Circulation. 2006;113:177
(Circulation. 2006;113:177.)
© 2006 American Heart Association, Inc.
Issue Highlights
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LONG-TERM ADHERENCE TO EVIDENCE-BASED SECONDARY PREVENTION THERAPIES IN CORONARY ARTERY DISEASE, by Newby et al.
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Many studies have focused on the underuse of various secondary
prevention treatments at hospital discharge and, as a result,
performance is improving. However, our knowledge about the long-term
use of these interventions is much more limited because of substantial
challenges in the collection of outpatient data. To address
this issue, Duke investigators have made use of the Duke Databank
for Cardiovascular Disease, which has been augmented with follow-up
information that includes self-reported medications. The study
includes 31 750 patients with coronary artery disease confirmed
by catheterization who were seen at Duke from 1995 through 2002.
The findings reveal some remarkable insights about the consistent
use rates of important secondary prevention therapies. See p
203.
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MYOCARDIAL VIABILITY TESTING AND THE EFFECT OF EARLY INTERVENTION IN PATIENTS WITH ADVANCED LEFT VENTRICULAR SYSTOLIC DYSFUNCTION, by Tarakji et al.
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Controversy remains regarding the role of revascularization
in patients with heart failure and left ventricular dysfunction.
Observational studies suggest that such patients with preserved
viability and ischemia benefit from revascularization, but definitive
recommendations are constrained by limitations and biases inherent
in cohort analyses. In this issue of
Circulation, Tarakji and
colleagues report on patients referred for positron-emission
tomography imaging of viability during consideration of revascularization.
Propensity scoring was used to match patients who underwent
revascularization to a group that was treated medically. Revascularization
was associated with a 48% reduction in the risk of mortality
over 3 years. Of interest, the modeled outcomes suggested only
minor influence of the extent of viability on the effect of
revascularization. Short of a full randomized trial, these data
provide the most robust analysis to date of the potential role
of revascularization in patients with left ventricular dysfunction.
In an accompanying editorial, Gibbons and colleagues (p 180)
place these results in context of previous observational studies
and ongoing randomized trials, and examine the strengths and
weaknesses of such an analytic approach. See p
230.
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RANDOMIZED TRIAL OF A NONPOLYMER-BASED RAPAMYCIN-ELUTING STENT VERSUS A POLYMER-BASED PACLITAXEL-ELUTING STENT FOR THE REDUCTION OF LATE LUMEN LOSS, by Mehilli et al.
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Although drug-eluting stents (DES) reduce restenosis and the
need for repeat revascularization procedures, concerns over
the long-term safety of these devices persist. DES utilize polymers
to deliver antirestenotic drugs. The possibility that polymers
may promote inflammatory and thrombotic processes and adversely
affect vessel wall healing has led to the development of polymer-free
stents with a microporous surface as an alternative for local
drug delivery. The ISAR-TEST (Intracoronary Stenting and Angiographic
Restenosis- Test Equivalence Between 2 Drug-Eluting Stents Trial)
investigators studied whether polymer-free stents coated in
the cardiac catheterization laboratory with 2% rapamycin solution
are not inferior to polymer-based paclitaxel-eluting stents
for the prevention of restenosis. They showed no significant
differences in in-stent late lumen loss, angiographic restenosis,
or target lesion revascularization rates between the nonpolymer
rapamycin-stent and polymer paclitaxel-stent groups. Additional
studies are necessary to determine the impact of this non-polymer
stent system on long term safety end points. See p
273.
Visit http://www.circ.ahajournals.org:
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Clinician Update
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Venous Thromboembolism in Children. See p
e12.
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Images in Cardiovascular Medicine
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Cardiac Teratoma in a Newborn With Right Ventricular Outflow
Tract Obstruction. See p
e17.
Noninvasive Characterization of Left Atrial Mass. See p e19.
Architecture of Intracoronary Thrombi in ST-Elevation Acute Myocardial Infarction: Time Makes the Difference. See p e21.
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Book Review
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See p
e24.
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Correspondence
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See p
e25.
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