INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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Cilostazol Significantly Reduces Restenosis in Diabetics With DES.
Cilostazol has previously been shown to inhibit neointimal hyperplasia and restenosis after bare-metal stent implantation. Lee and colleagues randomized diabetic patients undergoing drug-eluting stent (DES) implantation to either sirolimus- or paclitaxel-eluting stents, and to either standard therapy of aspirin and clopidogrel, or standard therapy plus cilostazol. In-stent late lumen loss was significantly lower in the cilostazol versus the standard group, as was 6-month in-segment restenosis (8% vs. 16%). In the 88 patients assigned to sirolimus-eluting stents and cilostazol, there was no in-segment restenosis. Triple antiplatelet therapy with cilostazol after DES implantation decreases angiographic restenosis and late loss, compared to standard dual antiplatelet therapy in diabetic patients. See page 1181.
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Coronary Artery Disease
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NT-proBNP >500 pg/ml Predicts Increased Mortality in ACS Patients With Negative Troponins.
While an elevated troponin level is a strong marker of increased risk for patients with acute coronary syndromes (ACS), further risk-stratifying chest pain patients with negative troponins has important prognostic implications. Weber and colleagues measured N-terminal B-type natriuretic peptide (NT-proBNP) in over 2,500 troponin-negative (troponin T  0.01 ng/ml) patients from two different registries with suspected ACS. In these 2 cohorts, an optimal cutoff value of 474 pg/ml for NT-proBNP identified patients at higher risk. Patients with NT-proBNP levels below this cutoff had 6 month mortality <2%, compared with 8% to 12% for patients with higher BNP levels. This study suggests that measuring the NT-proBNP level can substantially improve risk stratification of patients with chest pain or ACS and negative troponin values. See page 1188. See figure.
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Coronary Artery Disease
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Circulating Lipid Hydroperoxides Predict Cardiovascular Events.
Lipid hydroperoxides (LOOH) are generated from polyunsaturated fatty acids; LOOH may be further modified to generate reactive products that may lead to the oxidation of LDL particles. Walter and colleagues analyzed LOOH levels from patients with stable coronary artery disease (CAD) who were followed for 3 years for clinical events and angiographic progression of CAD. Subjects with baseline levels of LOOH in the highest quartile were more than twice as likely to experience a nonfatal vascular event or undergo a major vascular procedure, and were more likely to have progression of CAD based on intravascular ultrasound studies. Circulating LOOH are independently associated with cardiovascular risk and may be a useful marker of oxidative stress. See page 1196. See figure.
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Mitral Surgery and Embolism
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Risk of Stroke After Mitral Valve Surgery Varies With Type of Surgery.
Russo and colleagues collected data on the incidence of stroke from over 1,300 patients who underwent mitral valve surgery and were then followed for 10 years. Two-thirds of patients had mitral valve repair (MRep); the rest were evenly distributed between biologic and mechanical prostheses. The 5-year risk of stroke was lowest for MRep at 6%, compared to 8% for biologic and 16% for mechanical. Most of this risk occurred in the first 30 days. After 30 days, those with either a MRep or a biologic prosthesis were not at increased risk compared to a control population. Those with Mechanical valves were 5 times more likely to suffer a stroke, and had higher bleeding complications compared to the control population. These results suggest that mitral valve replacement with a mechanical prosthesis results in increased long-term risk of stroke, whereas biologic replacements or MRep do not increase the long-term risk of stroke, although there is substantial risk of perioperative stroke. See page 1203. See figure.
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Drug-Eluting Stenting Followed by Cilostazol Treatment Reduces Late Restenosis in Patients With Diabetes Mellitus: The DECLARE-DIABETES Trial (A Randomized Comparison of Triple Antiplatelet Therapy With Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation in Diabetic Patients)
- Seung-Whan Lee, Seong-Wook Park, Young-Hak Kim, Sung-Cheol Yun, Duk-Woo Park, Cheol Whan Lee, Myeong-Ki Hong, Hyun-Sook Kim, Jae-Ki Ko, Jae-Hyeong Park, Jae-Hwan Lee, Si Wan Choi, In-Whan Seong, Yoon Haeng Cho, Nae-Hee Lee, June Hong Kim, Kook-Jin Chun, and Seung-Jung Park
J. Am. Coll. Cardiol. 2008 51: 1181-1187.
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N-Terminal B-Type Natriuretic Peptide Assessment Provides Incremental Prognostic Information in Patients With Acute Coronary Syndromes and Normal Troponin T Values Upon Admission
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J. Am. Coll. Cardiol. 2008 51: 1188-1195.
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Circulating Lipid Hydroperoxides Predict Cardiovascular Events in Patients With Stable Coronary Artery Disease: The PREVENT Study
- Mary F. Walter, Robert F. Jacob, Rebekah E. Bjork, Barrett Jeffers, Jan Buch, Yoshiko Mizuno, R. Preston Mason on behalf of the PREVENT Investigators
J. Am. Coll. Cardiol. 2008 51: 1196-1202.
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Thromboembolic Complications After Surgical Correction of Mitral Regurgitation: Incidence, Predictors, and Clinical Implications
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Interventional Cardiology
Coronary Artery Disease
