Background: A CT ‘calcium score’, which detects calcified atheroma actually present in coronary arteries, has been shown to be powerfully predictive of CVD, and superior to Framingham in several published studies. We tested the hypothesis that patients (pts) whose calcium score demonstrated ‘premature ageing’, relative to others of their age and gender, were more likely to have a family history (FH) of CVD and hyperlipidaemia. Methods: Using a prospective, comprehensive database we audited 2500 consecutive pts to undergo a 64-slice CT calcium score from 0708/06 to 06/10/11. We excluded 162 (6%) pts with a history of CVD allocating those remaining to age/gender appropriate centile bands from a widely used ‘normal’ population (Hoff et al, Am J Cardiol 2001;87:1335–1339). We assessed pts as above or below the 75th or 90th centile for their age and gender, and recorded pts with hyperlipidaemia or FH of CVD. We then adjusted these models using multivariate logistic regression models, for 20 known cardiovascular risk factors. Results: Of 2338 pts, 58% were male: mean age 57 (SD9) years. 607 (26%) pts had an Agatston score > 75th centile, and 256 (11%) > 90th centile for age/gender. In univariate and multivariate models FH of CVD and hyperlidaemia were independent predictors of >age/gender centile (table).Tabled 1Centile≤75thn = 1731>75thn = 607PuniPmva≤90thn = 2081>90thn = 256PuniPmvaHyperlipidaemia37%54%0.0001<0.000141%59%<0.0001<0.0001Family history45%53%0.00010.03145%61%<0.00010.0074Age, mean (SD)57 (10)56 (8)0.056–57(9)54(8)0.00010.0012Gender (%male)59%56%0.29–58%55%0.38–Smoker4%6%0.0110.0414%5%0.33–Diabetes5%9%0.005–6%11%0.036–Hypertension32%41%0.0001–33%44%<0.0001–Puni = univariate association, Fishers exact test, Pmva = multivariate analysis, logistic regression. Open table in a new tab Puni = univariate association, Fishers exact test, Pmva = multivariate analysis, logistic regression. Conclusion: Pts with a FH of premature CVD or hyperlipidaemia should consider this simple non-invasive, low radiation, easily accessible test. A calcium score provides a unique opportunity to detect early calcified atheroma and personalise discussions, which may also improve adherence to preventative strategies.

Background: A ‘calcium score’, which detects calcified atheroma actually present in coronary arteries, is powerfully predictive of cardiovascular (CVS) events, and superior to Framingham in several published studies. The New Zealand Guideline Group (NZGG) 2009 Adjusted Framingham CVS risk score (FRS) includes a 5% increase for FH [“Premature coronary heart disease or ischaemic stroke”]. We assessed the relationship between FH and calcium score.

Background: A recent innovation to the standard New Zealand Guideline Group (NZGG) cardiovascular (CVS) risk assessment tool has been the introduction of 'heart age' to aid interpretation of risk. However, this approach relies on a risk factor model with only moderate discriminability. A 'calcium score', which detects calcified atheroma actually present in coronary arteries, is powerfully predictive of CVS events, and superior to Framingham in several published studies. We assessed the NZGG estimation of risk with the observed calcium score.

Background: Aortic stenosis (AS) carries a poor prognosis once symptoms develop, with mortality up to 50% at two years in untreated patients. Transcatheter aortic valve implantation (TAVI) is a new treatment option for patients at high risk for surgical valve replacement. We report the periprocedural and six-month results of TAVI using the CoreValve prosthesis from a multicentre registry in Australia and New Zealand.

Background: The association of lipoprotein (a) level with cardiovascular disease (CVD), coronary calcification and traditional risk factors has not been fully defined. This study aimed to examine the relationship between Lp(a), coronary calcium score (CACS) and risk factors in a cohort of patients undergoing CT coronary angiography.

