INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Focus Issue: Drug-Eluting Stents and Thrombosis
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No Late Risk for Stent Thrombosis Seen With DES STEMI.
Some analyses have suggested that drug-eluting stents have higher rates of stent thrombosis when used for ST-segment elevation myocardial infarctions (STEMIs). The STRATEGY trial randomized 175 patients with STEMI to either tirofiban followed by sirolimus-eluting stent (SES) or abciximab plus bare-metal stent (BMS). Over 2 years of follow-up, the incidence of death, MI, or target vessel revascularization was lower in the SES compared with the BMS group (hazard ratio 0.56), mainly driven by the lower rate of target vessel revascularization (hazard ratio 0.34). Despite discontinuing thienopyridine use after an average of 6 months, there were no differences in the rates of confirmed, probable, or possible stent thrombosis, either early or late. An accompanying editorial reviews the evidence for the risk of stent thrombosis with DES for STEMI and concludes that there is no increased risk seen in randomized trials. See pages 138
and 146
. See figure.
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Coronary Artery Disease Risk
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MPO Predictive of Future Cardiac Events in Healthy Individuals.
Myeloperoxidase (MPO) exerts many effects that may be proatherogenic, including oxidation of low-density lipoprotein, oxidative modification of apolipoprotein A1, and reducing nitric oxide bioavailability. Meuwese and colleagues measured MPO in baseline serum samples from a subgroup of the EPIC-Norfolk population study. Cases were defined as apparently healthy men and women, who developed coronary artery disease (CAD) during 8-years of follow-up. Controls were matched for age, gender, and enrollment time and remained free of CAD. Myeloperoxidase levels were significantly higher in cases than in controls. Risk of future CAD increased in consecutive quartiles of MPO concentration, with an odds ratio (OR) of 1.49 in the top versus bottom quartile and an OR of 1.82 for fatal CAD. This study further validates the use of MPO to assess cardiac risk and extends its potential utility to apparently healthy individuals. See page 159
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Heart Rhythm Disorders
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Predictive Value of Microvolt T-Wave Alternans in High-Risk Patients.
Microvolt T-wave alternans (TWA) is an emerging technique to identify patients at risk for sudden cardiac death. Cantillon and colleagues compared the ability of TWA and traditional electrophysiologic testing (EPS) to predict arrhythmia-free survival and total mortality in patients with an ejection fraction  35% and a history of either nonsustained ventricular tachycardia and/or syncope. Arrhythmia-free survival in TWA-negative patients was 81% versus 66% in subjects with non-negative TWA study. The negative predictive value of TWA for 2-year mortality was 90% versus 83% for EPS. An editorial by Klingenheben proposes that the predictive efficacy of the TWA is largely dependent on the patient population studied and cautions that recommendations regarding the clinical use of TWA need to be based on trials in well-defined patient populations. See pages 166
and 174
. See figure.
Related Articles
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Two-Year Clinical Follow-Up After Sirolimus-Eluting Versus Bare-Metal Stent Implantation Assisted by Systematic Glycoprotein IIb/IIIa Inhibitor Infusion in Patients With Myocardial Infarction: Results From the STRATEGY Study
- Marco Valgimigli, Gianluca Campo, Chiara Arcozzi, Patrizia Malagutti, Roberto Carletti, Fabrizio Ferrari, Dario Barbieri, Giovanni Parrinello, Gianfranco Percoco, and Roberto Ferrari
J. Am. Coll. Cardiol. 2007 50: 138-145.
[Abstract]
[Full Text]
[PDF]
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Drug-Eluting Stents: Is Their Future as Bright as Their Past?
- Adnan Kastrati and Albert Schömig
J. Am. Coll. Cardiol. 2007 50: 146-148.
[Full Text]
[PDF]
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Serum Myeloperoxidase Levels Are Associated With the Future Risk of Coronary Artery Disease in Apparently Healthy Individuals: The EPIC-Norfolk Prospective Population Study
- Marijn C. Meuwese, Erik S.G. Stroes, Stanley L. Hazen, Joram N. van Miert, Jan Albert Kuivenhoven, Robert G. Schaub, Nicholas J. Wareham, Robert Luben, John J.P. Kastelein, Kay-Tee Khaw, and S. Matthijs Boekholdt
J. Am. Coll. Cardiol. 2007 50: 159-165.
[Abstract]
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Predictive Value of Microvolt T-Wave Alternans in Patients With Left Ventricular Dysfunction
- Daniel J. Cantillon, Kenneth M. Stein, Steven M. Markowitz, Suneet Mittal, Bindi K. Shah, Daniel P. Morin, Eran S. Zacks, Matthew Janik, Shaun Ageno, Andreas C. Mauer, Bruce B. Lerman, and Sei Iwai
J. Am. Coll. Cardiol. 2007 50: 166-173.
[Abstract]
[Full Text]
[PDF]
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Microvolt T-Wave Alternans for Arrhythmia Risk Stratification in Left Ventricular Dysfunction: Which Patients Benefit?
- Thomas Klingenheben
J. Am. Coll. Cardiol. 2007 50: 174-175.
[Full Text]
[PDF]
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Focus Issue: Drug-Eluting Stents...
Coronary Artery Disease Risk
