INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
 |
Interventional Cardiology
|
|---|
SES Superior to PES in Patients With Small Vessel Disease.
The SIRTAX trial was a randomized controlled trial comparing the safety and efficacy of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES). In the overall study, SES provided lower late luminal loss, which translated into lower rates of clinical and angiographic restenosis. The current study examines the impact of vessel size on outcomes, notably <2.75 mm. In these small vessels, 2-year major adverse cardiac events (MACE) was 2 times higher in the PES group, driven chiefly by a 69% reduction in the risk of target lesion revascularization (TLR) in favor of SES. Compared with PES, SES more effectively reduce MACE and TLR in small-vessel disease. Differences between SES and PES appear less pronounced in patients with large- and mixed-vessel disease. See page 1123. See figure.
|
Antiplatelet Therapy
|
|---|
Poor Responders to Clopidogrel Respond Well to Ticlopidine.
Depending on the criteria, 10% to 30% of patients may be poor responders to clopidogrel. Campo and colleagues investigated whether or not this was a class effect with thienopyridines or was specific to clopidogrel by sequentially giving both drugs to patients and measuring platelet aggregation (PA). Clopidogrel and ticlopidine were equally effective in inhibiting PA, and about 20% of subjects were nonresponders to each medication. However, only 3.5% were nonresponders to both drugs. This study suggests that poor responsiveness to clopidogrel is due to a drug-specific mechanism, rather than a class effect of thienopyridines. See page 1132. See figure.
|
Heart Rhythm Disorders
|
|---|
Algorithm May Improve Risk Stratification for ICD Implantation.
Currently, most guidelines used to determine eligibility for implantable cardioverter-defibrillator (ICD) implantation rely solely on the measured ejection fraction (EF). Buxton and colleagues used data from the MUSTT study trial to examine the risk of total mortality and arrhythmic death associated with 25 variables. The variables having the greatest prognostic impact were functional class, history of heart failure, nonsustained ventricular tachycardia not related to bypass surgery, EF, age, left ventricular conduction abnormalities, inducible sustained ventricular tachycardia, enrollment as an inpatient, and atrial fibrillation. The model demonstrates that patients whose only risk factor is EF <30% have predicted 2-year arrhythmic death risk <5%. This model suggests that the risk of sudden death is related to multiple variables and suggests that this risk can be fairly easily calculated. See page 1150.
|
Cardiac Imaging
|
|---|
CCTA Predictive of All-Cause Mortality.
The prognostic value of identification of coronary artery disease (CAD) by computed tomographic coronary angiography (CCTA) has yet to be defined. Min and colleagues examined the risk of death from all causes by CCTA-defined extent and severity of CAD in over 1,100 patients. The CCTA measurements predictive of death included stenosis severity in the proximal left anterior descending artery and extent of CAD by number of vessels  50% and 70% stenosis. One-year mortality was 99.7% for patients with no stenosis >50% versus only 85% for those patients with 50% stenosis in the left main. In patients presenting with chest pain, CCTA identifies individuals at increased risk for all-cause death, and a negative CCTA portends an extremely low risk for death. See page 1161. See figure.
|
Cardiac Imaging
|
|---|
Robust Risk Stratification With Dipyridamole CMR.
Although cardiac magnetic resonance imaging (CMR) provides excellent spatial resolution, there is little agreement on the best imaging protocol to predict the risk of future cardiac events in patients with suspected coronary artery disease (CAD). Bodi and colleagues reviewed outcomes from 420 patients with chest pain and known or suspected CAD who underwent a standardized protocol that calculated the number of segments of abnormal wall motion at rest (AWM-rest), abnormal wall motion with dipyridamole (AWM-D), and delayed enhancement. Major adverse cardiac events were 4 to 5 times more frequent in patients with abnormalities in each of the parameters, with AWM-D proving the most robust predictor. Dipyridamole stress CMR appears to be useful for predicting the outcome of patients with known or suspected CAD. See page 1174. See figure.
|
Congenital Heart Disease
|
|---|
Percutaneous VSD Closure.
