INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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SES Superior to BMS for STEMI.
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Page 1929
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Some authors have postulated that drug-eluting stents (DES) may not be preferable to bare-metal stents (BMS) during acute myocardial infarctions because they may delay healing of the recently ruptured endothelium. The SESAMI trial randomized over 300 patients undergoing emergency percutaneous coronary intervention to either sirolimus-eluting stents (SES) or BMS. Sirolimus-eluting stents were found to significantly reduce the major study end points, with reductions of >50% for binary restenosis, target lesion revascularization, target vessel revascularization, and adverse cardiac events. This small study suggests that in patients with acute myocardial infarction, SES are superior to BMS. See page 1924. See figure.
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Cardiac Surgery
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Genetic Variations in CRP and P-Selectin May Protect Against Cognitive Dysfunction After CABG.
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Page 1938
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Postoperative cognitive decline (POCD) occurs in approximately one-third of patients who undergo bypass surgery. Mathew and colleagues compared the frequencies of several gene polymorphisms in patients who did or did not have evidence of POCD. Two gene variations seemed to affect the likelihood of POCD; one in the CRP gene and one in the P-selectin gene. Patients that had the minor allele for CRP were 3 times less likely to experience POCD; those with the less common form of P-selectin were only half as likely to have POCD. This study may help to identify patients at high or low risk for POCD and helps us to understand the pathophysiology of POCD. See page 1934. See figure.
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Heart Failure
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BNP Level Correlates With Risk of In-Hospital Mortality for Acute Decompensated Heart Failure.
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Page 1948
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Although serum levels of B-type natriuretic peptide (BNP) are known to correlate with long-term outcomes, it is unknown if they can be used to predict in-hospital mortality. Fonarow and colleagues analyzed BNP data from nearly 50,000 hospitalizations for acute decompensated heart failure. There was a linear relationship between BNP and in-hospital mortality for those with either preserved or reduced systolic function. The mortality rate was <2% for those with a BNP level <430 pg/ml and 6% for those with a BNP level >1,730 pg/ml. Thus, an elevated BNP level on admission is a significant predictor of in-hospital mortality. See page 1943. See figure.
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Heart Rhythm Disorders
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Implantable Loop Recorders May Be Cheaper for Diagnosing Palpitations.
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Page 1953
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Determining the etiology of infrequent palpitations can be frustrating and time-consuming. Giada and colleagues compared a conventional diagnostic strategy to one with expedited placement of an implantable loop recorder (ILR) in patients with unexplained, infrequent (<1 episode/month) palpitations. A diagnosis was obtained in only 21% of patients in the conventional strategy group versus 73% of subjects in the ILR group. Despite the higher initial cost, the cost per diagnosis in the ILR group was approximately 50% lower than in the conventional strategy group. This study suggests that ILRs may increase diagnostic accuracy when assessing patients with infrequent palpitations. See page 1951. See figure.
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Heart Disease in Children
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Evidence of Increased Oxidative Stress in Children With Hypercholesterolemia.
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Page 1978
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Martino and colleagues sought to gain understanding regarding the relationship between oxidative stress and atherosclerosis by studying the correlation between oxidative stress and cholesterol levels in children with or without hypercholesterolemia. Serum levels of 8-hydroxy-2'-deoxyguanosine, a marker of oxidative stress, and plasma levels of soluble CD40L were both highly correlated with cholesterol in children and adults. This study suggests that children with hypercholesterolemia have an early increase of oxidative stress that may be responsible for up-regulation of CD40L and potentially predisposes them to premature atherosclerosis. See page 1974. See figure.
Related Article
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Randomized Trial of Sirolimus-Eluting Stent Versus Bare-Metal Stent in Acute Myocardial Infarction (SESAMI)
- Maurizio Menichelli, Antonio Parma, Edoardo Pucci, Rosario Fiorilli, Francesco De Felice, Marco Nazzaro, Alessia Giulivi, Domenico Alborino, Arianna Azzellino, and Roberto Violini
J. Am. Coll. Cardiol. 2007 49: 1924-1930.
[Abstract]
[Full Text]
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Interventional Cardiology
Cardiac Surgery