Circulation. 2006;114:753
(Circulation. 2006;114:753.)
© 2006 American Heart Association, Inc.
Issue Highlights
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RISK OF THROMBOEMBOLIC EVENTS AFTER PERCUTANEOUS LEFT ATRIAL RADIOFREQUENCY ABLATION OF ATRIAL FIBRILLATION, by Oral et al.
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In patients with atrial fibrillation (AF), thromboembolism and
the need for anticoagulation influence the risks and benefits
of catheter ablation for maintaining sinus rhythm. Ablation
has a risk of thromboembolism. After a successful procedure,
withdrawal of anticoagulation would be attractive to many patients,
but there are limited data on the safety of this approach. Oral
and colleagues examined these issues in a 755 consecutive patients
with AF. They observed a 1.1% risk of thromboembolism during
the first few weeks after catheter ablation. After >3 months,
warfarin was discontinued in selected low-risk patients. This
low-risk group did not experience thromboembolic events during
follow-up. These findings provide an estimate of early thromboembolism
risk and support withdrawal of anticoagulation in selected low-risk
patients who are in sinus rhythm late after AF ablation. Further
data are needed addressing warfarin withdrawal in higher-risk
groups who undergo a successful ablation procedure. See p
759.
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ADVERSE IMPACT OF BLEEDING ON PROGNOSIS IN PATIENTS WITH ACUTE CORONARY SYNDROMES, by Eikelboom et al.
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Although great progress has been made in the treatment of patients
with acute coronary syndromes, many of the commonly used pharmacological
and interventional treatments are associated with increased
risk of bleeding. In this issue of
Circulation, Eikelboom and
colleagues study 34 146 patients from the Organization to Assess
Ischemic Syndromes (OASIS) and Clopidogrel in Unstable Angina
to Prevent Recurrent Events (CURE) studies to determine if bleeding
was associated with adverse clinical outcome. They report that
in patients with acute coronary syndromes without persistent
ST-segment elevation, there was a strong association between
bleeding and death. Although bleeding is typically considered
a reversible adverse outcome, these findings highlight the potential
dangers of using common interventions aimed at treatment of
cardiovascular events. See p
774.
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RANDOMIZED, DOUBLE-BLIND, MULTICENTER STUDY OF THE ENDEAVOR ZOTAROLIMUS-ELUTING PHOSPHORYLCHOLINE-ENCAPSULATED STENT FOR TREATMENT OF NATIVE CORONARY ARTERY LESIONS: CLINICAL AND ANGIOGRAPHIC RESULTS OF THE ENDEAVOR II TRIAL, by Fajadet et al.
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The efficacy of drug-eluting stents (DES) has been demonstrated
in a number of clinical trials. In these studies, DES have been
shown to decrease the rates of clinical and angiographic restenosis
observed with bare metal stents from 20% to 40% to single-digit
numbers. Moreover, long-term follow-up has shown that these
results are durable over a number of years. Interestingly, local
delivery of antiproliferative drugs to the vessel wall has been
associated with stent malapposition or thrombosis owing to delayed
healing; this finding has been attributed to both the drug delivered
as well as the delivery system. To overcome these adverse effects,
DES with novel delivery systems and antiproliferative agents
are being developed and employed clinically. In this issue of
Circulation, Fajadet et al present the ENDEAVOR II trial, a
randomized, double-blind study that compares the Endeavor zotarolimus-eluting
phosphorylcholine polymer-coated stent with bare metal stents.
See p
798.
Visit http://circ.ahajournals.org:
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Cardiology Patient Page
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Heparin-Induced Thrombocytopenia. See p
e355.
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Images in Cardiovascular Medicine
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Contrast-Enhanced Magnetic Resonance Imaging of a Patient With
Chloroquine-Induced Cardiomyopathy Confirmed by Endomyocardial
Biopsy. See p
e357.
Iatrogenic Internal Mammary Artery-to-Great Cardiac Vein Anastomosis. See p e359.
Silent Double Aortic Arch Found in an Elderly Man. See p e360.
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Correspondence
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See p
e362.
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RISK OF THROMBOEMBOLIC EVENTS...
ADVERSE IMPACT OF BLEEDING...