Circulation. 2007;115:2247
doi: 10.1161/CIRCULATIONAHA.107.183525
(Circulation. 2007;115:2247.)
© 2007 American Heart Association, Inc.
Issue Highlights
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DIRECT INTRAMYOCARDIAL BUT NOT INTRACORONARY INJECTION OF BONE MARROW CELLS INDUCES VENTRICULAR ARRHYTHMIAS IN A RAT CHRONIC ISCHEMIC HEART FAILURE MODEL, by Fukushima et al.
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Cell therapies directed at the damaged ventricle hold promise
for improving ventricular function but with potential proarrhythmic
electrophysiological effects. Fukushima and colleagues assessed
the effects of bone marrow–derived stem cells administered
by direct intraventricular injection or retrogradely via injection
into the coronary venous system 3 weeks after myocardial infarction
in rats. The 2 routes of delivery produced similarly small amounts
of donor cells persisting in the myocardium and a similar improvement
in LV ejection fraction. ECG telemetry revealed spontaneous
ventricular arrhythmias that were prominent for the first 2
weeks after intramyocardial injection but not after intracoronary
injection. Further examination showed inflammatory cell clusters
after intramyocardial injection but not after intracoronary
injection. Thus, the route of delivery influenced short-term
arrhythmias independent of the effect on ventricular function.
The findings emphasize the potential importance of the route
of delivery as a determinant of adverse effects that will need
to be considered in human trials. See p
2254.
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RANDOMIZED TRIAL COMPARING SAME-DAY DISCHARGE WITH OVERNIGHT HOSPITAL STAY AFTER PERCUTANEOUS CORONARY INTERVENTION: RESULTS OF THE ELECTIVE PCI IN OUTPATIENT STUDY (EPOS), by Heyde et al.
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Patients who undergo percutaneous coronary interventions in
the United States are routinely hospitalized overnight for observation
to facilitate monitoring for the occurrence of any major complications.
With improvements in the procedure, particularly the widespread
use of stents, the likelihood of complications has fallen dramatically.
The discharge of a patient who has had a successful procedure
and is stable would improve patient satisfaction and reduce
procedure-related costs. The study reported by Heyde et al in
this issue of Circulation was a randomized trial of same-day
discharge or overnight stay in 800 consecutive patients scheduled
for elective angioplasty. Patients were then evaluated after
the procedure as to whether they met predefined criteria for
same-day randomization. Twenty percent of both groups did not.
The primary outcome of death, myocardial infarction, coronary
artery bypass graft surgery, repeat percutaneous coronary intervention,
or puncture-related complications within 24 hours of percutaneous
coronary intervention was not different between groups (2.2%
for same-day and 4.2% for the overnight group). The findings
were similar at 30 days. The study by Heyde et al confirms that
selected patients undergoing elective percutaneous coronary
intervention and who have had a successful procedure without
complications can be safely discharged the same day. The implications
for savings of healthcare costs are significant. See p
2299.
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TARGETING PLATELETS IN ACUTE EXPERIMENTAL STROKE: IMPACT OF GLYCOPROTEIN IB, VI, AND IIB/IIIA BLOCKADE ON INFARCT SIZE, FUNCTIONAL OUTCOME, AND INTRACRANIAL BLEEDING, by Kleinschnitz et al.
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Platelet adherence to the vessel wall is mediated by select
surface glycoproteins and is often the first phase in the formation
of a thrombus. Although much is known about this process in
the coronary arteries, less is known about the relative role
of select platelet glycoproteins in the cerebral circulation
and stroke. In the current issue of
Circulation, Kleinschnitz
and colleagues study antibodies against platelet glycoproteins
that mediate vessel wall adhesion in an animal stroke model.
They report that blocking platelet adhesion decreased the degree
of stroke. In addition, blocking platelet adhesion was not accompanied
by the increased cerebral hemorrhage that was seen with use
of a glycoprotein IIb/IIIa inhibitor. These results suggest
that inhibition of platelet adhesion to the vessel wall could
be a viable treatment for ischemic stroke and suggest the utility
of further clinical investigation. See p
2323.
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Cardiology Patient Page
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Drug-Eluting Stents. See p
e426.
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Images in Cardiovascular Medicine
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Serial Multimodality Assessment of Myocardial Infarction in
Mice Using Magnetic Resonance Imaging and Micro-Positron Emission
Tomography Provides Complementary Information on the Progression
of Scar Formation. See p
e428.
Myocardial Delayed Enhancement by Computed Tomography in Hypertrophic Cardiomyopathy. See p e430.
Left Atrial–Esophageal Fistula After Pulmonary Vein Isolation: A Cautionary Tale. See p e432.
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Correspondence
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See p
e434.
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Drug-Eluting Stents
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Letter by Rose and Dunn Regarding Article, "Expression of Heat Shock Protein 27 in Human Atherosclerotic Plaques and Increased Plasma Level of Heat Shock Protein 27 in Patients With Acute Coronary Syndrome"
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Circulation 2007 115: e434.
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Randomized Trial Comparing Same-Day Discharge With Overnight Hospital Stay After Percutaneous Coronary Intervention: Results of the Elective PCI in Outpatient Study (EPOS)
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Circulation 2007 115: 2299-2306.
[Abstract]
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Direct Intramyocardial But Not Intracoronary Injection of Bone Marrow Cells Induces Ventricular Arrhythmias in a Rat Chronic Ischemic Heart Failure Model
- Satsuki Fukushima, Anabel Varela-Carver, Steven R. Coppen, Kenichi Yamahara, Leanne E. Felkin, Joon Lee, Paul J.R. Barton, Cesare M.N. Terracciano, Magdi H. Yacoub, and Ken Suzuki
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Targeting Platelets in Acute Experimental Stroke: Impact of Glycoprotein Ib, VI, and IIb/IIIa Blockade on Infarct Size, Functional Outcome, and Intracranial Bleeding
- Christoph Kleinschnitz, Miroslava Pozgajova, Mirko Pham, Martin Bendszus, Bernhard Nieswandt, and Guido Stoll
Circulation 2007 115: 2323-2330.
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DIRECT INTRAMYOCARDIAL BUT NOT...
RANDOMIZED TRIAL COMPARING SAME...