Circulation. 2005;111:717
(Circulation. 2005;111:717.)
© 2005 American Heart Association, Inc.
Issue Highlights
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TIMES TO TREATMENT IN TRANSFER PATIENTS UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN THE UNITED STATES: NATIONAL REGISTRY OF MYOCARDIAL INFARCTION (NRMI)-3/4 ANALYSIS, by Nallamothu et al.
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Primary percutaneous coronary angioplasty (PCI) has emerged
as an attractive alternative reperfusion strategy for myocardial
infarction (MI), and recent trials indicate it may be superior
to fibrinolysis. However, PCI may necessitate transfer of MI
patients to hospitals with such capabilities, and the inherent
delay due to transfer may mitigate potential benefits. In this
issue of Circulation, Nallamothu and colleagues analyze data
from the National Registry of Myocardial Infarction to assess
the time to PCI in more than 4000 patients treated at 419 hospitals
in the United States. The investigators report that the "door-to-balloon"
time was 180 minutes (twice the recommended standard) in 50
percent of the patients; fewer than 5 percent were treated within
90 minutes. Presence of comorbidity, nonclassical presentation,
and rural location of the treating hospital were key correlates
of longer time to PCI. The authors emphasize the need for improved
process-of-care systems to maximize the therapeutic benefits
of PCI in MI patients. See p
761.
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RISK OF RESTENOSIS AND HEALTH STATUS OUTCOMES FOR PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION VERSUS CORONARY ARTERY BYPASS GRAFT SURGERY, by Spertus et al.
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Most studies comparing bypass surgery (CABG) to percutaneous
coronary intervention (PCI) have found similar outcomes with
regard to death and myocardial infarction but more angina and
need for repeat revascularization procedures after PCI, presumably
because of restenosis. In this report, Spertus et al demonstrate
a correlation between preprocedural restenosis risk (as measured
by a scoring system they previously developed) and health outcome
at follow-up. Administering the Seattle Anginal Questionnaire
to 1469 patients undergoing CABG or PCI, they found no differences
in 1-year angina or quality of life among the 37.4% of patients
at low risk for restenosis, but a significant benefit for CABG
when patients were at intermediate or high restenosis risk.
This study provides the clinician with another useful tool when
facing the complex choice between CABG and PCI. Also, because
this study was performed in the bare metal stent era, it should
encourage the use of drug-eluting stents, particularly in patients
at increased risk for restenosis. See p
768.
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EARLY AND MID-TERM RESULTS OF DRUG-ELUTING STENT IMPLANTATION IN UNPROTECTED LEFT MAIN, by Chieffo et al.
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Recent advances in coronary stent design, together with the
introduction of drug-eluting stents, have allowed percutaneous
coronary intervention (PCI) to be offered as a revascularization
strategy to high-risk patients, including those with unprotected
left main coronary artery disease. Although the majority of
patients with unprotected left main disease requiring revascularization
are referred for coronary artery bypass grafting surgery, unprotected
left main PCI and stent placement have been performed in selected
patients. These patients warrant careful postprocedural surveillance
for restenosis because the initial presenting symptom may be
sudden death. Newer drug-eluting stents may have some utility
in this setting inasmuch as they have markedly reduced the rates
of restenosis in coronary vessels. In this issue of Circulation,
Chieffo et al report their experience with drug-eluting stents
in unprotected left main PCI. See p
791.
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Visit www.circ.ahajournals.org:
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Images in Cardiovascular Medicine
Acute Pericarditis Caused by Acrylic Bone Cement After Percutaneous
Vertebroplasty. See p
e98.
Radial Arteriovenous Fistula After Cardiac Catheterization. See p e99. 
Correspondence
Letters Regarding Article by Hu et al, "Heme Oxygenase-1 Inhibits Angiotensin II-Induced Cardiac Hypertrophy In Vitro and In Vivo." See p e100.
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