Circulation. 2006;114:2001
(Circulation. 2006;114:2001.)
© 2006 American Heart Association, Inc.
Issue Highlights
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TRANSTHORACIC INCREMENTAL MONOPHASIC VERSUS BIPHASIC DEFIBRILLATION BY EMERGENCY RESPONDERS (TIMBER): A RANDOMIZED COMPARISON OF MONOPHASIC WITH BIPHASIC WAVEFORM ASCENDING ENERGY DEFIBRILLATION FOR THE RESUSCITATION OF OUT-OF-HOSPITAL CARDIAC ARREST DUE TO VENTRICULAR FIBRILLATION, by Kudenchuk et al.
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Shocks with a biphasic wave form are more effective than monophonic
shocks for terminating ventricular fibrillation in many situations.
All new defibrillators have biphasic waveforms, but a large
number of monophasic waveform devices remain in use. Should
replacement of these devices receive a high priority? Kudenchuk
and colleagues conducted a randomized trial comparing monophasic
and biphasic shocks for treatment of out-of-hospital cardiac
arrests. A unique aspect of their trial was blinding of the
investigators that extended through the data analysis and review
process, unblinding only after the manuscript had been accepted
for publication. Arrest victims received cardiopulmonary resuscitation
before shock, consistent with present guidelines. Biphasic waveform
defibrillation was not superior to the monophasic waveform,
although a trend toward better survival did favor the biphasic
waveform. The study should inform communities and institutions
that are prioritizing resources for replacement of monophasic
waveform defibrillators. See p
2010.
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HOSPITAL DELAYS IN REPERFUSION FOR ST-ELEVATION MYOCARDIAL INFARCTION: IMPLICATIONS WHEN SELECTING A REPERFUSION STRATEGY, by Pinto et al.
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The survival benefit associated with primary percutaneous coronary
intervention (PPCI) in ST-segment elevation myocardial infarction
may be attenuated if door-to-balloon (DB) time is delayed by
1 hour beyond door-to-needle (DN) times for fibrinolytic therapy.
Whereas DB times are rapid in randomized trials, they are often
prolonged in routine practice. In this issue of
Circulation,
Pinto et al calculated DB-DN times by subtracting median DN
time from median DB time at a hospital using data from 192 509
patients at 645 National Registry of Myocardial Infarction hospitals.
Longer DB-DN times were associated with increased mortality.
The DB-DN times in which mortality rates with PPCI were no better
than those of fibrinolysis varied considerably depending upon
patient age, symptom duration, and infarct location. As indicated
in the American College of Cardiology/American Heart Association
ST-elevation myocardial infarction guidelines and discussed
in this issue in an accompanying editorial by Van de Werf, both
the hospital-based PCI-related delay (DB-DN time) as well as
patient characteristics should be considered when selecting
a reperfusion strategy. See p 2019 (editorial on p
2002).
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AGE-DEPENDENT EFFECT OF ABCIXIMAB IN PATIENTS WITH ACUTE CORONARY SYNDROMES TREATED WITH PERCUTANEOUS CORONARY INTERVENTIONS, by Ndrepepa et al.
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Advanced age is associated with a poorer outcome in percutaneous
coronary interventions (PCI) and acute coronary syndromes (ACS)
than that of younger patients. With an expected increase in
the proportion of patients >65 years to more than 20% of
the population by 2030, understanding the benefit of therapy
in the elderly is increasingly important. This study by Ndrepepa
and colleagues examined the effect of age on the benefit of
abciximab in 2022 patients with ACS undergoing PCI as part of
the Intracoronary Stenting and Antithrombotic Regimen: Rapid
Early Action for Coronary Treatment (ISAR-REACT 2) trial. Although
the incidence of major cardiac events at 30 days fell from 13.8%
to 7.7% (
P=0.001) in patients <70 years of age treated with
abciximab, it was unchanged in older patients (9.9% versus 10.9%,
P=NS). These findings persisted after adjustment for baseline
differences. Age is an important factor in the efficacy of abciximab
in patients with high risk ACS undergoing PCI. See p
2040.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Acute Stenosis of Porcine Stentless Bioprosthesis Caused by
Infective Endocarditis. See p
e567.
Epicardial Tachycardia Originating From a Persistent Left Superior Vena Cava. See p e569.
Correspondence Between Delayed Enhancement Patterns in Multislice Computed Tomography and Magnetic Resonance Imaging in a Case of Acute Myocarditis. See p e571.
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Correspondence
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See p
e573.
Related Articles:
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Fine-Tuning the Selection of a Reperfusion Strategy
- Frans J. Van de Werf
Circulation 2006 114: 2002-2003.
[Extract]
[Full Text]
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Acute Stenosis of Porcine Stentless Bioprosthesis Caused by Infective Endocarditis
- Tsuyoshi Taketani, Kan Nawata, Noboru Motomura, Minoru Ono, and Shinichi Takamoto
Circulation 2006 114: e567-e568.
[Extract]
[Full Text]
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Epicardial Tachycardia Originating From a Persistent Left Superior Vena Cava
- Mark D. O’Neill, Anders Jönsson, Yoshihide Takahashi, Mélèze Hocini, Pierre Jaïs, and Michel Haïssaguerre
Circulation 2006 114: e569-e570.
[Extract]
[Full Text]
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Correspondence Between Delayed Enhancement Patterns in Multislice Computed Tomography and Magnetic Resonance Imaging in a Case of Acute Myocarditis
- Alban B. Redheuil, Arshid Azarine, Pierre Garrigoux, and Elie Mousseaux
Circulation 2006 114: e571-e572.
[Extract]
[Full Text]
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Letter by Brocco et al Regarding Article, "Percutaneous Treatment With Drug-Eluting Stent Implantation Versus Bypass Surgery for Unprotected Left Main Stenosis: A Single-Center Experience"
- Stefano Brocco, Paolo Spolaore, and Giuseppe Tarantini
Circulation 2006 114: e573.
[Extract]
[Full Text]
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Transthoracic Incremental Monophasic Versus Biphasic Defibrillation by Emergency Responders (TIMBER): A Randomized Comparison of Monophasic With Biphasic Waveform Ascending Energy Defibrillation for the Resuscitation of Out-of-Hospital Cardiac Arrest due to Ventricular Fibrillation
- Peter J. Kudenchuk, Leonard A. Cobb, Michael K. Copass, Michele Olsufka, Charles Maynard, and Graham Nichol
Circulation 2006 114: 2010-2018.
[Abstract]
[Full Text]
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Age-Dependent Effect of Abciximab in Patients With Acute Coronary Syndromes Treated With Percutaneous Coronary Interventions
- Gjin Ndrepepa, Adnan Kastrati, Julinda Mehilli, Franz-Josef Neumann, Jurriën ten Berg, Olga Bruskina, Franz Dotzer, Melchior Seyfarth, Jürgen Pache, Josef Dirschinger, Kurt Ulm, Peter B. Berger, and Albert Schömig
Circulation 2006 114: 2040-2046.
[Abstract]
[Full Text]
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