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Restenosis rate after stent implantation for short lesions can be predicted using the variables percent diameter stenosis after the procedure and vessel size. This meta-analysis indicates that the concept of "the bigger the better" holds true for coronary stent implantation. Applicability of the model beyond short lesions should be tested.

Resting echocardiography is the most important tool for diagnosing valvular heart disease. However, treatment planning in valvular heart diseases may require additional information in some patients, particularly asymptomatic patients with severe valve disease or symptomatic patients with moderate disease. Stress echocardiography provides invaluable information in these situations and aids decision making. Stress echocardiography is performed using either physical stress or dobutamine stress and various valve parameters are monitored during the stress. Further, the ventricular performance, which is an important determinant of outcome in valve disease is also closely monitored during stress which helps immensely in planning the intervention. Lastly, possibility of associated coronary artery disease can also be evaluated, especially in the elderly. This article discusses the role of stress evaluation in assessment of valve disease in the commonly encountered clinical situations.

Glycoprotein IIb/IIIa inhibitor PCI Safety a b s t r a c t Aims: The aim of the study was to assess the safety and efficacy of Bivalirudin þ Glycoprotein (Gp) IIb/IIIa inhibitor as compared to unfractionated Heparin (UFH) þ Gp IIb/IIIa inhibitor in high risk patients undergoing elective percutaneous coronary intervention (PCI). The primary end point was time to sheath removal and ambulation where as periprocedure myocardial damage, access site bleeding and major adverse cardiac events (MACE) rates were secondary end points.Methods: One hundred and one high risk patients undergoing elective PCI were randomly assigned to either Bivalirudin þ GpIIb/IIIa inhibitor or UFH þ Gp IIb/IIIa inhibitor. PCI was performed by standard technique and activated clotting time was monitored immediately on arrival to recovery area and every 60 min thereafter. Sheath were pulled out once ACT was below 150 seconds and patients were mobilized 6hrs after sheath were removed. Periprocedure myocardial damage was assessed by serial Trop I levels.Results: Patient assigned to Bivalirudin þ Tirofiban has significantly reduced time to sheath removal and ambulation as compared to those who received UFH þ tirofiban (p < 0.0001) although peak Act did not differ in the groups. Peak Trop I levels were significantly lower in Bivalirudin þ Tirofiban group (p ¼ 0.023) and peri-procedure Trop I elevation occurred in significantly lower number of patients treated with Bivalirudin þ Tirofiban (p ¼ 0.029). Conclusions:The combination of Bivalirudin þ Tirofiban was safe and effective as compared to UFH þ Tirofiban in high risk patients undergoing elective PCI.