INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Myocardial Infarction
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Pre-Existing Depression Not Associated With Increased Risk Post-MI.
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Page 1838
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While some studies have detected a 2-fold higher mortality risk for depressed subjects following a myocardial infarction (MI), others have found no excess risk. Dickens and colleagues interviewed almost 600 subjects within 5 days of an MI, and assessed them for depression preceding this event. Subjects were then followed for at least 6 years, including a subsequent assessment of depression 1 year later. There was no evidence of increased risk among those who were depressed either before their index MI, or 12 months later. In fact, there were no deaths in subjects found to be depressed at both time points. This study finds that long-term depression does not increase post-MI mortality, although there a debate remains as to the significance of new onset depression in the weeks and months following an MI. See page 1834. See figure.
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White Cell Count and Cardiovascular Mortality
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White Blood Cell Count and Mortality.
The white blood cell (WBC) count is a crude measure of inflammation. Ruggiero and colleagues report on the relationship between WBC count and mortality between 1958 and 2002 in subjects recruited for the Baltimore Longitudinal Study of Aging. There has been a downward trend in WBC count over time, and this has correlated with a downward trend in overall and cardiovascular mortality. Above the threshold of 3,500 WBC/mm3, the estimated mortality risk was 11% higher per each increase of 1,000 WBC/mm3. This study provides important long-term information on trends in the WBC count, and further supports this ubiquitous measure for predicting subsequent risk. See page 1841.
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Heart Rhythm Disorders
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Identification and Treatment of Pacemaker Infections.
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Page 1857
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Infection of a permanent pacemaker or implantable cardioverter-defibrillator raises many management issues. Sohail and colleagues reviewed the records of almost 200 cases of cardiac device infections seen at the Mayo Clinic. Generator pocket infection and device-related endocarditis were the most common clinical presentations; coagulase-negative staphylococci and Staphylococcus aureus were the most commonly isolated pathogens. Almost 100% of patients underwent complete device removal, and 96% of patients were cured with both complete device removal and antibiotic administration. The authors conclude by proposing management guidelines for suspected cardiac device infections based on their experiences. See page 1851. See figure.
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Cardiac Imaging
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Coronary Calcium Score Predicts Long-Term Prognosis.
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Page 1865
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The appropriate role for coronary artery calcium (CAC) scores in risk stratification remains controversial. Budoff and colleagues report data from an observational cohort of over 25,000 asymptomatic individuals referred for CAC scanning and then followed for all-cause mortality over a mean of almost 7 years. The CAC was an independent predictor of mortality in a multivariable model controlling for age, gender, ethnicity, and cardiac risk factors. The relative risk for death was 63 times higher for a score >1,000 compared to a score of 0. An accompanying editorial wonders about the significance of these findings, especially the reduction in predictive power when age is added to the models as one of the variables. See pages 1860 and 1871. See figure.
Related Article
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Depression Is a Risk Factor for Mortality After Myocardial Infarction: Fact or Artifact?
- Chris Dickens, Linda McGowan, Carol Percival, Barbara Tomenson, Lawrence Cotter, Anthony Heagerty, and Francis Creed
J. Am. Coll. Cardiol. 2007 49: 1834-1840.
[Abstract]
[Full Text]
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Myocardial Infarction
White Cell Count and...