doi: 10.1161/01.CIR.0000060182.93067.4D
(Circulation. 2003;107:e9007.)
© 2003 American Heart Association, Inc.
Cardiovascular News
Circulation Newswriter
Manuscript Submissions to Circulation Set Record
In December 2002, the editorial offices of Circulation received 670 manuscripts, the most ever in a single month.
"This is an indication of the importance of research into cardiovascular disease around the world and the need for a weekly journal such as Circulation to insure the prompt dissemination of that information," said James T. Willerson, MD, Editor of Circulation. "Circulation has continued to receive reports of some of the best research ongoing in cardiovascular medicine today, and its ability to get that information to the clinician and the research community in a timely fashion has prompted many of those in the field to use it as a medium for communicating their results. As the journal continues, we expect that it will continue to reflect advances in the continuing war on cardiovascular disease worldwide."
Nicotine and Its Ways
Researchers from Germany and California answered "yes" to the logical question: "If antigen-presenting cells play a role in adaptive immunity and this plays a role in the growth of atherosclerotic plaque, and nicotine increases the growth of atherosclerotic lesions, does nicotine stimulate antigen-producing cells and their ability to stimulate T-cells?"
In this week’s issue of Circulation (Circulation. 2003;107:604–611), scientists led by Alexandra Aicher, MD, and Christopher Heeschen, MD, of the Department of Internal Medicine IV, Molecular Cardiology at the University of Frankfurt, Germany, used dendritic cells derived from human monocytes and from mouse bone marrow as antigen-producing cells. They found that the nicotine induced expression by dendritic cells of co-stimulatory molecules such as CD86 and CD40, as well as adhesion molecules such as LFA-1 and CD54. In addition, the nicotine caused the human dendritic cells to increase secretion of interleukin-12—a proinflammatory TH1 cytokine—7 times.
They concluded from these and other experiments that nicotine activates dendritic cells and increases their ability to stimulate T-cell proliferation and the secretion of cytokines. These effects may play a key role in the effect the chemical has on the progression of atherosclerotic lesions, the authors noted.
Off-Pump, On-Pump Coronary Artery Bypass Surgery Same But Cheaper for Low-Risk Patients
The popularity of off-pump coronary artery bypass graft surgery has increased in the past decade with the development of new instrumentation and new concerns about neurocognitive impairments found 5 years after surgery. In this study in the January 30, 2003, issue of the New England Journal of Medicine, European researchers led by Hendrik M. Nathoe, MD, of the University Medical Center Utrecht in Utrecht, the Netherlands, found that the outcomes of off-pump and on-pump surgery were similar, but that the off-pump technique reduced cost.
In this multicenter study, 139 patients with single- or two-vessel coronary disease were randomized to on-pump surgery and 142 with the same disease to off-pump surgery. The cost and cardiac outcome of the surgery were reviewed one year after the surgery.
After one year, the rate of death, stroke, heart attack and coronary reintervention was 9.4% for those in the on-pump group and 12% in the off-pump group. Grafts remained patent in 93% of on-pump surgery patients and in 91% of off-pump patients who were included in a randomized subgroup of patients.
The main difference was in cost. The on-pump technique cost $1839 more in direct patient care costs than the off-pump surgery. The costs were $14 908 for on-pump versus $13 069 for off-pump—a difference of 14.1%.
The authors noted: "In current practice, however, off-pump surgery is increasingly being performed in patients with single- and double-vessel disease. With respect to costs and cost effectiveness, these data must be interpreted with regard to the setting and the country in which the study was conducted. There may be substantial differences in costs in other practices and countries. This is especially true with respect to the costs of hospital stay, which may be a source of important savings."
In an accompanying perspective, Eric Rose, MD, of the Columbia University College of Physicians and Surgeons noted: "Reliable data comparing outcomes in high-risk patients are sorely lacking. In the future, randomized trials and outcome data from large registries will make it possible to explore the potential risks and benefits in the latter, substantially larger cohort of surgical patients. Until such data are available, we will not know whether off-pump bypass surgery is a step forward, backward, or sideways."
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