Circulation. 2005;111:1567
(Circulation. 2005;111:1567.)
© 2005 American Heart Association, Inc.
Issue Highlights
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GENDER DIFFERENCES IN OUTCOMES AFTER PRIMARY ANGIOPLASTY VERSUS PRIMARY STENTING WITH AND WITHOUT ABCIXIMAB FOR ACUTE MYOCARDIAL INFARCTION: RESULTS OF THE CONTROLLED ABCIXIMAB AND DEVICE INVESTIGATION TO LOWER LATE ANGIOPLASTY COMPLICATIONS (CADILLAC) TRIAL, by Lansky et al.
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Prior studies have suggested that women presenting with acute
myocardial infarction have increased short-term and longer-term
mortality rates as compared with men. Investigators from the
CADILLAC study, a large, multicenter randomized trial of different
reperfusion modalities in acute myocardial infarction, analyzed
their database to understand whether outcome varied by reperfusion
approach. As noted by previous investigators, women presenting
with acute myocardial infarction were older, had smaller body
surface area, and had a higher burden of cardiovascular disease
risk factors than did their male counterparts. Adjustment for
baseline differences, particularly smaller body surface area,
attenuated the sex differences in mortality rates. Notably,
primary stenting (compared with percutaneous transluminal coronary
angioplasty) reduced restenosis and significantly reduced major
adverse cardiac events at 1 year in women. In addition, abciximab
use with stenting diminished 30-day ischemia-related revascularization
without an excess in bleeding and stroke complications. Confirming
prior investigations, the investigators report an average 0.75-hour
delay between myocardial infarction and percutaneous balloon
intervention, which includes significant delays both in arriving
to the emergency department and in being transferred from the
emergency department to the catheterization laboratory. As the
authors note, such major delays represent an important modifiable
target to further improve outcomes for women in acute myocardial
infarction. Interventions that can effectively reduce myocardial
infarction treatment delays in women as well as men require
further study and public health attention. See p
1611.
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THROMBOSIS MODULATES ARTERIAL DRUG DISTRIBUTION FOR DRUG-ELUTING STENTS, by Hwang et al.
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Drug-eluting stents have reduced restenosis rates to the single-digit
range, a benefit that has proven durable over several years
of follow-up; however, these stents have not eradicated restenosis,
and investigators have not yet been able to determine why a
small percentage of patients return with symptoms. To achieve
the maximum benefit of the drug eluted from the stent, the stent
must be directly in contact with the vessel wall. Although this
appears to be the case angiographically in the majority of patients,
it has been suggested that subclinical thrombus deposition on
the vessel wall influences the pharmacodynamics of drug elution.
In this issue of
Circulation, Hwang et al report a series of
elegant ex vivo and in vivo studies that clarify the effect
of thrombus on paclitaxel pharmacokinetics and how this influences
drug distribution. See p
1619.
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CD40/CD40 LIGAND SIGNALING IN MOUSE CEREBRAL MICROVASCULATURE AFTER FOCAL ISCHEMIA/REPERFUSION, by Ishikawa et al.
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Ischemic stroke, like unstable coronary syndromes, is regulated
by the interface between inflammation and thrombosis, and this
involves signaling between the blood vessel wall and the circulating
cells. One such interface is due to the interaction between
CD40 and the membrane glycoprotein CD40 ligand found on leukocytes,
platelets, and the endothelium. Although interaction between
CD40–CD40 ligand is increased in acute coronary syndromes
and thrombotic strokes, the contribution of expression of CD40
by select cells to ischemic stroke is unknown. In mice deficient
in either CD40 or CD40 ligand, Ishikawa and colleagues demonstrate
a decrease in platelet and leukocyte adhesion as well as a decrease
in injury size in a cerebral infarct model. These findings suggest
that the CD40–CD40 ligand interaction contributes to the
thrombotic and inflammatory processes regulating acute ischemic
stroke. See p
1690.
Visit www.circ.ahajournals.org:
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Cardiology Patient Page
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Peripheral Arterial Disease. See p
e169.
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Images in Cardiovascular Medicine
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Torsade de Pointes in a Patient With Wolff-Parkinson-White Syndrome.
See p
e173.
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Correspondence
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Letter Regarding Article by Okoshi et al, "Neuregulins Regulate
Cardiac Parasympathetic Activity: Muscarinic Modulation of ß-Adrenergic
Activity in Myocytes From Mice With Neuregulin-1 Gene Deletion.
" See p
e175.
Letter Regarding Article by Hlatky et al, "Medical Costs and Quality of Life 10 to 12 Years After Randomization to Angioplasty or Bypass Surgery for Multivessel Coronary Artery Disease. " See p e176.
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CD40/CD40 Ligand Signaling in Mouse Cerebral Microvasculature After Focal Ischemia/Reperfusion
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Circulation 2005 111: 1690-1696.
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Thrombosis Modulates Arterial Drug Distribution for Drug-Eluting Stents
- Chao-Wei Hwang, Andrew D. Levin, Michael Jonas, Pamela H. Li, and Elazer R. Edelman
Circulation 2005 111: 1619-1626.
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Gender Differences in Outcomes After Primary Angioplasty Versus Primary Stenting With and Without Abciximab for Acute Myocardial Infarction: Results of the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial
- Alexandra J. Lansky, Cody Pietras, Ricardo A. Costa, Yoshihiro Tsuchiya, Bruce R. Brodie, David A. Cox, Eve D. Aymong, Thomas D. Stuckey, Eulogio Garcia, James E. Tcheng, Roxana Mehran, Manuela Negoita, Martin Fahy, Ecaterina Cristea, Mark Turco, Martin B. Leon, Cindy L. Grines, and Gregg W. Stone
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Peripheral Arterial Disease
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Circulation 2005 111: e169-e172.
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Torsade de Pointes in a Patient With Wolff-Parkinson-White Syndrome
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Circulation 2005 111: e173-e174.
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Letter Regarding Article by Okoshi et al, "Neuregulins Regulate Cardiac Parasympathetic Activity: Muscarinic Modulation of ß-Adrenergic Activity in Myocytes From Mice With Neuregulin-1 Gene Deletion" • Response
- Katrien Lemmens, Vincent F.M. Segers, Gilles W. De Keulenaer, Katashi Okoshi, Masaharu Nakayama, Xinhua Yan, Marina P. Okoshi, Adam J.T. Schuldt, Beverly H. Lorell, and Mark A. Marchionni
Circulation 2005 111: e175.
[Full Text]
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Letter Regarding Article by Hlatky et al, "Medical Costs and Quality of Life 10 to 12 Years After Randomization to Angioplasty or Bypass Surgery for Multivessel Coronary Artery Disease" • Response
- Faizel Osman, Sohail Qaisar, Michael Pitt, Mark A. Hlatky, Derek B. Boothroyd, Kathryn A. Melsop, Maria M. Brooks, Daniel B. Mark, Bertram Pitt, Guy S. Reeder, William J. Rogers, Thomas J. Ryan, Patrick L. Whitlow, and Robert D. Wiens
Circulation 2005 111: e176-e177.
[Full Text]
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GENDER DIFFERENCES IN OUTCOMES...
THROMBOSIS MODULATES ARTERIAL...