INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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SES Superior to PES in Diabetics.
Lee and colleagues compared the effectiveness of sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) in patients with diabetes. A total of 400 patients were randomized to either PES or SES with a primary end point of in-segment restenosis at 6 months. The relative risk of the primary end point was 0.19 for those randomized to SES; similar reductions were found for in-stent restenosis and 9-month target vessel revascularization. These results suggest that in diabetic patients, SES are superior to PES. See page 727.
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Antiplatelet Therapy
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Dual Nonresponders at High Risk for Stent Thrombosis.
There is limited data on either the prevalence or clinical significance of resistance to both clopidogrel and aspirin. Gori and colleagues assessed platelet reactivity to measure resistance to clopidogrel and to aspirin. The incidence of dual nonresponsiveness was 6%, while nonresponsiveness to clopidogrel or aspirin was found in 6% and 11.5%, respectively. Definite/probable stent thrombosis was 5 times more likely in dual nonresponders (11%) than in patients with resistance to either one alone or with no resistance. Nonresponsiveness to both aspirin and clopidogrel occurs in about 1 in 20 patients and identifies patients at very high risk for stent thrombosis. See page 734. See figure.
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Heart Failure
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Serum Levels of ACE2 Correlate With HF Severity.
Angiotensin-converting enzyme 2 (ACE2) is a recently discovered homologue of the more widely known angiotensin-converting enzyme that antagonizes the effects of angiotensin II and may be protective in animal heart failure (HF) models. Epelman and colleagues measured serum activity of ACE2 (sACE2) in patients with suspected HF. sACE2 activity correlated with B-type natriuretic peptide levels, ejection fraction, and New York Heart Association functional class. These results show that sACE2 activity is increased in patients with HF and suggest that sACE2 may be a target for modulation. See page 750. See figure.
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Valvular Heart Disease
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Increased Heat Production in Stenotic Aortic Valve Leaflets.
Toutouzas and colleagues hypothesized that heat production in the leaflets would correlate with inflammation and neoangiogenesis in patients with aortic valve stenosis (AVS). The temperature of the aortic valve leaflets and the aortic wall were measured in 25 patients undergoing aortic valve surgery. The difference in temperature between the leaflets and the wall ( T) was higher in patients with AVS than in those with aortic insufficiency, and T correlated with the degree of inflammation and vascular endothelial growth factor expression. These finding support the hypothesis that an active inflammatory process is involved in the progression of AVS. See page 758.
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A Randomized Comparison of Sirolimus- Versus Paclitaxel-Eluting Stent Implantation in Patients With Diabetes Mellitus
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Interventional Cardiology
Antiplatelet Therapy
