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(Circulation. 2005;112:3815.)
© 2005 American Heart Association, Inc.

Issue Highlights

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	RETINAL AND CEREBRAL MICROEMBOLIZATION DURING CORONARY ARTERY BYPASS SURGERY: A RANDOMIZED, CONTROLLED TRIAL, by Ascione et al.

 
Retinal microvasculature damage was assessed in a randomized study of 20 patients who had a coronary artery bypass (CAB) either with cardiopulmonary bypass or "off pump." The authors found that the off-pump CAB technique reduced Doppler high-intensity transient signals. The patients who had off-pump surgery had lower levels of S100 protein. However, there was no difference in postoperative visual acuity, and only 1 on-pump CAB patient had microvascular damage detected by color fundus photography. The use of the fundus microvascular to make inferences about the brain microvasculature is controversial. However, in this small randomized study, the measurable parameters suggest advantages favoring the off-pump technique. The search for the safest technique to perform CAB surgery to minimize neurological damage requires large randomized studies with late follow-up because most neurological changes after CAB are transient. See p 3833.

	ANGIOGRAPHIC AND CLINICAL OUTCOMES IN PATIENTS RECEIVING LOW-MOLECULAR-WEIGHT HEPARIN VERSUS UNFRACTIONATED HEPARIN IN ST-ELEVATION MYOCARDIAL INFARCTION TREATED WITH FIBRINOLYTICS IN THE CLARITY-TIMI 28 TRIAL, by Sabatine et al.

 
In patients with acute ST-segment-elevation myocardial infarction (STEMI) treated with fibrinolysis, controversy remains about the role of unfractionated heparin (UFH) versus low-molecular-weight heparin (LMWH), as definitive trials have not been performed. In this issue of Circulation, Sabatine and colleagues examine the influence of choice of heparin therapy on angiographic and clinical outcomes among 2860 patients enrolled in the CLARITY-TIMI 28 trial. In this trial, designed to assess the impact of early treatment with clopidogrel in STEMI, almost half of the population was treated with adjunctive LMWH and half with UFH, on clinical grounds. After adjustment for baseline differences and incorporation of propensity analysis, treatment with LMWH was associated with a lower rate . . . [Full Text of this Article]

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