Check out this cool app for improved teaching and communicating with your patients and colleagues.

http://www.drawmd.com/

Informative web site and nice article on OCT

http://www.hindawi.com/journals/crp/2011/312978/

Comments on the Ozaki study

Typical Japanese study.  Single center, non-randomized.  I have great respect for Professor Akasaka and his team.  I believe they are the most experienced OCT (Optical Coherence Tomography) team in the world.

No surprise that presence TCFA ( thin-cap fibroatheroma) is related to higher observation of MVO (microvascular obstruction).   I think OCT will change the management of coronary disease due to data like these.  Would love to see the NIH fund a outcome driven study with OCT.

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• Original Article

Thin-Cap Fibroatheroma as High Risk Plaque for Microvascular Obstruction in Patients With Acute Coronary Syndrome

1. Yuichi Ozaki, 
2. Atsushi Tanaka*, 
3. Takashi Tanimoto, 
4. Hironori Kitabata,
5. Manabu Kashiwagi, 
6. Takashi Kubo, 
7. Shigeho Takarada, 
8. Kohei Ishibashi,
9. Kenichi Komukai, 
10. Yasushi Ino, 
11. Kumiko Hirata, 
12. Masato Mizukoshi,
13. Toshio Imanishi and 
14. Takashi Akasaka

+Author Affiliations

1. Wakayama Medical University, Japan

1. ↵* Corresponding author; email: a-tanaka@wakayama-med.ac.jp

Abstract

Background—Plaque contents can cause microvascular impairment, which is an important determinant of clinical outcomes in patients with acute coronary syndrome (ACS). We hypothesized that percutaneous coronary intervention (PCI) for thin-cap fibroatheroma (TCFA) could easily disrupt the fibrous cap and expose the contents of plaque to coronary flow, possibly resulting in microvascular obstruction (MVO). The purpose of this study was to investigate whether TCFA was associated with MVO following PCI in patients with ACS.

Methods and Results—We enrolled 115 patients with ACS who were successfully recanalized with PCI. The patients were divided into a ruptured plaque group (n=59), a non-rupture with TCFA group (n=21), and a non-rupture and non-TCFA group (n=35) according to optical coherence tomography findings of the culprit lesion. Using contrast-enhanced magnetic resonance imaging, we assessed MVO. There were no statistically significant differences in patient's characteristics. The non-rupture with TCFA group more frequently presented MVO (ruptured plaque 27% vs. non-rupture with TCFA 43% vs. non-TCFA and non-rupture 9%, P=0.012). The prevalence of MVO increases as cap thickness decreases.

Conclusions—TCFA is more frequently associated with MVO following PCI. TCFA is a high-risk plaque for MVO following PCI in patients with ACS.

Healthcare reimbursement penalizes the have-not's

Boston Medical Center, like most city hospitals, serves a poor sector of the population.  75% of it's patients live below the poverty line.  They lost $25M last year, in part due to reduced federal and state support and low reimbursement rates.

On the flip side are institutions like Massachusetts General Hospital and its sister site, Brigham and Women's.  These more renowned (and profitable) hospitals get preferential treatment from insurers and get the highest reimbursement rates in the greater-Boston area.

Hey, I have a good idea!  Let's slash Medicare and Medicaid to the bone.  Then all those poor people will just die and stop costing all us other folks so much money.  What a messed up system.  We do need healthcare reform but not the kinds that are bandied about by our politicos.