INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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Few Differences Between PES and SES in "Real-World" Registry.
The STENT (Strategic Transcatheter Evaluation of New Therapies) registry is the first multicenter registry in the U.S. to collect long-term outcomes of drug-eluting stents from "real-world" practice. In this prospective, nonrandomized cohort of almost 10,000 procedures, the choice of a paclitaxel-eluting stent (PES) or a sirolimus-eluting stent (SES) was at the discretion of the physician. Nine-month outcomes for death, myocardial infarction, target vessel revascularization, and stent thrombosis were nearly identical and statistically equal for PES and SES. The results of this "real-world" study show that clinical restenosis and major adverse cardiac events following PES and SES procedures are infrequent and similar at 9 months. See page 1214.
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Acute Myocardial Infarction
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IVUS Detected Plaque Rupture Associated With Larger MIs.
Kusama and colleagues performed intravascular ultrasound (IVUS) in patients with first anterior acute myocardial infarction (MI) who were reperfused within 6 h to determine the impact of culprit plaque morphology on infarct size. Patients with plaque rupture were 5 times more likely to have no-reflow, had larger MIs, and had lower ejection fractions than those with no detectable plaque rupture. This suggests that embolization of plaque material may contribute to the progression of myocardial damage in patients with anterior acute MI. See page 1230.
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Acute Myocardial Infarction
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Low GFR Predicts More Left Ventricular Hypertrophy, Worse Outcomes in Post-MI Patients.
Verma and colleagues reanalyzed data collected from the VALIANT (VALsartan In Acute myocardial INfarcTion) trial to quantify the effect of renal dysfunction on echocardiographic and clinical variables in patients after a first myocardial infarction (MI). Subjects with reduced estimated glomerular filtration rate (GFR) had larger left atrial (LA) volumes and a higher left ventricular mass index (LVMI), but there were no differences in infarct size or ejection fraction. Glomerular filtration rate, LA volume, and LVMI were all associated with an increased risk of major adverse cardiac events in a multivariable model. Thus, reduced systolic function alone does not account for an increased risk of cardiovascular mortality in post-MI patients with impaired renal function. See page 1238.
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Heart Rhythm Disorders
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Upgrade to CRT Reduces Frequency of Atrial Tachyarrhythmias.
Yannopoulos and colleagues hypothesized that cardiac resynchronization therapy (CRT) may reduce the frequency and severity of atrial tachyarrythmias (ATs). The frequency of device-detected AT for the year prior to CRT was compared with the subsequent 2 years for patients in whom worsening heart failure (HF) resulted in an upgrade from conventional dual-chamber implantable pacemaker or cardioverter-defibrillator (ICD) to CRT. Within 3 months following CRT, the frequency of AT decreased significantly and further declined with time, with 90% of subjects being free from AT at 1 year. This analysis suggests that upgrading from an ICD to CRT may significantly reduce the frequency of AT and result in fewer hospitalizations for HF and atrial arrhythmias. See page 1246. See figure.
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Interventional Cardiology
Acute Myocardial Infarction