Introduction

Atherosclerotic plaques can develop in the early years of life and build up for years before they become clinically apparent. Often, an acute coronary syndrome (ACS) is the first indication of underlying atherosclerotic disease. These cardiac events are frequently triggered by vulnerable plaques, currently defined as nonobstructive, lipid-rich, thin-cap fibroatheroma (TCFA). Percutaneous coronary intervention (PCI) has always focused on management only after plaque rupture has produced an acute event, because current imaging technology does not possess sufficient resolut

Earlier this year, Dr. Mansoor Qureshi and I were invited to provide interventional cardiology training at the Tahir Heart Institute in Rabwah, Pakistan. At times, I felt totally lost, as if suddenly thrust into a square dance. Everyone else knew the steps and followed the caller. I was reduced to imitating what I saw, a couple of beats behind the rest. With the backdrop of daily violence, it was a heady experience. The objective data are strongly filtered through my subjective experience. Be warned.

The Beginning

My name is Dave Hartman. Although my training and licensure is as a

What is the size of your cath lab staff and facility?

The cath lab at Frederick Memorial Healthcare System is a new department, approved by the Maryland Healthcare Commission to perform primary percutaneous coronary intervention (pPCI) as of March 14, 2008. Until a permanent structure is built, we are currently renting a modular catheterization lab through Modular Devices Inc. (MDI) of Indianapolis, Indiana, which is giving the hospital time to make crucial long-term decisions regarding the construction and design of the new, permanent cath lab within the next two years.

We currentl

Northridge Hospital Medical Center, in the heart of the San Fernando Valley, is a 411-bed hospital with two cardiac catheterization laboratories. The emergency department (ED) is a trauma center as well as an official ST-elevation myocardial infarction (STEMI) Receiving Center, as designated by Los Angeles County, California, on December 1, 2006 (more information about this certification is available at the Los Angeles County Health Services website, at http://ems.dhs.lacounty. gov/ STEMI.htm).

Cath Lab Digest spoke with Michael Cromwell, RN, BSN, Clinical Supervisor, Cardiac Catheterizatio

Parma Community General Hospital, a 348-bed community hospital in the largest suburb of Cleveland, has cut door-to-balloon times in half — from 119 minutes to 60 minutes — through an ongoing team approach. Physician champions from emergency medicine and cardiology joined with nursing leaders and quality specialists to form a “Code ST-elevation myocardial infarction (STEMI)” team. That collaboration, coupled with a 30-minute response time by catheterization laboratory (cath lab) staff, even during off hours, and the transmission of 12-lead electrocardiograms (ECGs) by the emergency medi

Combining Mechanical Reperfusion and Pharmacologic Therapy to Improve Myocardial Perfusion

Case 2 of 5: Continuation of STEMI Case Series from September 2008 Cath Lab Digest

History of Present Illness

A 57 year-old male was brought to the Harrisburg Hospital emergency room via ambulance for ongoing severe chest pain of 1 hour’s duration. He was determined to have acute inferior wall myocardial infarction by electrocardiographic (ECG) criteria. A Code STEMI protocol was initiated by the emergency room staff. The patient immediately after arrival to the ER went

Two outstanding STEMI experiences are highlighted in the present issue of Cath Lab Digest. They have been submitted from hospitals in Ohio and California, and both demonstrate superb STEMI processes in action. Both institutions deserve praise for their robust efforts in mastering the process of STEMI intervention. As a result of their meticulous teamwork, the challenge of achieving consistent door-to-balloon (D2B) times of < 90 minutes, both on- and off-hours, was easily surpassed at both institutions. Readers can pick up valuable tips from their experience. Several of these have been previous

This monthly column in Cath Lab Digest reviews important points of distinction in drug-eluting stents, from characteristics to techniques, to provide valuable and relevant information about this technology.

Dr. Feldman currently practices at Evanston Hospital, where he is director of the cardiac catheterization laboratory and holds the Walgreen Chair in interventional cardiology. He received his undergraduate and medical training at Indiana University, completing residency training as Chief Resident at Rush-Presbyterian-St. Luke’s Medical Center in Chicago, Illinois. After finishing his

The problems were familiar ones: days were hectic and unpredictable; the staff was constantly juggling the schedule in order to slot emergencies and urgent cases between scheduled ones; cases were too often bumped or delayed with unhappy and hungry patients kept waiting; and the staff was stressed and frustrated. But in the fall of 2007, the administration and staff of the cardiac catheterization laboratory at Kennestone Hospital — WellStar Health System’s 633-bed flagship hospital in Marietta, Georgia — decided to undertake an innovative approach to solving these common problems with th

Cath Lab Digest talks with Gregg W. Stone, MD, Director of Cardiovascular Research and Education, Center for Interventional Vascular Therapy, New York-Presbyterian Hospital/Columbia University Medical Center; Professor of Medicine, Columbia University College of Physicians and Surgeons; Chairman of the Cardiovascular Research Foundation, New York, New York

Dr. Stone was the principal investigator in the SPIRIT III and SPIRIT IV trials, which looked at Abbott Vascular’s Xience V stent. (Xience V is also distributed as the Promus stent by Boston Scientific Corporation.)