INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Clinical Trial
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Early Abciximab Improves TIMI Score for ST-Segment Elevation MIs.
Glycoprotein IIb/IIIa inhibitors improve myocardial reperfusion in patients with acute myocardial infarction (MI) but whether they should be started in the emergency room (ER) or after initial angiography remains unclear. Maioli and colleagues randomized approximately 200 patients presenting to their institution with acute MI to either abciximab in the ER or just before percutaneous coronary intervention (PCI). The average door-to-balloon time was similar in both groups (<90 min), but patients who received abciximab in the ER received it an average of 41 min earlier. This was associated with a nearly 3-fold greater likelihood of Thrombolysis In Myocardial Infarction (TIMI) flow grade 3, improved myocardial blush grade, and better left ventricular function. This study suggests that in patients with acute MI, early abciximab administration improves pre-PCI angiographic findings, post-PCI tissue perfusion, and left ventricular function, probably via early recanalization of the infarct-related artery. See page 1517.
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Myocardial Infarction
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Novel Biomarker Enhances the Prognostic Utility of BNP.
Adrenomedullin (ADM) is a 52 amino acid peptide originally isolated from human pheochromocytoma cells but subsequently found to be highly expressed in endothelial cells. Adrenomedullin signals through cyclic adenosine monophosphate and has biologic activity similar to B-type natriuretic peptide (BNP) causing vasodilation via production of nitric oxide, increasing cardiac output and inducing natriuresis. Khan and colleagues measured plasma levels of ADM in nearly 1,000 post-acute myocardial infarction patients, 3 to 5 days after chest pain onset. Adrenomedullin was higher in patients with poor outcomes; it was particularly useful in further risk stratifying subjects with elevated BNP. This study suggests that ADM is released into the circulation following acute myocardial infarction and may provide useful prognostic information, especially in those with elevated BNP levels. See page 1525. See figure.
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Atherosclerosis
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Metabolic Syndrome Linked to Carotid Inflammation.
Recent studies have demonstrated that [18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) can identify and quantify the degree of inflammation within carotid artery plaques. Tahara and colleagues studied over 200 patients referred for FDG-PET and measured several cardiac risk factors. The results revealed that waist circumference, use of hypertensive medication, low high-density lipoprotein cholesterol, insulin resistance, and high-sensitivity C-reactive protein were significant independent predictors of carotid inflammation. Furthermore, the number of components of the metabolic syndrome that a subject had was quantitatively related to the degree of inflammation. This study confirms that increased inflammation in carotid plaques is found in subjects with the components of the metabolic syndrome. See page 1533. See figure.
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Heart Disease in Women
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Comparing Female and Male Atherosclerotic Plaques With IVUS.
Most large-scale clinical trials have fewer female participants. Nicholls and colleagues compared female and male participants in the 3 large-scale trials that included serial intravascular ultrasound (IVUS) exams. Female participants in these studies had higher levels of body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, systolic blood pressure, and diastolic blood pressure. Despite this, females had less plaque in terms of percent atheroma volume (PAV) and total atheroma volume (TAV). With medical therapy, males and females had similar changes in both PAV and TAV. This study suggests that despite the presence of more risk factors, the extent of atheroma in females with angiographic coronary artery disease is less than in males, but there were no differences in the rates of plaque progression or regression, or in response to medical therapy. See page 1546.
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Pulmonary Vascular Disease
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Infusion of EPCs Helpful for Pulmonary Hypertension.
The etiology of idiopathic pulmonary arterial hypertension (IPAH) is poorly understood. Wang and colleagues hypothesized that infusion of autologous-derived endothelial progenitor cells (EPCs) might improve outcomes by restoring a healthy endothelium. Thirty-one subjects with IPAH were randomized to either EPC infusion or conventional therapy. After 12 weeks, the mean distance covered in the 6-min walk test increased by 48.2 m (nearly 20%) with EPC infusion versus only a 2% change in the conventional therapy group. There were also significant improvements in pulmonary vascular resistance and cardiac output; there were no obvious toxicities or adverse events related to the infusion. Autologous transplantion of EPCs may be a safe and effective therapy for IPAH, although larger and longer-term studies are clearly needed. See page 1566.
Related Article
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Randomized Early Versus Late Abciximab in Acute Myocardial Infarction Treated With Primary Coronary Intervention (RELAx-AMI Trial)
- Mauro Maioli, Francesco Bellandi, Mario Leoncini, Anna Toso, and Roberto Piero Dabizzi
J. Am. Coll. Cardiol. 2007 49: 1517-1524.
[Abstract]
[Full Text]
[PDF]
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Clinical Trial
Myocardial Infarction
