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(Circulation. 2004;110:1875.)
© 2004 American Heart Association, Inc.
Issue Highlights |
SURVIVAL AFTER CORONARY REVASCULARIZATION AMONG PATIENTS WITH KIDNEY DISEASE, by Hemmelgarn et al.
Patients with end-stage renal disease have a high risk of cardiovascular disease. Clinicians are often faced with decisions about coronary revascularization in these patients, but relatively little information is available about the outcomes in this group. The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) collects information on all patients undergoing cardiac catheterization in Alberta, Canada. Investigators made use of APPROACH to compare survival for various clinical strategies (percutaneous coronary intervention, bypass surgery, medical therapy) among patients with dialysis-dependent kidney disease, non–dialysis-dependent kidney disease, or a serum creatinine <2.3 mg/dL. This observational study provides evidence about whether kidney function should influence the choice of revascularization strategy. See p 1890.
COMORBIDITY AND MYOCARDIAL DYSFUNCTION ARE THE MAIN EXPLANATIONS FOR THE HIGHER 1-YEAR MORTALITY IN ACUTE MYOCARDIAL INFARCTION WITH LEFT BUNDLE-BRANCH BLOCK, by Stenestrand et al.
Left bundle-branch block (LBBB) in the setting of myocardial infarction has been associated with increased short-term and long-term mortality, although the reasons for the poor prognosis in such patients have not been elucidated. The large Swedish registry of more than 88 000 myocardial infarction patients allowed extensive multivariable analysis to evaluate the risk contribution by LBBB, not only the associated risk. After adjustment for differences in age, comorbidities, left ventricular ejection fraction, and acute treatment, the authors found no significant difference in 1-year mortality in those patients with and without LBBB. These data demonstrate no specific causal relationship that links the conduction abnormality itself to a higher mortality rate. These findings highlight the importance of emphasizing the specific clinical characteristics of each patient, rather than the presence of LBBB, in selecting patients for specific therapies in the setting of myocardial infarction. See p 1896.
LEFT VENTRICULAR REMODELING AND HEART FAILURE IN DIABETIC PATIENTS TREATED WITH PRIMARY ANGIOPLASTY FOR ACUTE MYOCARDIAL INFARCTION, by Carrabba et al.
Diabetes mellitus is a major risk factor for both coronary artery disease and heart failure. Progressive left ventricular remodeling with chamber dilation is an important cause of heart failure after myocardial infarction. The study by Carrabba et al provides evidence that diabetics are more likely to develop heart failure after myocardial infarction. Surprisingly, the development of heart failure was not related to left ventricular dilation, but rather appeared to be due to diastolic dysfunction. These findings emphasize the unique pathophysiology of heart failure in diabetic patients and highlight the importance of better understanding the determinants of diastolic dysfunction in diabetes. See p 1974.
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Special Report
Left Ventricular Form and Function: Scientific Priorities and Strategic Planning for Development of New Views of Disease. See p e333.
Images in Cardiovascular Medicine
Calcified Pleural Plaque Can Rupture Thoracic Aorta. See p e337. 
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Evaluation of Coronary Artery Aneurysms in Kawasaki Disease by Multislice Computed Tomographic Coronary Angiography. See p e339.
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Circulation 2004 110: e333-e336.
Circulation 2004 110: e337-e338.
Circulation 2004 110: e339.
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