INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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Pretreatment Platelet Reactivity Predicts Subsequent Clinical Outcomes in STEMI.
While reduced responsiveness to clopidogrel seems to correlate with subsequent outcomes, there is less data available regarding baseline platelet reactivity. This substudy of the STRATEGY trial compared platelet reactivity prior to treatment, after glycoprotein IIb/IIIa inhibitor bolus, and predischarge with outcomes over the next year. Pretreatment platelet reactivity was higher in ST-segment elevation myocardial infarction (STEMI) patients than in control patients, and correlated directly with the peak creatine kinase measurements and with the risk of TIMI flow grade <3 at the end of the percutaneous coronary intervention. This increased risk remained throughout the first year after STEMI. This study suggests that baseline platelet reactivity can identify those at greatest risk for poor outcomes after STEMI. See page 2178. See figure.
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Myocardial Infarction and Depression
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Understanding Post-MI Depression and Cardiac Risk.
Previous studies have suggested an increased risk for cardiac events in patients with clinical depression after a myocardial infarction (MI). Many believe that beta-blockers may induce or worsen depression, and this may hinder their use in post-MI patients. The first study compared the rate for developing depression among those prescribed or not-prescribed beta-blockers after an MI. Overall, there was no relationship between beta-blocker use and the presence of depressive symptoms, though there was a trend towards increased depression in those with high-dose or long-term beta-blocker usage. The second study followed nearly 500 post-MI patients for a mean of 2.5 years. Depression developed in approximately 20% of these patients, half of whom had a previous history of depression. Compared to non-depressed patients, those with an incident depression had an increased risk of cardiovascular events (hazard ratio 1.65), but those without a previous history of depression did not. See pages 2204, 2209, and 2215. See figure.
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Heart Rhythm Disorders
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T-Wave Alternans in Post-MI Patients With Normal EF.
Microvolt T-wave alternans (MTWA) has been found to be useful in identifying low ejection fraction (EF) patients at increased risk of ventricular arrhythmias. Ikeda and colleagues wanted to extrapolate these finding for those with preserved EF. Over 1,000 Japanese myocardial infarction (MI) survivors underwent an MTWA study and were followed for 3 years, during which time 2% suffered either a fatal or potentially fatal arrhythmia. The hazard ratio was almost 20 for those who had a positive MTWA. This study and the accompanying editorial by Klingenheben suggest that MTWA may be useful in patients with preserved EF in order to identify those patients most in need of aggressive post-MI therapies. See pages 2268 and 2275. See figure.
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Cardiac Imaging
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Reproducibility of MRI Observations for ARVD.
There is debate about the most useful magnetic resonance imaging (MRI) based criteria for arrhythmogenic right ventricular dysplasia (ARVD) because many of these measurements rely on qualitative assessments. Tandri and colleagues studied the reproducibility and diagnostic accuracy of MRI by comparing the results obtained from two different MRI readers analyzing the same scans. Overall, there was good agreement between the readers for all measures except for fat infiltration. This study suggests that qualitative assessments based on MRI of the right ventricle are reproducible, but more work is needed before any one criterion can be relied upon for the diagnosis. See page 2277. See figure.
Related Article
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Value of Platelet Reactivity in Predicting Response to Treatment and Clinical Outcome in Patients Undergoing Primary Coronary Intervention: Insights Into the STRATEGY Study
- Gianluca Campo, Marco Valgimigli, Donato Gemmati, Gianfranco Percoco, Silvia Tognazzo, Giordano Cicchitelli, Linda Catozzi, Patrizia Malagutti, Maurizio Anselmi, Corrado Vassanelli, Gianluigi Scapoli, and Roberto Ferrari
J. Am. Coll. Cardiol. 2006 48: 2178-2185.
[Abstract]
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Interventional Cardiology
Myocardial Infarction and...
