Circulation. 2007;116:2655
doi: 10.1161/CIRCULATIONAHA.107.187681
(Circulation. 2007;116:2655.)
© 2007 American Heart Association, Inc.
Issue Highlights
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TIME TO CORONARY ANGIOGRAPHY AND OUTCOMES AMONG PATIENTS WITH HIGH-RISK NON–ST-SEGMENT–ELEVATION ACUTE CORONARY SYNDROMES: RESULTS FROM THE SYNERGY TRIAL, by Tricoci et al.
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In this issue, Tricoci et al evaluated the relationship between
time from hospital admission to coronary angiography and outcomes
in high-risk patients with non–ST-segment–elevation
acute coronary syndromes. Data from 10 027 patients enrolled
in the SYNERGY trial were analyzed, and patients were grouped
by 6-hour time from hospital admission–to–coronary
angiography intervals. Primary outcomes were 30-day death or
myocardial infarction, in-hospital TIMI and GUSTO major bleeding,
and blood transfusion. Overall, 9216 (92%) patients underwent
angiography, with 6352 (64%) within 48 hours. Unadjusted and
adjusted rates of death/myocardial infarction increased with
increasing time to angiography. The adjusted odds ratio for
death/myocardial infarction in patients receiving angiography
in <6 hours was 0.56 (95% confidence interval 0.41–0.74),
whereas after 30 hours, there was no significant benefit compared
with further delayed angiography. Major bleeding and transfusion
did not significantly vary across time-to-angiography intervals.
In addition, the analyses showed that 2 variables, admission
to US hospitals and day of admission, were the most powerful
predictors of time to angiography and suggest that randomized
clinical trials are needed to provide definitive evidence on
optimal timing of coronary angiography. See p 2669 (editorial
p
2656).
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FIRST-IN-HUMAN EVALUATION OF ANTI–VON WILLEBRAND FACTOR THERAPEUTIC APTAMER ARC1779 IN HEALTHY VOLUNTEERS, by Gilbert et al.
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Although antithrombotic therapies that alter platelet–platelet
interactions are commonly used in primary and secondary prevention
of cardiovascular disease, much less is known about the utility
of inhibiting platelet binding to the blood vessel wall. In
this study, Gilbert and colleagues report the results of a novel
inhibitor (ARC1779) of platelet-vessel wall binding. This inhibitor
is an aptamer that binds to activated von Willebrand factor,
which prevents binding to the platelet GP1b receptor. This randomized,
double-blind, placebo-controlled study in 47 healthy volunteers
is a first-in-human study that reports that ARC1779 is well
tolerated and without bleeding. Further studies will be needed
to establish the clinical utility of this novel therapy in patients
with platelet-mediated thrombotic events. See p
2678.
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ENDOGENOUS TESTOSTERONE AND MORTALITY DUE TO ALL CAUSES, CARDIOVASCULAR DISEASE, AND CANCER IN MEN: EUROPEAN PROSPECTIVE INVESTIGATION INTO CANCER IN NORFOLK (EPIC-NORFOLK) PROSPECTIVE POPULATION STUDY, by Khaw et al.
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The role of endogenous sex hormones in healthy adults is controversial.
The administration of high doses of testosterone has been associated
with adverse outcomes. However, low concentrations of circulating
testosterone also have been associated with adverse cardiovascular
risk factors such as elevated lipids, blood pressure, and glucose
concentration, as well as with intermediate cardiovascular phenotypes.
Additionally, although not definitive, some studies have suggested
that low serum testosterone concentrations also are associated
with cardiovascular disease. In the present issue, Khaw and
colleagues conducted a nested case control study in the EPIC-Norfolk
study of middle-aged men without diagnosed cancer or cardiovascular
disease. In follow-up, the investigators reported a lower rate
of cardiovascular and all-cause mortality in men with increasing
quartiles of endogenous testosterone concentrations. Whether
low circulating endogenous testosterone concentrations is a
risk marker or is causally related to increased cardiovascular
disease events will need to be examined in other cohorts and
with other study designs. See p 2694 (editorial p
2658).
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Predominant, Severe Right Ventricular Outflow Tract Obstruction
in Hypertrophic Cardiomyopathy. See p
e551.
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Correspondence
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See p
e554.
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Evaluating the Optimal Timing of Angiography: Landmark or off the Mark?
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Testosterone Making an Entry Into the Cardiometabolic World
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Predominant, Severe Right Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy
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Letter by Ly Regarding Article, "Direct Intramyocardial but Not Intracoronary Injection of Bone Marrow Cells Induces Ventricular Arrhythmias in a Rat Chronic Ischemic Heart Failure Model"
- Hung Q. Ly
Circulation 2007 116: e554.
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First-in-Human Evaluation of Anti–von Willebrand Factor Therapeutic Aptamer ARC1779 in Healthy Volunteers
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TIME TO CORONARY ANGIOGRAPHY...
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