INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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DES Reduce Revascularization by 43% in Real-World Registry.
Abbott and colleagues investigated the effectiveness and safety of drug-eluting stents (DES) as used in routine clinical practice in North America. Patients in the Dynamic Registry, sponsored by the National Heart, Lung, and Blood Institute, who received at least one DES were compared with patients who received at least one bare-metal stent (BMS) prior to the introduction of DES. At 1 year, there was no difference in the cumulative rate of death or myocardial infarction. The rate of target vessel revascularization was 5.0% in DES and 9.2% in BMS patients, and similar reductions were observed in complex and simple lesion types. These findings support the use of DES compared with BMS in real-world experience. See page 2029. See figure.
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Coronary Artery Disease
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Pioglitazone Improves MBF in Patients With FCHL.
Familial combined hyperlipidemia (FCHL) is a complex genetic disorder characterized by high serum cholesterol, low high-density lipoprotein (HDL) cholesterol, insulin resistance, and premature coronary atherosclerosis. Naoumova and colleagues studied the effect of pioglitazone on serum lipid parameters and myocardial blood flow (MBF) and myocardial glucose utilization (MGU) using positron emission tomographic scanning in patients with FCHL. Subjects randomized to pioglitazone showed significant increases in MGU and resting MBF. These effects were accompanied by a 28% increase in HDL and a 35% decrease in serum insulin. In patients with FCHL, the addition of pioglitazone led to significant improvements in MGU and MBF, with a favorable effect on serum lipid and metabolic parameters. See page 2051.
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Biomarkers
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H-FABP Improves Risk Stratification in ACS Patients.
Heart-type fatty acid-binding protein (H-FABP) is released into the circulation following myocardial ischemia, possibly within as little as 15 min. The EMMACE-2 trial enrolled patients with suspected acute coronary syndrome (ACS), and H-FABP levels were measured 12 to 24 h after symptom onset. The all-cause 1-year mortality for subjects with H-FABP <5.8 µg/l was 2% versus 23% for patients above this level. This assay provided complementary information to measurement of troponin; no patients with low H-FABP and negative troponin levels died during the next 6 months. Heart-type fatty acid-binding protein predicts 1-year mortality after ACS and identifies high-risk patients in a manner that is additive to clinical risk factors and troponin. Heart-type fatty acid-binding protein may be able to detect myocardial ischemia with or without necrosis. See page 2061. See figure.
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Surgery for Congenital Disease
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Stress Testing Following Surgical Repair of Anomalous Coronary Arteries.
Anomalous aortic origin of a coronary artery that courses between the 2 great vessels (AAOCA) is a rare anomaly that carries an increased risk for sudden cardiac death. Brothers and colleagues measured the effectiveness of surgical repair to normalize cardiac perfusion by performing various modalities of stress testing. Twenty-four children who underwent AAOCA surgery underwent an exercise stress test, stress echocardiogram, and stress myocardial perfusion scans 1 year after surgical repair. One of 8 patients with repair of an anomalous left coronary artery had a stress test suggestive of inducible ischemia versus 50% of the anomalous right coronary artery patients. Abnormal stress testing occurs frequently after AAOCA repair, especially after anomalous right coronary artery repair. Further studies are needed to determine if an abnormal stress test confers a worse prognosis in this population. See page 2078.
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Hypertension
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Cigarette Smoking Modestly Increases Risk of Developing Hypertension.
The relationship between cigarette smoking and hypertension is poorly understood. Bowman and colleagues assessed the use of cigarettes in the 28,000 women who participated in the Women’s Health Study who did not have hypertension at baseline and who were then followed for 10 years. There was a trend between cigarette use and the development of hypertension that became statistically significant for those who smoked >15 cigarettes per day. The hazard ratio among women who smoked  25 cigarettes per day was 1.2. This study suggests that cigarette use does confer an increased risk for developing hypertension, although confounding risk factors cannot be excluded by this study design. See page 2085.
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Interventional Cardiology
Coronary Artery Disease
