INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Clinical Trial
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SES Superior to BMS in Diabetics.
The SCORPIUS study is the largest multicenter, randomized study in diabetic patients comparing sirolimus-eluting stents (SES) versus bare-metal stents (BMS). Two hundred patients with diabetes were randomized to SES or BMS with angiographic follow-up at 8 months. Both in-segment restenosis (>50%) and target lesion revascularization (TLR) were 4 times more likely to occur with BMS than SES. The SES is safe and effectively reduces clinical and angiographic restenosis in diabetics. See page 1627. See figure.
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Interventional Cardiology
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Plaque Necrotic Core Volume Predicts Risk of Distal Embolization.
In this issue, two articles examine the relationship between plaque composition, assessed by Virtual Histology intravascular ultrasound (VH-IVUS), and the risk of distal embolization. In the first study, 71 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI) were evaluated for ST-segment re-elevation as a marker of distal embolization. The necrotic core volume in the culprit lesion was the major predictor of distal embolization. In the second study, 44 patients with angina undergoing PCI were evaluated for high-intensity transient signals using a Doppler guidewire in the distal vessel. Similarly, the necrotic core size by VH-IVUS before PCI was an independent predictor of distal embolization. An accompanying editorial stresses that these findings may help us to understand distal embolization but offer little information on how to prevent it. See pages 1635,
1641,
and
1647. See figure.
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Coronary Artery Disease
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Statins Protective for Vascular Surgery.
Feringa and colleagues tested the hypothesis that statins are cardioprotective in patients undergoing vascular surgery. In a prospective study of 359 patients, statin dose and cholesterol levels were recorded before surgery. In multivariate analysis, lower low-density lipoprotein (LDL) cholesterol correlated with less frequent myocardial ischemia, troponin T release, 30-day cardiac events, and late cardiac events. Higher statin doses (expressed as percentage of maximum recommended therapeutic dose) also correlated with these outcomes, even after adjusting for LDL cholesterol. These results suggest that statins are cardioprotective for patients undergoing major vascular surgery, both directly by lowering LDL cholesterol and possibly through pleiotropic effects. See page 1649. See figure.
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Heart Failure
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Intravenous Iron Improves EF, Symptoms, and BNP.
Forty subjects with ejection fraction <35%, hemoglobin <12.5 g/dl, and iron saturation <20% were randomized to 5 weekly infusions of iron sucrose complex (ISC) or placebo. Six months later, those who had received ISC had higher ejection fractions and lower brain natriuretic peptide (BNP) levels. They also had a higher New York Heart Association functional class, fewer hospitalizations, and improved creatinine clearance. This study suggests that treating iron deficiency with ISC can substantially improve a patient’s symptoms, as well as several markers of disease severity. See page 1657. See figure.
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The Relationship Between Coronary Plaque Characteristics and Small Embolic Particles During Coronary Stent Implantation
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Intensity of Statin Therapy in Relation to Myocardial Ischemia, Troponin T Release, and Clinical Cardiac Outcome in Patients Undergoing Major Vascular Surgery
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Usefulness of Virtual Histology Intravascular Ultrasound to Predict Distal Embolization for ST-Segment Elevation Myocardial Infarction
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Intravenous Iron Reduces NT-Pro-Brain Natriuretic Peptide in Anemic Patients With Chronic Heart Failure and Renal Insufficiency
- Jorge Eduardo Toblli, Alejandra Lombraña, Patricio Duarte, and Federico Di Gennaro
J. Am. Coll. Cardiol. 2007 50: 1657-1665.
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Distal Embolization After Percutaneous Coronary Interventions: Prediction, Prevention, and Relevance
- Prediman K. Shah
J. Am. Coll. Cardiol. 2007 50: 1647-1648.
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One-Year Results of the SCORPIUS Study: A German Multicenter Investigation on the Effectiveness of Sirolimus-Eluting Stents in Diabetic Patients
- Dietrich Baumgart, Volker Klauss, Frank Baer, Franz Hartmann, Helmut Drexler, Wolfgang Motz, Heinrich Klues, Stefan Hofmann, Wolfgang Völker, Thomas Pfannebecker, Hans-Peter Stoll, Georg Nickenig for the SCORPIUS Study Investigators
J. Am. Coll. Cardiol. 2007 50: 1627-1634.
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