AIMS:New Zealand (NZ) patients are recommended to undergo an 'adjusted' Framingham score to assess their cardiovascular (CVS) risk. The current (2009) NZ CVS Risk Guideline does not recommend the use of a 'calcium score' as an additional risk tool, although it has been shown to be powerfully predictive of CVS events above the predictive power of traditional Framingham risk factors. Calcium scores of >400 are very strongly predictive of a future CVS event and give direct evidence of atheromatous disease in the coronary circulation. Identification of people with advanced, premature coronary atheroma would allow early treatment of those who may benefit from more vigorous preventative strategies, including statin therapy.METHODS:Using a prospectively acquired, comprehensive database we audited the first 1000 patients (7 August 2006 to 28 November 2008) to undergo a 64-slice computed tomographic (CT) cardiac angiogram (GE Light Speed), which included a scan for a 'calcium score', at the Mercy Hospital, Auckland. We excluded 58 patients who had experienced one or more of a previous myocardial infarction (MI) (n=21), coronary artery bypass graft (CABG) surgery (n=15), percutaneous coronary intervention (PCI) (n=13) or stroke (n=21) and who therefore already had definite evidence of vascular disease and would be automatically placed in a high risk strata. We calculated each patient's Framingham risk from the original 'Anderson' equation, used by the 1996 NZ CVS risk Guideline, and the 'adjusted' Framingham 5-year CVS risk using the NZ Guidelines Group 2003/2009 recommendations, and then compared this with the observed calcium scores.RESULTS:The mean patient age was 56 (SD 9) years; 364 (39%) patients were female, 82% patients were Caucasian. 41% were current (4.6%) or previous (36%) cigarette smokers, 35% had a history of hypertension, 44% hyperlipidaemia and 5.6% had diabetes mellitus. The percentage of patients at 'low' 5-Year CVS risk (0-10% 5-year risk), using the 1996 and 2003/2009 guideline methods, was 78% and 58% respectively. Of patients in these Framingham 'low-risk' groups, 10% and 8.8% had a calcium score of >400 Agatston units, indicating that they were actually at very high CVS risk, and 203 (28%) and 147 (27%) respectively had a calcium score of >100 Agatston units, indicating that they were actually at 'high risk' and not 'low risk'.CONCLUSION:Approximately 10% to 27% of patients with a low CVS risk as assessed by the established Framingham equation have a markedly increased calcium score and hence a significantly increased risk of a CVS event. Currently promoted methods of risk assessment may be inadvertently, falsely re-assuring these patients. Clinicians managing patients may consider a calcium score as an additional tool to the standard risk assessment strategies.

Background: Transcatheter aortic valve implantation (TAVI) is now an established treatment for patients with severe symptomatic aortic stenosis (AS) who are not operative candidates or at very high surgical risk. This study summarises our single centre experience in 47 consecutive patients undergoing TAVI with either the CoreValve or Edwards Sapien devices.

Background: Computed tomography coronary angiography (CTCA) is proving to be a powerful technique to detect the presence of coronary artery disease and guide patient management. Concerns regarding the total radiation dose received by patients (pts) have led to new protocols designed to lower the radiation dose.

Background: Computed tomography coronary angiography (CTCA) is a powerful technique to detect coronary artery disease. Concerns regarding the total radiation dose of CTCA has led to new protocols designed to lower the dose.

Background: A strong family history (FH) of cardiovascular (CVS) disease increases a patients (pts) relative risk of CVS disease by 50–100%. Calcium scores are strongly predictive of a CVS event.

生物可吸收支架较金属药物洗脱支架(DES)有可能减少晚期支架内血栓(ST)的发生,因不存在外源性的金属材料和血液相接触,所以不必顾虑血管内皮化延迟或不完全.此外,永久置入的金属支架会影响外科血运重建,堵塞边支血管,妨碍血管的扩张性重塑和血管舒缩反应,还将影响非介人性检查如冠脉多层CT和MRI的成像.

Background: Surgical aortic valve replacement is the standard of care for symptomatic patients (pts) with severe AS. For inoperable or very high risk patients, percutaneous aortic valve replacement (PAVR) is now an option. This study summarises our single centre experience in the first 16 pts who underwent PAVR using a CoreValve® revalving system, consisting of a self-expanding multi-level nitinol frame with a tri-leaflet porcine pericardial valve.

