INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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DES Associated With Reduced Mortality and Subsequent MIs.
Long-term outcomes with drug-eluting stents (DES) are addressed in 2 articles and a commentary in this issue of the Journal. Kelbæk and colleagues report 3-year outcomes from the SCANDSTENT trial, which randomized subjects with complex lesions to sirolimus-eluting stents (SES) or bare-metal stents (BMS). Major adverse cardiac event rates were 3 times higher with BMS, driven mostly by repeat revascularizations; there was a statistically significant reduction in myocardial infarction (MI) with SES. Groeneveld and colleagues used a Medicare database to develop a propensity-matched cohort of up to 150,000 elderly patients who received either a BMS or DES. Those who received DES had an adjusted mortality hazard ratio of 0.83. The commentary by Anderson suggests that these reports show that DES not only reduce restenosis, but may also improve mortality and lower the future risk of MI. See pages 2011, 2017, and
2025. See figure.
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Acute Coronary Syndromes
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Early and Late Benefits of Prasugrel Compared With Clopidogrel.
Prasugrel is a novel P2Y12 receptor inhibitor that was compared with clopidogrel in the TRITON–TIMI 38 study of acute coronary syndrome patients undergoing percutaneous coronary intervention. This report uses landmark analysis, with a day 3 cutpoint, to separate events that could be attributed to the loading dose (periprocedural events) and the maintenance dose (events during long-term follow-up). Prasugrel significantly reduced ischemic events during both periods. Bleeding was similar to clopidogrel during the first 3 days, but was significantly higher during the maintenance phase. These results suggest that further studies should focus on the safety of lowering the maintenance dose of prasugrel, especially in patients at high risk for bleeding complications. See page 2028. See figure.
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Erectile Dysfunction and Cardiac Disease
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ED is a Strong Predictor of Adverse Cardiac Events in Diabetics.
Two articles in this issue studied outcomes in diabetic males with or without erectile dysfunction (ED). In 2,306 Chinese subjects with diabetes, 27% had ED at baseline. These patients were twice as likely to experience a cardiac event, an excess risk that remained significant after multivariate adjustment. Similarly, in nearly 300 Italian subjects with diabetes and coronary artery disease, the adjusted risk for major adverse coronary events was 2.1 in those with ED. These 2 studies confirm that ED is a potent risk marker for cardiovascular events in diabetics. See pages 2040, 2045, and 2051.
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Heart Rhythm Disorders
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Atrial Microvascular Dysfunction May Predispose to AF.
Some recent evidence, including findings of fibrosis and loss of muscle mass in the atria, suggest that atrial ischemia may precipitate atrial fibrillation (AF). Skalidis and colleagues report that fractional flow reserve in the left atrial circumflex branch artery is lower in subjects with a history of AF than in control subjects. These results provide more evidence that microvascular dysfunction and atrial ischemia may contribute to the pathophysiology of AF. See page 2053.
Related Articles
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Long-Term Outcome in Patients Treated With Sirolimus-Eluting Stents in Complex Coronary Artery Lesions: 3-Year Results of the SCANDSTENT (Stenting Coronary Arteries in Non-Stress/Benestent Disease) Trial
- Henning Kelbæk, Lene Kløvgaard, Steffen Helqvist, Jens F. Lassen, Lars R. Krusell, Thomas Engstrøm, Hans E. Bøtker, Erik Jørgensen, Kari Saunamäki, Samir Aljabbari, Per Thayssen, Anders Galløe, Gunnar V.H. Jensen, and Leif Thuesen
J. Am. Coll. Cardiol. 2008 51: 2011-2016.
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Drug-Eluting Compared With Bare-Metal Coronary Stents Among Elderly Patients
- Peter W. Groeneveld, Mary Anne Matta, Alexis P. Greenhut, and Feifei Yang
J. Am. Coll. Cardiol. 2008 51: 2017-2024.
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Drug-Eluting Stents: Life Insurance With a Better Death Benefit
- H. Vernon Anderson
J. Am. Coll. Cardiol. 2008 51: 2025-2027.
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Early and Late Benefits of Prasugrel in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: A TRITON–TIMI 38 (TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel–Thrombolysis In Myocardial Infarction) Analysis
- Elliott M. Antman, Stephen D. Wiviott, Sabina A. Murphy, Juri Voitk, Yonathan Hasin, Petr Widimsky, Harish Chandna, William Macias, Carolyn H. McCabe, and Eugene Braunwald
J. Am. Coll. Cardiol. 2008 51: 2028-2033.
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Erectile Dysfunction as a Predictor of Cardiovascular Events and Death in Diabetic Patients With Angiographically Proven Asymptomatic Coronary Artery Disease: A Potential Protective Role for Statins and 5-Phosphodiesterase Inhibitors
- Carmine Gazzaruso, Sebastiano B. Solerte, Arturo Pujia, Adriana Coppola, Monia Vezzoli, Fabrizio Salvucci, Cinzia Valenti, Andrea Giustina, and Adriana Garzaniti
J. Am. Coll. Cardiol. 2008 51: 2040-2044.
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Erectile Dysfunction Predicts Coronary Heart Disease in Type 2 Diabetes
- Ronald Ching-Wan Ma, Wing-Yee So, Xilin Yang, Linda Wai-Ling Yu, Alice Pik-Shan Kong, Gary Tin-Choi Ko, Chun-Chung Chow, Clive Stewart Cockram, Juliana Chung-Ngor Chan, and Peter Chun-Yip Tong
J. Am. Coll. Cardiol. 2008 51: 2045-2050.
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Erectile Dysfunction: The New Harbinger for Major Adverse Cardiac Events in the Diabetic Patient
- Robert A. Kloner
J. Am. Coll. Cardiol. 2008 51: 2051-2052.
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Isolated Atrial Microvascular Dysfunction in Patients With Lone Recurrent Atrial Fibrillation
- Emmanuel I. Skalidis, Michalis I. Hamilos, Ioannis K. Karalis, Gregory Chlouverakis, George E. Kochiadakis, and Panos E. Vardas
J. Am. Coll. Cardiol. 2008 51: 2053-2057.
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Interventional Cardiology
Acute Coronary Syndromes
