INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
 |
Clinical Trial
|
|---|
MTWA Does Not Predict Arrhythmias in ICD Patients.
Testing for microvolt T-wave alternans (MTWA) may help to predict the risk of ventricular tachyarrhythmic events (VTEs). The MASTER trial evaluated the utility of MTWA in post-infarction prophylactic defibrillator (implantable cardioverter-defibrillator [ICD]) recipients. After 2 years of follow-up, there was no significant difference in VTEs between MTWA non-negative and MTWA negative patients. MTWA does not appear to be a sufficient discriminator of risk to be used for decisions regarding the necessity of ICD implantation. See page 1607. See figure.
|
Interventional Cardiology
|
|---|
Bioabsorbable Stents May Have More Late Stent Recoil.
Bioabsorbable polymer stents are more flexible than metallic stents and are designed to be fully metabolized and absorbed over 2 to 3 years. Tanimoto and colleagues repeated intravascular ultrasound images in patients who had received a bioabsorbable everolimus-eluting coronary stent 6 months earlier. The mean reduction in cross-sectional area was 0.65 mm2 or 7.6%. This compares to 0.6% for the Palmaz-Schatz stent and 0.3% for the XIENCE V stent seen in earlier studies. These results suggest that bioabsorbable polymer stents do have more stent recoil than metallic stents. See page 1616.
|
Interventional Cardiology
|
|---|
SES Superior to BA for ISR: Long-Term Results.
The RIBS-II study randomized patients with in-stent restenosis (ISR) to either sirolimus-eluting stent (SES) or balloon angioplasty (BA). At 1 year, subjects assigned to SES had a lower restenosis rate (11% vs. 39%). This article focuses on outcomes over the subsequent 3 years. There were similar rates of death, myocardial infarction, and target vessel revascularization, with similar low rates of stent thrombosis. The event-free survival was higher in the SES arm (76% vs. 65%). The improved outcomes with SES for ISR are maintained up to 4 years after intervention with no evidence of a late "catch-up." See page 1621.
|
NSAIDs and Myocardial Infarction
|
|---|
Risk of MI With NSAIDs Linked to Degree of COX-2 Inhibition.
García Rodríguez and colleagues studied the association between the frequency, dose, and duration of use of nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of myocardial infarction (MI). The hazard ratio for current users was 1.35. The risk increased with treatment duration and dose, and there was a significant correlation between the degree of inhibition of cyclooxygenase (COX)-2, but not COX-1. This study suggests that the degree of inhibition of COX-2 is a surrogate predictor of the relative increased risk of MI by NSAIDs. See pages 1628 and
1637. See figure.
|
Heart Failure
|
|---|
Differences in Etiology of HF and Clinical Outcomes Across the World.
Blair and colleagues used data collected during the EVEREST trial to examine differences in the presentation and management of heart failure (HF) by geographical location. Subjects were divided into 4 geographic regions: North America, South America, Western Europe, and Eastern Europe. There were significant differences in unadjusted 1-year mortality, cardiovascular mortality, hospitalization for HF, etiology of HF, and comorbidities by region. The heterogeneous outcomes were related to differences in severity, etiology, and management of HF and need to be considered when planning global clinical trials for patients with HF. See pages 1640 and
1649. See figure.
|
Pre-Clinical Research
|
|---|
Imaging Transplanted Stem Cells Made Possible by Transfection.
Terrovitis and colleagues wanted to develop a technique that would allow in vivo imaging of viable transplanted stem cells. Rat cardiac-derived stem cells (rCDCs) were transfected with the gene for the sodium-iodide symporter (NIS), which promotes cellular uptake of technetium 99m (99mTc) or iodine 124 (124I). The transfected cells were then injected into the myocardium shortly after ligation of the left anterior descending artery. Cells were visualized as regions of 99mTc or 124I uptake on single-photon emission computed tomography and positron emission tomography images, respectively. This approach allows for stem cell tracking using clinically available imaging modalities. See pages 1652 and
1661. See figure.
|
News From the NCDR
|
|---|
Prior CABG Associated With Longer DTB Times.
Kim and colleagues queried the National Cardiovascular Data Registry (NCDR) to determine whether a prior history of coronary artery bypass graft (CABG) surgery correlates with prolonged door-to-balloon (DTB) times among ST-segment elevation myocardial infarction patients. In the 70,000 patients examined, median DTB time was 15 min longer in patients with prior CABG (113 min vs. 98 min), and only 40% of patients with CABG had a DTB <90 min. This analysis finds that a history of CABG surgery is associated with significantly prolonged DTB, which may substantially impact the performance measurement for a given hospital depending on the case mix. See page 1665.
|
Year in Cardiology Series
|
|---|
The Year in Heart Failure.
Tang and Francis summarize the year's most relevant publications related to heart failure. The articles are placed in context and arranged into categories including genetics, biomarkers, and treatment strategies. They conclude that the reliance on mega-trials to formulate clinical evidence for the treatment of heart failure is becoming outdated, with a new emphasis needed on individualized therapy based on genetic, biochemical, and echocardiographic profiling. See page 1671.