Background: Cardiac imaging by 64-slice computed tomography (CT) is a powerful new tool to assess cardiac anatomy and guide patient (pt) management in various heart conditions. Our programme has an ongoing commitment to audit and feedback of results. Our experience from the initial 500 pts are presented.

Background: The incidence of significant non-cardiac findings which may alter management in patients undergoing CT coronary angiography varies depending on the population being studied.

Background: Cardiac imaging by 64-slice computed tomography (CT) is a powerful new tool to assess cardiac anatomy and guide patient (pt) management in various heart conditions. Quality assurance is required with ongoing audit of procedures, to assess risks and outcomes.

The aim of this first‐in‐human study was to evaluate the feasibility and safety of the novel AST petal side‐access bifurcation stent. Outcomes following percutaneous coronary intervention for bifurcations remain inferior to those of nonbifurcated lesions. Even with drug‐eluting stents, restenosis occurs especially at the side‐branch (SB) ostium. The petal stent uniquely deploys strut elements into the SB, supporting the ostium and carina. The primary endpoint of this 13‐patient prospective registry was in‐hospital major adverse cardiac events (MACE). Secondary end points included acute minimum lumen diameter (MLD) at the SB ostium, lesion success, device success, procedural success, 30‐day MACE, and 4‐month SB ostial MLD. The study lesion was successfully treated in 13 patients with the study stent being successfully implanted in 12. Target lesions were left anterior descending coronary artery in nine subjects, left circumflex in three, and right coronary artery in one. In‐hospital MACE were limited to two non‐Q‐wave myocardial infarctions. In‐stent main branch MLD increased from a mean of 0.63 ± 0.45 mm to 2.61 ± 0.47 mm at the index procedure and for this initial bare metal version of the stent, 4‐month mean MLD measured 1.02 ± 0.42mm and there was target vessel revascularization on two patients. The feasibility of safely deploying this first‐generation petal stent was demonstrated in selected patients with challenging coronary bifurcation lesions. It is a promising platform for drug delivery, with unique scaffolding of the side‐branch ostium. © 2007 Wiley‐Liss, Inc.

OBJECTIVE:We sought to define clinical and angiographic variables that may predict patients and lesions at increased risk for distal embolism during percutaneous intervention (PCI), as assessed by debris retrieval from a distal-protection filter device.BACKGROUND:Distal thrombo- and atheroembolism may contribute to periprocedural myocardial necrosis during PCI, which may in turn affect long-term outcomes. Distal protection devices have been used to reduce this occurrence with variable outcomes depending on lesion and patient subsets.METHODS:194 consecutive patients in whom the FilterWire(R) device (FW) [Boston Scientific Corp., Natick, MA] was used for native coronary vessel (n =129) or vein graft (n = 65) PCI were studied. FW debris was visually analyzed using a semi-quantitative grading score. Patients with "significant" debris (particles > or = 1 mm diameter) were compared with those with "nonsignificant" debris (no debris or particles <1 mm) with respect to clinical (age, gender, coronary disease risk factors, clinical presentation, periprocedural medications), and angiographic (vessel treated, vessel size, lesion length, lesion characteristics, angiographic thrombus and TIMI flow before and after PCI) variables.RESULTS:Significant debris was retrieved in 55% of patients, more frequently from vein graft (69%) than native vessel lesions (48%, p = 0.006). No clinical characteristics predicted significant debris retrieval. Angiographic predictors of significant debris by multivariate analysis were longer stent length and final TIMI flow <3 (p = 0.009 and 0.007, respectively).CONCLUSION:Longer stent length, likely reflecting increased lesion length and plaque burden, predicted significant distal embolism during PCI in native vessel and vein graft lesions, as assessed by debris collected in a distal vascular protection device. This suggests that use of vascular protection devices should be considered during PCI of long lesions.