Butera and colleagues report their results in 104 patients who underwent percutaneous closure of a perimembranous ventricular septal defect (pmVSD) using an Amplatzer VSD device (muscular or eccentric) (AGA Medical Corp., Plymouth, Minnesota) . The attempt to place a device was successful in 96% of patients who were followed for 3 years. No deaths occurred, and the total occlusion rate was 84% at discharge and 99% during follow-up. A total of 13 early complications occurred (11.5%), but in all but 2 subjects (1.9%) these were transient and occurred in subjects <6 years old. This study suggests that VSDs can be safely and successfully closed percutaneously, although caution should be used in those <6 years of age, and patients should be monitored for developing heart block. See page 1189.
Related Articles
-
Impact of Vessel Size on Outcome After Implantation of Sirolimus-Eluting and Paclitaxel-Eluting Stents: A Subgroup Analysis of the SIRTAX Trial
- Mario Togni, Stéphanie Eber, Jeannette Widmer, Michael Billinger, Peter Wenaweser, Stéphane Cook, Rolf Vogel, Christian Seiler, Franz R. Eberli, Willibald Maier, Roberto Corti, Marco Roffi, Thomas F. Lüscher, Ali Garachemani, Otto M. Hess, Simon Wandel, Bernhard Meier, Peter Jüni, and Stephan Windecker
J. Am. Coll. Cardiol. 2007 50: 1123-1131.
[Abstract]
[Full Text]
[PDF]
-
Poor Responsiveness to Clopidogrel: Drug-Specific or Class-Effect Mechanism?: Evidence From a Clopidogrel-to-Ticlopidine Crossover Study
- Gianluca Campo, Marco Valgimigli, Donato Gemmati, Gianfranco Percoco, Linda Catozzi, Alice Frangione, Federica Federici, Fabrizio Ferrari, Matteo Tebaldi, Serena Luccarelli, Giovanni Parrinello, and Roberto Ferrari
J. Am. Coll. Cardiol. 2007 50: 1132-1137.
[Abstract]
[Full Text]
[PDF]
-
Limitations of Ejection Fraction for Prediction of Sudden Death Risk in Patients With Coronary Artery Disease: Lessons From the MUSTT Study
- Alfred E. Buxton, Kerry L. Lee, Gail E. Hafley, Luis A. Pires, John D. Fisher, Michael R. Gold, Mark E. Josephson, Michael H. Lehmann, Eric N. Prystowsky for the MUSTT Investigators
J. Am. Coll. Cardiol. 2007 50: 1150-1157.
[Abstract]
[Full Text]
[PDF]
-
Prognostic Value of Multidetector Coronary Computed Tomographic Angiography for Prediction of All-Cause Mortality
- James K. Min, Leslee J. Shaw, Richard B. Devereux, Peter M. Okin, Jonathan W. Weinsaft, Donald J. Russo, Nicholas J. Lippolis, Daniel S. Berman, and Tracy Q. Callister
J. Am. Coll. Cardiol. 2007 50: 1161-1170.
[Abstract]
[Full Text]
[PDF]
-
Prognostic Value of Dipyridamole Stress Cardiovascular Magnetic Resonance Imaging in Patients With Known or Suspected Coronary Artery Disease
- Vicente Bodi, Juan Sanchis, Maria P. Lopez-Lereu, Julio Nunez, Luis Mainar, Jose V. Monmeneu, Oliver Husser, Eloy Dominguez, Francisco J. Chorro, and Angel Llacer
J. Am. Coll. Cardiol. 2007 50: 1174-1179.
[Abstract]
[Full Text]
[PDF]
-
Transcatheter Closure of Perimembranous Ventricular Septal Defects: Early and Long-Term Results
- Gianfranco Butera, Mario Carminati, Massimo Chessa, Luciane Piazza, Angelo Micheletti, Diana Gabriella Negura, Raul Abella, Alessandro Giamberti, and Alessandro Frigiola
J. Am. Coll. Cardiol. 2007 50: 1189-1195.
[Abstract]
[Full Text]
[PDF]
|
Top
Interventional Cardiology
Antiplatelet Therapy
