INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Clinical Trials
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Hyperoxemic Therapy Not Positive for Primary End Point.
Experimental evidence suggests that supraphysiologic levels of oxygen may reduce reperfusion injury by decreasing tissue edema and preventing the formation of lipid peroxide radicals. The AMIHOT trial used a novel catheter-based system to deliver blood mixed with aqueous oxygen (AO) to the infarct-related artery in patients treated with primary percutaneous coronary intervention. Subjects were eligible if they had either an anterior ST-segment elevation myocardial infarction (STEMI) or a large inferior STEMI and had <24 h of symptoms. There was no difference in the incidence of major adverse cardiac events at 30 days or in final infarct size at 14 days. A post-hoc analysis suggests that patients with anterior MIs treated within 6 h of symptom onset did better with AO. An accompanying editorial laments the lack of efficacy of strategies designed to limit reperfusion injury. See pages 397 and 406. See figure.
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Statins and Toxicity
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High-Dose Statins Associated With Increased Risk of Cancer.
Alsheikh-Ali and colleagues pooled data from 23 trials with over 300,000 subject-years of data to compare the rates of elevated liver enzymes, rhabdomyolysis, and incident cancer in patients treated with statins. Changes in low-density lipoprotein (LDL) levels, as reflected in absolute LDL reductions, % LDL reduction, or achieved LDL levels, all were unrelated to elevated liver enzyme levels or to rhabdomyolysis. Higher doses of statins, on the other hand, were associated with elevated liver enzymes. With new cancer cases, a worrying trend emerged. There was a significant relationship between achieved LDL levels and new cancer cases. Two accompanying editorial comments point out the considerations involved in the decision to publish the paper and that the apparent increased risk of incident cancer should be considered hypothesis-generating rather than conclusive because there was no particular type of cancer that was increased and the relatively short duration of most of the studies involved. See pages 409, 419, and 421. See figure.
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Heart Rhythm Disorders
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Limited Efficacy of VT Ablation in Patients With ARVD.
Patients with arrhythmogenic right ventricular dysplasia (ARVD) frequently experience ventricular arrhythmias; those with implantable cardioverter-defibrillators may receive frequent discharges that have encouraged some to consider catheter-based ventricular tachycardia (VT) ablations. Dalal and colleagues reviewed the efficacy of VT ablations in 24 patients who underwent a total of 48 ablation procedures. Procedural success was reported in 46%, partial success in 31%, and failure in 23% of patients. During follow-up, VT recurred after 85% of the procedures and in all but one of the 24 patients. This study suggests that catheter-based ablation of VT for patients with ARVD has limited long-term efficacy and should not be considered curative. See page 432. See figure.
Related Articles
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Acute Myocardial Infarction With Hyperoxemic Therapy (AMIHOT): A Prospective, Randomized Trial of Intracoronary Hyperoxemic Reperfusion After Percutaneous Coronary Intervention
- William W. O’Neill, Jack L. Martin, Simon R. Dixon, Antonio L. Bartorelli, Daniela Trabattoni, Pranobe V. Oemrawsingh, Douwe E. Atsma, Michael Chang, William Marquardt, Jae K. Oh, Mitchell W. Krucoff, Raymond J. Gibbons, J. Richard Spears for the AMIHOT Investigators
J. Am. Coll. Cardiol. 2007 50: 397-405.
[Abstract]
[Full Text]
[PDF]
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The Search for Myocardial Protection: Is There Still Hope?
- Christopher B. Granger and Manesh R. Patel
J. Am. Coll. Cardiol. 2007 50: 406-408.
[Full Text]
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Effect of the Magnitude of Lipid Lowering on Risk of Elevated Liver Enzymes, Rhabdomyolysis, and Cancer: Insights From Large Randomized Statin Trials
- Alawi A. Alsheikh-Ali, Prasad V. Maddukuri, Hui Han, and Richard H. Karas
J. Am. Coll. Cardiol. 2007 50: 409-418.
[Abstract]
[Full Text]
[PDF]
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Means and Ends of Statins and Low-Density Lipoprotein Cholesterol Lowering
- John C. LaRosa
J. Am. Coll. Cardiol. 2007 50: 419-420.
[Full Text]
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Low-Density Lipoprotein Reduction and Cancer: Not Definitive But Provocative
- Anthony N. DeMaria and Ori Ben-Yehuda
J. Am. Coll. Cardiol. 2007 50: 421-422.
[Full Text]
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Long-Term Efficacy of Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy
- Darshan Dalal, Rahul Jain, Harikrishna Tandri, Jun Dong, Shaker M. Eid, Kalpana Prakasa, Crystal Tichnell, Cynthia James, Theodore Abraham, Stuart D. Russell, Sunil Sinha, Daniel P. Judge, David A. Bluemke, Joseph E. Marine, and Hugh Calkins
J. Am. Coll. Cardiol. 2007 50: 432-440.
[Abstract]
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Clinical Trials
Statins and Toxicity
