Circulation. 2006;114:2571
(Circulation. 2006;114:2571.)
© 2006 American Heart Association, Inc.
Issue Highlights
 |
HIGH PLASMA ALDOSTERONE LEVELS ON ADMISSION ARE ASSOCIATED WITH DEATH IN PATIENTS PRESENTING WITH ACUTE ST-ELEVATION MYOCARDIAL INFARCTION, by Beygui et al.
|
|---|
After myocardial infarction, angiotensin-converting enzyme inhibitors
have a proven beneficial effect to limit maladaptive ventricular
remodeling. These agents have the additional therapeutic advantage
of decreasing levels of aldosterone, the final common mediator
of the renin-angiotensin-aldosterone pathway. Despite optimal
therapy with angiotensin-converting enzyme inhibitors, evidence
suggests that an "aldosterone escape" occurs, and aldosterone
levels remain elevated even with lowered angiotensin II levels.
This is supported by results from large-scale clinical trials
that demonstrate an additional mortality benefit in patients
with myocardial infarction who are treated with aldosterone
antagonists or mineralocorticoid receptor blockers. In addition,
a number of small studies have measured aldosterone levels directly
and suggested that they are elevated in the setting of acute
myocardial infarction. In this issue of
Circulation, Beygui
et al determine plasma aldosterone levels in patients with myocardial
infarction at the time of presentation and examine the influence
on clinical outcome. See p
2604.
|
THORACIC AORTIC ANEURYSM AND DISSECTION: INCREASING PREVALENCE AND IMPROVED OUTCOMES REPORTED IN A NATIONWIDE POPULATION-BASED STUDY OF MORE THAN 14 000 CASES FROM 1987 TO 2002, by Olsson et al.
|
|---|
The prevalence, incidence, and survival of thoracic aortic disease
(TAD) (aneurysm and dissection) are poorly defined, as much
of the available information comes from small studies that do
not reflect current experience. The study in this issue by Olsson
et al examined the prevalence, incidence, and mortality rates
of TAD in patients with and without surgical treatment from
Swedish National Healthcare Registry from 1987 to 2002. TAD
was identified in 14 229 individuals. Over the follow-up time,
the incidence of TAD increased by 28% and 52% for women and
men, respectively, and operative treatment rose by 15-fold and
7-fold, respectively. The operative mortality rate was 16%,
but both short- and long-term mortality rates improved over
time, with a 5-year mortality in operative survivors of 77%.
This study is the most comprehensive published to date and emphasizes
the need for improved identification and management of this
disorder. It supports the wider use of surgical treatment. See
p
2611.
|
A RANDOMIZED STUDY COMPARING SAME-DAY HOME DISCHARGE AND ABCIXIMAB BOLUS ONLY TO OVERNIGHT HOSPITALIZATION AND ABCIXIMAB BOLUS AND INFUSION AFTER TRANSRADIAL CORONARY STENT IMPLANTATION, by Bertrand et al.
|
|---|
It is usual practice to keep patients in the hospital overnight
following percutaneous coronary interventions to monitor for
complication such as abrupt closure and bleeding. The use of
coronary stents and glycoprotein IIb/IIIa agents has reduced
these complications, however. In addition, use of the radial
artery approach has been associated with lower bleeding complications.
This study by Bertrand et al enrolled 1005 patients who underwent
an uncomplicated radial artery percutaneous coronary intervention.
Patients were randomized to a bolus abciximab followed by same-day
discharge or to a bolus and infusion of abciximab and next-day
discharge. Twenty percent of the patients presented with high
risk acute coronary syndrome. The primary end point (death,
myocardial infarction, urgent revascularization, repeat hospitalization,
access site bleeding, or thrombocytopenia) at 30 days was not
different between groups (20.4% versus 18.2% respectively).
Bleeding was low in both groups. This study suggests that in
patients undergoing an uncomplicated percutaneous coronary intervention,
the use of a radial artery approach and a bolus of abciximab
followed by same-day discharge is safe strategy when compared
with a bolus and infusion of abciximab and next-day discharge.
See p
2636.
Visit http://circ.ahajournals.org:
|
Images in Cardiovascular Medicine
|
|---|
Coronary Artery Fistula With a Huge Aneurysm Treated by Transcatheter
Coil Embolization. See p
e631.
Early Differential Resolution of Right and Left Ventricular Obliteration in Löffler Endocarditis After Chemotherapy and Anticoagulation. See p e635.
FBI (Fast, Broad, Irregular): A Case for the Secret Service? See p e638.
|
Correspondence
|
|---|
See p
e640.
Related Articles:
-
Coronary Artery Fistula With a Huge Aneurysm Treated by Transcatheter Coil Embolization
- Sang-Ho Jo, Young-Jin Choi, Dong-Jin Oh, and Chong-Yun Rhim
Circulation 2006 114: e631-e634.
[Full Text]
-
Early Differential Resolution of Right and Left Ventricular Obliteration in Löffler Endocarditis After Chemotherapy and Anticoagulation
- Juan Benezet-Mazuecos, Pedro Marcos-Alberca, Jerónimo Farré, Miguel Orejas, Adolfo de la Fuente, and Elena Prieto
Circulation 2006 114: e635-e637.
[Full Text]
-
FBI (Fast Broad Irregular): A Case for the Secret Service?
- Sergio Richter and Pedro Brugada
Circulation 2006 114: e638-e639.
[Full Text]
-
Letter by Opie and Selker Regarding Article, "Reperfusion Starts in the Ambulance"
- Lionel H. Opie and Harry Selker
Circulation 2006 114: e640.
[Full Text]
-
Thoracic Aortic Aneurysm and Dissection: Increasing Prevalence and Improved Outcomes Reported in a Nationwide Population-Based Study of More Than 14 000 Cases From 1987 to 2002
- Christian Olsson, Stefan Thelin, Elisabeth Ståhle, Anders Ekbom, and Fredrik Granath
Circulation 2006 114: 2611-2618.
[Abstract]
[Full Text]
-
High Plasma Aldosterone Levels on Admission Are Associated With Death in Patients Presenting With Acute ST-Elevation Myocardial Infarction
- Farzin Beygui, Jean-Philippe Collet, Jean-Jacques Benoliel, Nicolas Vignolles, Raphaelle Dumaine, Olivier Barthélémy, and Gilles Montalescot
Circulation 2006 114: 2604-2610.
[Abstract]
[Full Text]
-
A Randomized Study Comparing Same-Day Home Discharge and Abciximab Bolus Only to Overnight Hospitalization and Abciximab Bolus and Infusion After Transradial Coronary Stent Implantation
- Olivier F. Bertrand, Robert De Larochellière, Josep Rodés-Cabau, Guy Proulx, Onil Gleeton, Can Manh Nguyen, Jean-Pierre Déry, Gérald Barbeau, Bernard Noël, Éric Larose, Paul Poirier, Louis Roy for the Early Discharge After Transradial Stenting of Coronary Arteries (EASY) Study Investigators
Circulation 2006 114: 2636-2643.
[Abstract]
[Full Text]
Top
HIGH PLASMA ALDOSTERONE LEVELS...
THORACIC AORTIC ANEURYSM AND...