INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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Meta-Analysis Finds Similar Efficacy for PES and SES in Diabetics.
Mahmud and colleagues performed a meta-analysis to estimate and compare rates of revascularization and major adverse cardiac events (MACE) in diabetic patients treated with paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES). In 13 randomized trials with over 2,000 diabetic patients, there were no differences in rates of target lesion revascularization, target vessel revascularization, or MACE. Similar results were found in registries that enrolled over 10,000 subjects with more real-world circumstances. These data suggest that there is similar clinical efficacy for PES and SES in diabetics; both stents show rates of revascularization <10%. See page 2385. See figure.
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Acute Coronary Syndromes
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Higher Clot Burden With ST Than With De Novo STEMI.
The presentation of stent thrombosis (ST) is often an ST-segment elevation myocardial infarction (STEMI). Chechi and colleagues compared outcomes and procedural success rates from 92 patients with STEMI due to ST with 98 patients with de novo STEMI. All patients underwent primary percutaneous coronary intervention. Patients with ST had a lower likelihood of successful reperfusion, higher distal embolization rates, and higher rates of in-hospital major adverse cardiovascular events. Stent thrombosis identifies a subgroup of STEMI patients with poor angiographic and early clinical outcomes; further research is needed to determine if these patients will benefit from interventions to reduce the clot burden, either pharmacologically or mechanically. See pages 2396 and
2403. See figure.
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Heart Rhythm Disorders
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Remote Steerable Sheath System for AF Ablations.
The safety and success of catheter-based ablation procedures requires precise catheter manipulation and stable contact during energy delivery. A robotic steerable guide catheter (SGC) could improve catheter stability and allow more freedom of movement. Saliba and colleagues studied this system in 40 subjects undergoing radiofrequency ablation of atrial fibrillation (AF) and atrial flutter (AFL). All pulmonary veins were successfully isolated, with good clinical success. This preliminary human experience suggests that mapping and ablation of AF and AFL using a remotely controlled robotic catheter is feasible with results comparable to the conventional approach. See pages 2407 and
2412. See figure.
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Cardiac Imaging
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Late Enhancement Predicts Worse Outcomes in Patients With NICM.
Wu and colleagues performed a prospective cohort study of 65 subjects with nonischemic cardiomyopathy (NICM) who were evaluated for the presence and extent of late gadolinium enhancement (LGE) by cardiac magnetic resonance. Patients were followed for an index composite end point of hospitalization, appropriate implantable cardioverter-defibrillator firing, and cardiac death. Forty-two percent of patients had LGE, despite no evidence of prior infarction or significant coronary artery disease. The adjusted hazard ratio was 8.2 for those with LGE compared with those with no LGE. The presence of LGE identifies NICM patients with worse prognosis, possibly by indicating the replacement of myocardium with fibrous tissue. See page 2414. See figure.
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Hypertension
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Carotid BP May Be Better at Predicting CV Events.
Pini and colleagues investigated whether central blood pressure (BP) predicts cardiovascular (CV) events better than brachial BP in elderly (age >65 years) individuals. Central blood pressure was measured using applanation tonometry, which uses an external pressure transducer applied to the skin over the common carotid artery to derive carotid pressure waveforms. In univariate analyses, both central and brachial systolic blood pressure (SBP) and pulse pressure (PP) predicted CV events; however after adjusting for age and gender, only carotid SBP and PP predicted CV events. This prospective study in a geriatric population demonstrates superior prognostic utility of central compared with brachial BP measurements. See pages 2432 and
2440.
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Interventional Cardiology
Acute Coronary Syndromes
