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Clifford J Kavinsky

Publications and source records attributed to Clifford J Kavinsky.

11 recordsLinked to original sources
PubMed2005

Myocardial infarction after taking zolmitriptan.

We report the case of a patient with mild non-obstructive coronary artery disease who sustained an inferior wall myocardial infarction shortly after taking zolmitriptan as abortive therapy for migraine headaches. A Medline search was performed to review all reported cases of myocardial infarction related to migraine therapy with zolmitriptan and related medications. Zolmitriptan may cause myocardial infarction (MI) even in the absence of significant coronary artery disease.

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PubMed2004

Silent myocardial ischemia: concepts and controversies.

Silent myocardial ischemia is a relatively common, but poorly understood, clinical entity. The most accurate means of detecting silent myocardial ischemia and the precise treatment endpoints remain unclear. However, the amount of ischemic myocardium appears to correlate with the likelihood of future adverse cardiac events. Evidence suggests that patients at highest risk of severe myocardial ischemia, even in the absence of symptoms, derive the greatest benefit from an aggressive diagnostic and therapeutic approach. This paper reviews the diagnosis and treatment of silent myocardial ischemia, and its clinical implication in select patient groups: those without coronary artery disease, those with coronary artery disease, diabetic patients, postrevascularization patients, and women.

Angioplasty, Balloon↗
PubMed2004

Spontaneous coronary artery dissection.

Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute myocardial ischemia with complex pathophysiology. This paper reviews the major diagnostic and therapeutic issues of this rare but important disease. The diagnosis of SCAD should be strongly considered in any patient who presents with symptoms suggestive of acute myocardial ischemia, particularly in young subjects without traditional risk factors for coronary artery disease (especially in young women during the peripartum period or in association with oral contraceptive use). Urgent coronary angiography is indicated to establish the diagnosis and to determine the appropriate therapeutic approach. The decision to pursue medical management, percutaneous coronary intervention, or surgical revascularization is based primarily on the clinical presentation, extent of dissection, and amount of ischemic myocardium at risk.

Aortic Dissection↗
PubMed2003

Correlates of failure following treatment with Sr-90 beta irradiation for in-stent restenosis.

We sought to determine the correlates of failure following intracoronary radiation therapy (IRT) with Sr-90 using the Novoste Beta-Cath system for the treatment of in-stent restenosis (ISR) in a broad range of patients. IRT has been shown to be more efficacious compared to placebo for the treatment of ISR in large randomized trials. However, even in patients treated with IRT, major adverse cardiac events occur in approximately 20% of cases on follow-up. This trial sought to elucidate the correlates of failure following successful IRT for ISR. To determine the correlates of IRT failure, we retrospectively compared the demographics, lesion characteristics, and clinical outcomes of 102 consecutive patients with ISR treated with Sr-90 from September 1998 to July 2001. IRT failure was defined as death, myocardial infarction (MI), or target vessel revascularization (TVR) due to repeat ISR on follow-up. A comparison of the clinical and angiographic profile of IRT failures (n = 16) vs. IRT successes (n = 86) revealed that a history of smoking (75% vs. 40%; P = 0.012), current use of calcium channel blockers (84% vs. 45%; P = 0.013), ostial location of target lesion (44% vs. 16%; P = 0.020), and mean posttreatment minimal luminal diameter (MLD; 1.64 +/- 0.19 vs. 2.21 +/- 0.29 mm; P < 0.001), respectively, were correlated with failure using univariate analysis. After multivariate regression analysis, the correlates of failure that remained significant were treatment of an ostial lesion (OR = 31.2; 95% CI = 2.6-382.7; P = 0.007) and final posttreatment MLD (P < 0.001). Ostial location of target lesion and smaller posttreatment MLD are correlated with subsequent death, MI, and TVR following therapy with Sr-90 for ISR.

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PubMedDate not supplied

Clinical and angiographic profile of patients with markedly elevated coronary calcium scores (>or=1000) detected by electron beam computed tomography.

OBJECTIVE: The objective of this study was to determine the clinical and angiographic profile of patients with extremely high coronary artery calcium scores (CACS; >or=1000) by electron beam computed tomography (EBCT). METHODS: All patients at Rush University Medical Center who had a calcium score >or=1000 and a coronary angiogram performed from 1997 to 2002 were identified using a prospectively collected database. The baseline demographics, symptom status, and degree of coronary stenosis by angiography and subsequent rate of coronary intervention were compared with that of patients with calcium scores <1000. RESULTS: The clinical and angiographic profile of patients with severe coronary calcification, detected by EBCT, revealed that patients with scores >or=1000 had a significantly higher prevalence of coronary stenosis >or=50% compared with patients with scores <1000 (97% vs. 57%, P<.001). The group with CACS >or=1000 was more likely to be male (90% vs. 75%, P=.027) and was older (64+/-8 vs. 59+/-10, P=.001) compared with the group with less severe calcification. Although there was a significantly higher rate of luminal stenosis detected by coronary angiography in the cohort with CACS >or=1000, there was no difference in subsequent percutaneous coronary intervention (PCI) and utilization of intracoronary stents between the two groups. CONCLUSIONS: A markedly elevated coronary calcium score (>or=1000) is correlated with increasing age and is associated with an increased likelihood of coronary stenosis >or=50%. However, the decision to perform coronary angiography in patients with severe coronary calcification should not be based solely on these findings, but should remain primarily dependent on the degree of ischemia detected by clinical and functional assessment.

