INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Focus Issue: Substudies From ExTRACT-TIMI 25
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Enoxaparin Superior to Unfractionated Heparin in Patients Treated With Fibrinolytics.
The ExTRACT-TIMI 25 study compared a strategy of enoxaparin (ENOX) with unfractionated heparin (UFH) as adjunctive therapy for fibrinolysis among more than 20,000 ST-segment elevation myocardial infarction (MI) patients. Two papers in this issue delve further into these results by comparing outcomes in those who subsequently underwent percutaneous coronary intervention (PCI) and those treated concomitantly with clopidogrel. Compared with UFH, ENOX was associated with both delayed onset and reduced recurrence of MI and improved outcomes in those who did undergo PCI. In patients also treated with clopidogrel, ENOX significantly reduced the rate of the composite of death, recurrent MI, myocardial ischemia, or stroke, with only a slight, statistically insignificant increased rate of bleeding. These 2 studies expand our understanding of the benefits of ENOX over UFH in 2 subgroups of postfibrinolysis patients; ENOX is superior in patients likely to undergo PCI and is also superior in patients treated with clopidogrel. See pages 2238 and 2256. See figure.
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Coronary Artery Disease
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Positive Arterial Remodeling Found in Culprit Lesions.
Toutouzas and colleagues used intravascular ultrasound and intracoronary thermography to investigate the morphological and functional characteristics of culprit lesions in patients with acute coronary syndromes (ACS) and chronic stable angina. Patients with ACS were more likely to have positive arterial remodeling and higher plaque temperatures. There was also a correlation between the presence of ruptured plaque fissures and temperature. This study seems to demonstrate that the inflammation in atherosclerotic lesions can lead not only to plaque rupture, but also to positive arterial remodeling. See page 2264. See figure.
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Preclinical Study
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Biodegradable Patch Improves Post-MI Cardiac Remodeling.
Myocardial infarction induces loss of contractile mass and scar formation resulting in adverse left ventricular (LV) remodeling. Fujimoto and colleagues hypothesized that an elastic, biodegradable polyester urethane urea (PEUU) patch could improve cardiac remodeling. A small PEUU patch was surgically implanted to the exterior myocardium 2 weeks postinfarct in a rat model. The patch prevented LV end-diastolic dilation. Furthermore, the PEUU patch was largely resorbed after 8 weeks and histologic examination revealed that there were abundant smooth muscle bundles with a mature contractile phenotype in the area of the patch. This PEUU patch appears to improve cardiac remodeling and stimulate smooth muscle tissue formation which should further improve contractile function in post-myocardial infarction patients. See page 2292. See figure.
Related Articles
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Percutaneous Coronary Intervention in Patients Receiving Enoxaparin or Unfractionated Heparin After Fibrinolytic Therapy for ST-Segment Elevation Myocardial Infarction in the ExTRACT-TIMI 25 Trial
- C. Michael Gibson, Sabina A. Murphy, Gilles Montalescot, David A. Morrow, Diego Ardissino, Marc Cohen, Dietrich C. Gulba, Oscar H. Kracoff, Basil S. Lewis, Nathan Roguin, Elliott M. Antman, Eugene Braunwald for the ExTRACT-TIMI 25 Investigators
J. Am. Coll. Cardiol. 2007 49: 2238-2246.
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Efficacy and Safety of Enoxaparin Versus Unfractionated Heparin in Patients With ST-Segment Elevation Myocardial Infarction Also Treated With Clopidogrel
- Marc S. Sabatine, David A. Morrow, Anthony Dalby, Mathias Pfisterer, Tibor Duris, Jose Lopez-Sendon, Sabina A. Murphy, Runlin Gao, Elliott M. Antman, Eugene Braunwald for the ExTRACT-TIMI 25 Investigators
J. Am. Coll. Cardiol. 2007 49: 2256-2263.
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Correlation Between Morphologic Characteristics and Local Temperature Differences in Culprit Lesions of Patients With Symptomatic Coronary Artery Disease
- Konstantinos Toutouzas, Andreas Synetos, Elli Stefanadi, Sophia Vaina, Virginia Markou, Manolis Vavuranakis, Eleftherios Tsiamis, Dimitrios Tousoulis, and Christodoulos Stefanadis
J. Am. Coll. Cardiol. 2007 49: 2264-2271.
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An Elastic, Biodegradable Cardiac Patch Induces Contractile Smooth Muscle and Improves Cardiac Remodeling and Function in Subacute Myocardial Infarction
- Kazuro L. Fujimoto, Kimimasa Tobita, W. David Merryman, Jianjun Guan, Nobuo Momoi, Donna B. Stolz, Michael S. Sacks, Bradley B. Keller, and William R. Wagner
J. Am. Coll. Cardiol. 2007 49: 2292-2300.
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Focus Issue: Substudies From...
Coronary Artery Disease
