INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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3-Year Outcomes From Patients With Unprotected Left Main Stenting.
The procedural success rates and long-term outcomes after drug-eluting stent (DES) implantation for unprotected left main coronary artery (ULMCA) disease are unclear. This retrospective registry reports the results from over 300 patients who underwent percutaneous coronary intervention with DES for ULMCA lesions, who had a minimum follow-up of 3 years. Cardiac death occurred in 9.2% of patients during the 3 years, but in only 6.2% of elective cases. The target lesion revascularization rate was under 6%. These data suggest that ULMCA stenting with DES is emerging as a viable alternative to coronary artery bypass grafting in select patients. See page 2212.
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Interventional Cardiology
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Longer Clopidogrel Use Improves Outcomes for Diabetic Patients With BMS and DES.
Brar and colleagues identified over 700 diabetic patients who underwent stent implantation with either bare-metal stents (BMS) or drug-eluting stents (DES) to determine if long-term outcomes differed between stent type and by duration of clopidogrel use. The risk of death or myocardial infarction (MI) was 5 times higher in those who used clopidogrel for <6 months compared with >9 months. Among clopidogrel nonusers (<6 months of use), the incidence of death and MI did not differ by stent type. These results suggest that clopidogrel should be used for at least 1 year in diabetics undergoing stent implantation regardless of whether the stent is a BMS or DES. See pages 2220 and
2228.
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Cardiac MR in Infarction
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Post-STEMI Microvascular Injury Can Be Quantified With CMR or Intracoronary Doppler Flow.
Hirsch and colleagues compared the severity of microvascular obstruction (MO) measured by cardiovascular magnetic resonance (CMR) and intracoronary Doppler flow measurements. Subjects had been treated with primary percutaneous coronary intervention for anterior ST-segment elevation myocardial infarction (STEMI) 4 to 8 days earlier. Using a Doppler guidewire, several markers of decreased tissue perfusion, including early systolic retrograde flow, and diastolic deceleration were more likely to be abnormal in patients with MO on CMR. These results demonstrate that there is a good correlation between CMR and intracoronary Doppler measurements for determining the extent of microvascular injury. See pages 2230 and
2239. See figure.
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Arrhythmias in Cardiac Transplants
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Frequency of Supraventricular Arrhythmias After Heart Transplantation.
Vaseghi and colleagues reviewed over 700 patients who underwent orthotopic heart transplantation (OHT) to understand the incidence, mechanisms, and management of supraventricular tachycardia (SVT) after OHT. Some SVTs were due to abnormalities in the donor heart, while others occurred near the suture lines or were typical isthmus-dependent flutter. Atrial fibrillation occurred only in the perioperative period or in patients with acute rejection or transplant vasculopathy. The majority of SVTs in OHT patients appear amenable to catheter ablation; atrial fibrillation in this population should prompt an evaluation for acute rejection and/or vasculopathy. See page 2241. See figure.
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Interventional Cardiology
Interventional Cardiology