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PubMedDate not supplied

Clinical and angiographic outcomes of cardiac transplant patients treated with intracoronary beta-radiation for in-stent restenosis: a case series.

BACKGROUND: Vascular brachytherapy (VBT) is effective for the treatment of in-stent restenosis (ISR), however, the effect of VBT clinical and angiographic outcomes of patients with ISR who have undergone orthotopic heart transplantation (OHT) requires further study. METHODS: All OHT patients with ISR treated with VBT using the Novoste Beta-Cath System at Rush University Medical Center were identified, and the clinical and angiographic outcomes were evaluated. RESULTS: Four OHT patients with ISR who underwent VBT were identified. The mean age was 48.5 years, and the mean duration posttransplantation was 7.5 years. The mean reference coronary vessel diameter was 3.06 mm. The primary interventional device utilized prior to VBT was cutting balloon angioplasty (CBA) in 75% and percutaneous balloon angioplasty in 25%. The mean duration of follow-up after VBT was 11 months. There were no deaths attributable due to cardiac disease, no myocardial infarction, and no target vessel revascularization on follow-up. Overall survival during this period was 75%, with one mortality due to stroke 8 months after VBT. CONCLUSIONS: VBT for the treatment of ISR in patients who have undergone OHT appears safe and feasible and is associated with acceptable clinical and angiographic outcomes.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Clinical outcomes of patients treated with the cutting balloon and Sr-90 beta-irradiation for instent restenosis.

BACKGROUND: The cutting balloon (CB) is an emerging therapy for the treatment of instent restenosis (ISR), but its impact on the clinical outcomes of patients treated with intracoronary radiation therapy (IRT) with Sr-90 compared with conventional PTCA and IRT is not clearly defined. METHODS: We compared the baseline demographics, angiographic characteristics and clinical outcomes of 102 consecutive patients with ISR treated either with CB+IRT (n=45) or with conventional PTCA+IRT (n=57). The combined endpoint was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of death, myocardial infarction (MI) or target vessel revascularization (TVR) at 6 months. RESULTS: The CB+IRT group had a shorter mean lesion length (14.3+/-6.5 vs. 21.1+/-15.7, P=.009), and greater utilization of glycoprotein IIb/IIIa inhibitors during the procedure (48.9% vs. 26.3%, P=.02) compared to the PTCA+IRT group. There were no significant differences in the baseline demographics, angiographic and procedural results, or subsequent MACE at 6 months between the two groups. CONCLUSION: The strategy of CB+IRT using Sr-90 for ISR is associated with similar procedural and clinical outcomes compared to conventional PTCA+IRT. Further study is warranted to determine which patient subgroups would derive the most benefit from this approach.

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PubMedDate not supplied

Visual assessment of procedural results following treatment with Sr-90 beta-radiation for instent restenosis.

BACKGROUND: Visual assessment (VA) of postprocedural % diameter stenosis (DS) is used routinely in clinical practice to determine the adequacy of coronary intervention. Although VA has been shown to underestimate final %DS after balloon angioplasty compared to quantitative coronary angiography (QCA), the impact of this effect on clinical outcomes following treatment with intracoronary radiation therapy (IRT) with Sr-90 for instent restenosis (ISR) is unknown. METHODS: To determine the effect of VA on the rate of major adverse cardiac events (MACEs) after IRT for ISR, we compared the clinical outcomes of 102 consecutive patients based on postprocedural %DS by QCA vs. %DS by VA. MACE was defined as death, M1 or need for target vessel revascularization (TVR). RESULTS: MACE rates for the 102 consecutive patients grouped according to postprocedural %DS by QCA and VA were compared. The mean %DS by QCA was 30.7%, while the mean %DS by VA was 12.5%. The mean %DS by VA across the QCA subgroups were 13.67%, 10.71% and 13.37%, respectively (P = .244). Fifty-two patients (51.0%) had %DS > 30% by QCA with the highest MACE percentage occurring in this subgroup. CONCLUSION: VA underestimated the %DS compared to QCA, and it was associated with worse MACE following treatment with Sr-90 for ISR.

Beta Particles↗
PubMedDate not supplied

Predictors of late cardiac events following treatment with Sr-90 beta-irradiation for instent restenosis.

BACKGROUND: Intracoronary radiation therapy (IRT) with Sr-90 using the Novoste Beta-Cath system has been shown to be an effective therapy for instent restenosis (ISR), but the temporal occurrence of cardiac events and the predictors of late complications require further investigation. METHODS: We analyzed the demographics, lesion characteristics and clinical outcomes of 138 consecutive patients with ISR treated with IRT from September 1998 to March 2002. Major adverse cardiac events (MACE) were defined as death, myocardial infarction (MI) or target vessel revascularization (TVR). Characteristics of early (< or =8 months) and late (>8 months) failures were analyzed. RESULTS: Thirty-two (23.1%) of 138 patients had MACE on follow-up; 25% (8/32) of failures occurred late after treatment with IRT. A comparison of the clinical and angiographic profile of early and late failures using univariate analysis indicates no correlations to late failure following IRT. Duration to failure after IRT was 14.25+/-3.69 months in the late group compared to 4.63+/-2.86 months in the early group (P<.001). CONCLUSIONS: Late MACE after IRT with Sr-90 for ISR occur beyond the traditional period for clinical restenosis in 25% of cases and are difficult to predict. Further study is warranted to identify patients at risk for the development of late complications after IRT.

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