INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Clinical Trial
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Fondaparinux Superior to Enoxaparin in ACS Patients Undergoing PCI.
The OASIS-5 trial demonstrated that the factor Xa inhibitor fondaparinux reduced major bleeding and improved 30-day mortality compared with enoxaparin in acute coronary syndrome (ACS) patients. This substudy compares the 2 medications in patients who underwent percutaneous coronary intervention (PCI) during the initial hospitalization. Fondaparinux was associated with a >50% reduction in major bleeding, with similar rates of ischemic events. However, there were rare cases of catheter-associated thrombosis when fondaparinux was used without unfractionated heparin during PCI. These data demonstrate that, in the context of an early invasive strategy, fondaparinux appears safer than enoxaparin, with the caveat that unfractionated heparin rather than intravenous fondaparinux be used as adjunctive therapy at the time of PCI. See page 1742.
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Myocardial Infarction
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Long-Term Mortality After Cardiogenic Shock.
Although cardiogenic shock is known to portend a high rate of early mortality following ST-segment elevation myocardial infarction (STEMI), less is known about the long-term effect on mortality. Singh and colleagues queried the Social Security database for patients enrolled in the GUSTO-I trial. In that trial, shock occurred in 8% of patients, 50% of whom died within the first 30 days. After excluding deaths within the first year, 2% to 4% of patients died each year, regardless of whether they experienced cardiogenic shock or not. The early mortality rate of STEMI complicated by cardiogenic shock is very high; however, those who survive for at least 1 year have similar survival rates as those who do not develop shock. See page 1752.. See figure.
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Myocardial Infarction
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Meta-Analysis of Cellular Therapy for AMI.
The intracoronary injection of either bone marrow cells or peripheral mononuclear cells is postulated to improve cardiac functional recovery after acute myocardial infarction (AMI), but the results of clinical studies have not been conclusive. Lipinksi and colleagues performed a meta-analysis of studies that randomized patients to either cellular injections or placebo within 14 days of AMI. There were 10 trials with almost 700 patients. Cellular therapy was associated with a modest but statistically significant increase in left ventricular ejection fraction of 3%, along with trends toward reduced death, re-hospitalization for heart failure, and repeat revascularization. This analysis of patients that received intracoronary cell therapy after AMI suggests statistically and clinically relevant benefits on cardiac function and remodeling. See page 1761. See figure.
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Coronary Artery Disease
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Novel Biomarker Links Inflammation, Platelet Adhesion, and CAD.
The F11 receptor (F11R) is expressed by both platelets and endothelial cells and has recently been demonstrated to foster platelet adhesion to cytokine-inflamed endothelial surfaces. Cavusoglu and colleagues developed an enzyme-linked immunosorbent assay for soluble F11R, which was then measured in nearly 400 patients undergoing angiography. Plasma F11R levels were independently associated with the presence and severity of coronary artery disease (CAD). These findings suggest that F11R may be an important mediator of the effects of inflammation on the vessel wall and may be a useful biomarker for grading cardiovascular risk. See page 1768. See figure.
Related Articles
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Efficacy and Safety of Fondaparinux Versus Enoxaparin in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: Results From the OASIS-5 Trial
- Shamir R. Mehta, Christopher B. Granger, John W. Eikelboom, Jean-Pierre Bassand, Lars Wallentin, David P. Faxon, Ron J.G. Peters, Andrzej Budaj, Rizwan Afzal, Susan Chrolavicius, Keith A.A. Fox, and Salim Yusuf
J. Am. Coll. Cardiol. 2007 50: 1742-1751.
[Abstract]
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Long-Term Outcome and its Predictors Among Patients With ST-Segment Elevation Myocardial Infarction Complicated by Shock: Insights From the GUSTO-I Trial
- Mandeep Singh, Jennifer White, David Hasdai, Patricia K. Hodgson, Peter B. Berger, Eric J. Topol, Robert M. Califf, and David R. Holmes, Jr
J. Am. Coll. Cardiol. 2007 50: 1752-1758.
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Impact of Intracoronary Cell Therapy on Left Ventricular Function in the Setting of Acute Myocardial Infarction: A Collaborative Systematic Review and Meta-Analysis of Controlled Clinical Trials
- Michael J. Lipinski, Giuseppe G.L. Biondi-Zoccai, Antonio Abbate, Reena Khianey, Imad Sheiban, Jozef Bartunek, Marc Vanderheyden, Hyo-Soo Kim, Hyun-Jae Kang, Bodo E. Strauer, and George W. Vetrovec
J. Am. Coll. Cardiol. 2007 50: 1761-1767.
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Association of Plasma Levels of F11 Receptor/Junctional Adhesion Molecule-A (F11R/JAM-A) With Human Atherosclerosis
- Erdal Cavusoglu, Elizabeth Kornecki, Malgorzata B. Sobocka, Anna Babinska, Yigal H. Ehrlich, Vineet Chopra, Sunitha Yanamadala, Cyril Ruwende, Moro O. Salifu, Luther T. Clark, Calvin Eng, David J. Pinsky, and Jonathan D. Marmur
J. Am. Coll. Cardiol. 2007 50: 1768-1776.
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