INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Clinical Trials
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No Difference in 1-Year Mortality in the ACUITY Trial of Bivalirudin.
The ACUITY trial found that in acute coronary syndrome (ACS) patients, bivalirudin resulted in less major bleeding and similar ischemic outcomes at 30 days compared with heparin-based regimens. In this article, White and colleagues extended the follow-up to 1 year. At 1 year, there were no differences in composite ischemia or mortality between the groups. The ACUITY trial demonstrated that bivalirudin decreases in-hospital bleeding in ACS patients without increasing the risk of ischemic events, but it may have been too small to demonstrate a reduction in 1-year mortality. See page 807. See figure.
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Clinical Trials
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Similar Outcomes at 10 Years for CABG Versus PCI of Proximal LAD Lesions.
The SIMA (Stent versus Internal Mammary Artery grafting) trial randomized 120 patients with single vessel disease of the proximal left anterior descending artery (LAD) to either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) with a bare-metal stent. After 10 years, 42% of the PCI group and 17% of the CABG group reached an end point (p < 0.001). The difference was primarily due to restenosis during the first year in the PCI group. Over 10 years, the incidence of death and myocardial infarction was identical at 10%. There was no difference in angina functional class. Both stent implantation and CABG are safe, effective, and durable for relieving symptoms in patients with isolated, proximal LAD stenosis. See page 815.
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Heart Failure
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Anemia Associated With a 2-Fold Greater Risk of Death in Patients with Heart Failure.
Groenveld and colleagues performed a systematic meta-analysis of studies that examined the relationship between anemia and mortality in patients with chronic heart failure (CHF). Thirty-four studies comprising over 150,000 patients were included. Nearly 40% of patients were anemic, although the definition of anemia varied in the studies. The risk of death was twice as high in anemic patients, and the risk increased with greater severity of anemia. This risk persisted after adjusting for confounding conditions. This study confirms that anemia is a powerful prognosticator for the risk of death in patients with CHF. See page 818. See figure.
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Heart Rhythm Disorders
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BW Defibrillations Reduce Calcium Current Heterogeneity.
Hwang and colleagues hypothesized that biphasic waveform (BW) shocks defibrillate more effectively than monophasic waveform (MW) shocks because of their differential effects on calcium currents. They simultaneously mapped membrane potential (Vm) and intracellular calcium (Cai) during MW and BW shocks in isolated rabbit ventricles. Biphasic waveform shocks resulted in less post-shock heterogeneity of Vm and Cai than MW shocks of the same strength and were effective at lower voltages. The defibrillation threshold became similar after calcium release from the sarcoplasmic reticulum was blocked. These results outline the physiology for the improved efficacy of BW compared with MW defibrillations. See page 828. See figure.
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Cardiac Imaging
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Electroanatomic Mapping for Identifying Post-Infarct Scar.
In patients with post-infarct ventricular arrhythmias, identifying the extent and location of scarring is necessary for planning ablation procedures. Codreanu and colleagues compared electroanatomic mapping using the CARTO system with delayed contrast magnetic resonance imaging (MRI). Electrogram (EGM) parameters, such as spiky EGM morphology, reduced voltage, and longer EGM duration, independently correlated with the presence of scar, but correlated poorly with intramural scar location and not at all with scar depth. A clear mismatch was observed in one-third of cases. The accuracy of endocardial mapping for precise scar delineation is limited. See page 839. See figure.
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Valvular Heart Disease
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Increased Oxidative Stress in Stenosed Aortic Valves.
Miller and colleagues hypothesized that increased oxidative stress may contribute to the progression of aortic valvular stenosis and calcification. Explanted valves from patients undergoing aortic valve replacement for aortic stenosis (AS) were compared with valve leaflets from hearts explanted for possible transplantation. Superoxide levels were increased 2-fold near the calcified regions of the stenotic valves; hydrogen peroxide levels were also markedly elevated. This study provides evidence that oxidative stress is increased in calcified regions of stenotic aortic valves and that this stress is due to reduction in the expression and activity of antioxidant enzymes. See page 843. See figure.
Related Articles
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Safety and Efficacy of Bivalirudin With and Without Glycoprotein IIb/IIIa Inhibitors in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: 1-Year Results From the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) Trial
- Harvey D. White, E. Magnus Ohman, A. Michael Lincoff, Michel E. Bertrand, Antonio Colombo, Brent T. McLaurin, David A. Cox, Stuart J. Pocock, James A. Ware, Steven V. Manoukian, Alexandra J. Lansky, Roxana Mehran, Jeffrey W. Moses, and Gregg W. Stone
J. Am. Coll. Cardiol. 2008 52: 807-814.
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10-Year Follow-Up of a Prospective Randomized Trial Comparing Bare-Metal Stenting With Internal Mammary Artery Grafting for Proximal, Isolated De Novo Left Anterior Coronary Artery Stenosis: The SIMA (Stenting versus Internal Mammary Artery grafting) Trial
- Jean-Jacques Goy, Urs Kaufmann, Michel Hurni, Stéphane Cook, Francesco Versaci, Patrick Ruchat, Osmund Bertel, Michael Pieper, Bernhard Meier, Luigi Chiarello, Eric Eeckhout for the SIMA Investigators
J. Am. Coll. Cardiol. 2008 52: 815-817.
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Anemia and Mortality in Heart Failure Patients: A Systematic Review and Meta-Analysis
- Hessel F. Groenveld, James L. Januzzi, Kevin Damman, Jan van Wijngaarden, Hans L. Hillege, Dirk J. van Veldhuisen, and Peter van der Meer
J. Am. Coll. Cardiol. 2008 52: 818-827.
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Superiority of Biphasic Over Monophasic Defibrillation Shocks Is Attributable to Less Intracellular Calcium Transient Heterogeneity
- Gyo-Seung Hwang, Liang Tang, Boyoung Joung, Norishige Morita, Hideki Hayashi, Hrayr S. Karagueuzian, James N. Weiss, Shien-Fong Lin, and Peng-Sheng Chen
J. Am. Coll. Cardiol. 2008 52: 828-835.
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Electroanatomic Characterization of Post-Infarct Scars: Comparison With 3-Dimensional Myocardial Scar Reconstruction Based on Magnetic Resonance Imaging
- Andrei Codreanu, Freddy Odille, Etienne Aliot, Pierre-Yves Marie, Isabelle Magnin-Poull, Marius Andronache, Damien Mandry, Wassila Djaballah, Denis Régent, Jacques Felblinger, and Christian de Chillou
J. Am. Coll. Cardiol. 2008 52: 839-842.
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Dysregulation of Antioxidant Mechanisms Contributes to Increased Oxidative Stress in Calcific Aortic Valvular Stenosis in Humans
- Jordan D. Miller, Yi Chu, Robert M. Brooks, Wayne E. Richenbacher, Ricardo Peña-Silva, and Donald D. Heistad
J. Am. Coll. Cardiol. 2008 52: 843-850.
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Clinical Trials
Clinical Trials