Related Articles
-
Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?: The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) Trial
- Theodore Chow, Dean J. Kereiakes, John Onufer, Alan Woelfel, Sinan Gursoy, Brett J. Peterson, Mark L. Brown, Wenji Pu, David G. Benditt on behalf of the MASTER Trial Investigators
J. Am. Coll. Cardiol. 2008 52: 1607-1615.
[Abstract]
[Full Text]
[PDF]
-
Late Stent Recoil of the Bioabsorbable Everolimus-Eluting Coronary Stent and its Relationship With Plaque Morphology
- Shuzou Tanimoto, Nico Bruining, Ron T. van Domburg, David Rotger, Petia Radeva, Jurgen M. Ligthart, and Patrick W. Serruys
J. Am. Coll. Cardiol. 2008 52: 1616-1620.
[Abstract]
[Full Text]
[PDF]
-
Long-Term Clinical Benefit of Sirolimus-Eluting Stents in Patients With In-Stent Restenosis: Results of the RIBS-II (Restenosis Intra-stent: Balloon angioplasty vs. elective sirolimus-eluting Stenting) Study
- Fernando Alfonso, María-José Pérez-Vizcayno, Rosana Hernández, Armando Bethencourt, Vicens Martí, José R. López-Mínguez, Juan Angel, Andrés Iñiguez, César Morís, Angel Cequier, Manel Sabaté, Javier Escaned, Pilar Jiménez-Quevedo, Camino Bañuelos, Alfonso Suárez, Carlos Macaya for the RIBS-II Investigators
J. Am. Coll. Cardiol. 2008 52: 1621-1627.
[Abstract]
[Full Text]
[PDF]
-
Role of Dose Potency in the Prediction of Risk of Myocardial Infarction Associated With Nonsteroidal Anti-Inflammatory Drugs in the General Population
- Luis Alberto García Rodríguez, Stefania Tacconelli, and Paola Patrignani
J. Am. Coll. Cardiol. 2008 52: 1628-1636.
[Abstract]
[Full Text]
[PDF]
-
Nonsteroidal Anti-Inflammatory Drugs and Cardiovascular Risk: Is Prostacyclin Inhibition the Key Event?
- Pietro Minuz
J. Am. Coll. Cardiol. 2008 52: 1637-1639.
[Full Text]
[PDF]
-
Continental Differences in Clinical Characteristics, Management, and Outcomes in Patients Hospitalized With Worsening Heart Failure: Results From the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan) Program
- John E.A. Blair, Faiez Zannad, Marvin A. Konstam, Thomas Cook, Brian Traver, John C. Burnett, Jr, Liliana Grinfeld, Holly Krasa, Aldo P. Maggioni, Cesare Orlandi, Karl Swedberg, James E. Udelson, Christopher Zimmer, Mihai Gheorghiade for the EVEREST Investigators
J. Am. Coll. Cardiol. 2008 52: 1640-1648.
[Abstract]
[Full Text]
[PDF]
-
Global Differences in the Outcome of Heart Failure: Implications for Clinical Practice
- Philip A. Poole-Wilson
J. Am. Coll. Cardiol. 2008 52: 1649-1651.
[Full Text]
[PDF]
-
Ectopic Expression of the Sodium-Iodide Symporter Enables Imaging of Transplanted Cardiac Stem Cells In Vivo by Single-Photon Emission Computed Tomography or Positron Emission Tomography
- John Terrovitis, Keng Fai Kwok, Riikka Lautamäki, James M. Engles, Andreas S. Barth, Eddy Kizana, Junichiro Miake, Michelle K. Leppo, James Fox, Jurgen Seidel, Martin Pomper, Richard L. Wahl, Benjamin Tsui, Frank Bengel, Eduardo Marbán, and M. Roselle Abraham
J. Am. Coll. Cardiol. 2008 52: 1652-1660.
[Abstract]
[Full Text]
[PDF]
-
Molecular Imaging: Antidote to Cardiac Stem Cell Controversy
- Joseph C. Wu
J. Am. Coll. Cardiol. 2008 52: 1661-1664.
[Full Text]
[PDF]
-
Association of Previous Coronary Artery Bypass Graft Surgery With Door-to-Balloon Time and In-Hospital Outcomes: A Report From the National Cardiovascular Data Registry (NCDR)
- Michael S. Kim, Tracy Y. Wang, David Dai, Andrew J. Klein, Eric D. Peterson, John S. Rumsfeld, and John C. Messenger
J. Am. Coll. Cardiol. 2008 52: 1665-1670.
[Full Text]
[PDF]
-
The Year in Heart Failure
- W.H. Wilson Tang and Gary S. Francis
J. Am. Coll. Cardiol. 2008 52: 1671-1678.
[Full Text]
[PDF]
|
Top
Clinical Trial
Interventional Cardiology
