Circulation. 2005;112:3815
(Circulation. 2005;112:3815.)
© 2005 American Heart Association, Inc.
Issue Highlights
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RETINAL AND CEREBRAL MICROEMBOLIZATION DURING CORONARY ARTERY BYPASS SURGERY: A RANDOMIZED, CONTROLLED TRIAL, by Ascione et al.
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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.
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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.
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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 of a closed infarct-related artery or death or
MI before angiography (OR 0.76,
P=0.027) and with a lower rate
of cardiovascular death or recurrent MI through 30 days (OR
0.68,
P=0.030). Infarct artery patency was 91% among patients
receiving clopidogrel and LMWH in association with fibrinolytic
therapy. These important data inform the choice of heparin therapy
in patients with STEMI receiving fibrinolytic therapy. See p
3846.
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TWENTY-YEAR TRENDS IN SERUM CHOLESTEROL, HYPERCHOLESTEROLEMIA, AND CHOLESTEROL MEDICATION USE: THE MINNESOTA HEART SURVEY, 1980–1982 TO 2000–2002, by Arnett et al.
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In this issue of
Circulation, Arnett and colleagues report from
the Minnesota Heart Study on lipid trends from 1980–1982
to 2000–2002, which indicate both positive and troubling
data. The downward trends in total cholesterol concentrations
reported nationally since 1960 are continuing to the present
and reflect a decrease in age-adjusted total cholesterol levels
and hypercholesterolemia prevalence and an increase in lipid-lowering
medication. However, a matter of concern is that younger adults
(25 to 34 years) have recently shown an increase in total cholesterol
levels. In addition, more than half of those with hypercholesterolemia
remain unaware of their condition. The present study underscores
the need for continued vigilance to increase screening as well
as lifestyle and pharmacological management of lipid disorders.
See p
3884.
Visit http://www.circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Aortic Endocarditis Caused by Inadvertent Left Ventricular Pacemaker
Lead Placement. See p
e361.
Infected Patent Ductus Arteriosus. See p e364.
A 360-Degree Aortic Dissection Tear Mimicking Massive Aortic Regurgitation. See p e366. 
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Correspondence
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See p
e367.
Related Articles:
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Retinal and Cerebral Microembolization During Coronary Artery Bypass Surgery: A Randomized, Controlled Trial
- Raimondo Ascione, Arup Ghosh, Barnaby C. Reeves, John Arnold, Mike Potts, Atul Shah, and Gianni D. Angelini
Circulation 2005 112: 3833-3838.
[Abstract]
[Full Text]
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Aortic Endocarditis Caused by Inadvertent Left Ventricular Pacemaker Lead Placement
- Matthias R. Schulze, Ralf Ostermaier, Yvonne Franke, Klaus Matschke, Martin U. Braun, and Ruth H. Strasser
Circulation 2005 112: e361-e363.
[Full Text]
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Infected Patent Ductus Arteriosus
- Ramarao S. Lankipalli, Kevin Lax, Martin G. Keane, F. Michael Toca, Joseph E. Bavaria, Bonnie L. Milas, Victor A. Ferrari, Sridhar R. Charagundla, and Frank E. Silvestry
Circulation 2005 112: e364-e365.
[Full Text]
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A 360-Degree Aortic Dissection Tear Mimicking Massive Aortic Regurgitation
- Marco Cirillo, Elena Conti, Giordano Tasca, and Giovanni Troise
Circulation 2005 112: e366.
[Full Text]
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Letter Regarding Article by von Lewinski et al, "Insulin Causes [Ca2+]i-Dependent and [Ca2+]i-Independent Positive Inotropic Effects in Failing Human Myocardium" • Response
- Chih-Hsueng Hsu, Cheng-I Lin, Jeng Wei, Dirk von Lewinski, Sebastian Bruns, Stefanie Walther, Harald Kögler, and Burkert Pieske
Circulation 2005 112: e367.
[Full Text]
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Twenty-Year Trends in Serum Cholesterol, Hypercholesterolemia, and Cholesterol Medication Use: The Minnesota Heart Survey, 1980–1982 to 2000–2002
- Donna K. Arnett, David R. Jacobs, Jr, Russell V. Luepker, Henry Blackburn, Christopher Armstrong, and Steven A. Claas
Circulation 2005 112: 3884-3891.
[Abstract]
[Full Text]
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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
- Marc S. Sabatine, David A. Morrow, Gilles Montalescot, Mikael Dellborg, Jose L. Leiva-Pons, Matyas Keltai, Sabina A. Murphy, Carolyn H. McCabe, C. Michael Gibson, Christopher P. Cannon, Elliott M. Antman, Eugene Braunwald for the Clopidogrel as Adjunctive Reperfusion Therapy (CLARITY)–Thrombolysis in Myocardial Infarction (TIMI) 28 Investigators
Circulation 2005 112: 3846-3854.
[Abstract]
[Full Text]
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