has submitted along with his associates Drs. Shah and Tcheng a case in which a patient presented with acute myocardial infarction while playing paintball. They describe their approach to management of this unusual presentation and then invited Drs. Jeffrey Werner, Joshua DeLeon and Zoltan Turi to comment on what their approaches would be in treating this patient. It is my hope that all of the articles in this issue of the Journal provide information that is useful for cardiovascular specialists in their daily care of patients with cardiovascular disease.