INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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DS Reduces Periprocedural Myocardial Injury.
Cuisset and colleagues hypothesized that microembolization during PCI can be reduced by direct stenting (DS) as opposed to stenting following balloon pre-dilation. The index of microcirculatory resistance (IMR) measures resistance to flow in the coronary microcirculation; higher values indicate higher resistance, which has been linked to microcirculatory embolization and inflammatory injury in the distal territory. Fifty patients were randomized to either DS or pre-dilation. Subjects randomized to pre-dilation had a mean IMR that was nearly twice as high as those undergoing DS. There were also higher troponin levels in those undergoing pre-dilation. These results suggest that DS may be superior to pre-dilation at preventing distal embolization of microemboli. See page 1060. See figure.
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Interventional Cardiology
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Double Bolus of Clopidogrel Reduces Platelet Aggregation Compared to Single Bolus.
L’Allier and colleagues compared 3 different clopidogrel loading regimens in patients undergoing elective angiography. Subjects were randomized to either 300 mg the day before and 75 mg the morning of, 600 mg the morning of, or 600 mg the day before and the day of the procedure. The primary end point was the change in adenosine diphosphate (ADP)–stimulated platelet aggregation compared to pre-clopidogrel levels. The double 600-mg load resulted in significantly greater platelet inhibition and a decrease in the percentage of subjects considered nonresponders. Clopidogrel 600 mg double bolus achieves greater platelet inhibition than conventional single loading doses. See page 1066. See figure.
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Heart Failure
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Continuous Hemodynamic Monitoring Does Not Reduce Hospitalizations for Chronic HF.
Accurately determining a patient’s volume status from symptoms is sometimes difficult; accurate, instantaneous, continuous hemodynamic measurements may improve titration of diuretics and prevent hospitalization. The COMPASS-HF trial enrolled almost 300 patients with New York Heart Association functional class III to IV heart failure (HF) who received an implantable hemodynamic monitor, which uses a pressure sensor in the right ventricle. In one-half of the patients, the physician was blinded to these measurements, while in the other one-half, the measurements were documented weekly and could be used to make medication adjustments. Those subjects whose physicians had access to the data had a nonsignificant 21% reduction in hospitalizations for HF. See pages 1073 and 1080.
Related Articles
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Direct Stenting for Stable Angina Pectoris Is Associated With Reduced Periprocedural Microcirculatory Injury Compared With Stenting After Pre-Dilation
- Thomas Cuisset, Michalis Hamilos, Narbeh Melikian, Eric Wyffels, Jaydeep Sarma, Giovanna Sarno, Emanuele Barbato, Jozef Bartunek, William Wijns, and Bernard De Bruyne
J. Am. Coll. Cardiol. 2008 51: 1060-1065.
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Clopidogrel 600-Mg Double Loading Dose Achieves Stronger Platelet Inhibition Than Conventional Regimens: Results From the PREPAIR Randomized Study
- Philippe L. L’Allier, Grégory Ducrocq, Nicolas Pranno, Stéphane Noble, Reda Ibrahim, Jean C. Grégoire, Fabian Azzari, Anna Nozza, Colin Berry, Serge Doucet, Benoit Labarthe, Pierre Théroux, Jean-Claude Tardif for the PREPAIR Study Investigators
J. Am. Coll. Cardiol. 2008 51: 1066-1072.
[Abstract]
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Randomized Controlled Trial of an Implantable Continuous Hemodynamic Monitor in Patients With Advanced Heart Failure: The COMPASS-HF Study
- Robert C. Bourge, William T. Abraham, Philip B. Adamson, Mark F. Aaron, Juan M. Aranda, Jr, Anthony Magalski, Michael R. Zile, Andrew L. Smith, Frank W. Smart, Mark A. O’Shaughnessy, Mariell L. Jessup, Brandon Sparks, David L. Naftel, Lynne Warner Stevenson on behalf of the COMPASS-HF Study Group
J. Am. Coll. Cardiol. 2008 51: 1073-1079.
[Abstract]
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Learning the Points of COMPASS-HF: Assessing Implantable Hemodynamic Monitoring in Heart Failure Patients
- John R. Teerlink
J. Am. Coll. Cardiol. 2008 51: 1080-1082.
[Full Text]
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Interventional Cardiology
Interventional Cardiology
