INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Acute Coronary Syndromes
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Multivessel or Culprit-Only Stenting During ACS?.
During acute coronary syndromes, there is a prothrombotic state that may increase the likelihood of complications for stenting of nonculprit vessels. Shishehbor and colleagues studied a registry of 1,240 patients with multivessel disease presenting with acute coronary syndromes (ACS). Approximately 40% of patients had interventions on more than one artery during the initial procedure. Over a median follow-up of 2.3 years, multivessel stenting resulted in fewer revascularization procedures, but no significant differences in death or myocardial infarction, and similar periprocedural complications. This observational study suggests that mutlivessel stenting is safe during acute coronary syndromes and may be associated with fewer revascularization procedures. See page 849.
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Cardiac Imaging
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MSCT for Low-Risk Chest Pain Patients.
Goldstein and colleagues randomized patients with chest pain and low-risk clinical features to either immediate computed tomographic angiography or a standard chest pain protocol with serial biomarkers and eventual nuclear perfusion imaging. Multislice computed tomography (MSCT) immediately excluded or identified coronary disease as the source of chest pain in 75% of patients. The remaining 25% of patients required stress testing due to intermediate-severity lesions or nondiagnostic image quality. During the initial emergency department visit, MSCT reduced diagnostic time (3.4 vs. 15.0 h) and lowered costs ($1,586 vs. $1,872). Multislice computed tomography may be a faster and cheaper method for identifying the etiology of chest pain in low-risk patients in the emergency department. See page 863.
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Adult Congenital Heart Disease
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Hospitalization Patterns for Adults With Congenital Heart Disease.
An increasing percentage of infants with congenital heart disease (CHD) are surviving into adulthood, but little is known about their subsequent health status or use of health care resources. Gurvitz and colleagues obtained data on all hospital discharges in California for CHD patients aged 12 to 44. For patients <20 years of age, 70% of hospitalizations occurred at 12 hospitals, but there was less consolidation for those over 21 years. Those over 17 years of age were more likely to be admitted through the emergency department, as were those without private insurance. This study reveals considerable differences in hospitalization patterns for CHD surrounding the transition from adolescence to adulthood. See page 875. See figure.
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Metabolic Syndrome in Adolescents
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Criteria for Diagnosing the Metabolic Syndrome in Adolescents.
The metabolic syndrome describes a confluence of findings that translate into increased cardiovascular risk in adults. Jolliffe and Janssen sought to define criteria for the metabolic syndrome in those ages 12 to 19 years. Using data from the National Health and Nutrition Examination surveys, they developed standardized curves for waist circumference, blood pressure, high-density lipoprotein, and triglycerides. They then established cut-points for each of these criteria that corresponded to the criteria cut-points in adults. These age-specific criteria for diagnosing the metabolic syndrome may help to understand the magnitude of the risk associated with adolescent obesity. See page 891.
Related Article
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In Unstable Angina or Non–ST-Segment Acute Coronary Syndrome, Should Patients With Multivessel Coronary Artery Disease Undergo Multivessel or Culprit-Only Stenting?
- Mehdi H. Shishehbor, Michael S. Lauer, Inder M. Singh, Derek P. Chew, Juhana Karha, Sorin J. Brener, David J. Moliterno, Stephen G. Ellis, Eric J. Topol, and Deepak L. Bhatt
J. Am. Coll. Cardiol. 2007 49: 849-854.
[Abstract]
[Full Text]
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Acute Coronary Syndromes
Cardiac Imaging