Circulation. 2007;116:585
doi: 10.1161/CIRCULATIONAHA.107.185625
(Circulation. 2007;116:585.)
© 2007 American Heart Association, Inc.
Issue Highlights
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A DECADE OF SHORT-TERM OUTCOMES IN POST–CARDIAC SURGERY VENTRICULAR ASSIST DEVICE IMPLANTATION: DATA FROM THE SOCIETY OF THORACIC SURGEONS’ NATIONAL CARDIAC DATABASE, by Hernandez et al.
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In this issue of
Circulation, Hernandez et al examined the Society
of Thoracic Surgeons’ National Cardiac Database to assess
the trends in the incidence of post–cardiac surgery shock
requiring ventricular assist device implantation, survival rates,
and risk factors for mortality. During the period 1995–2004,
a total of 5735 patients had a ventricular assist device placed
(0.3% cardiac surgeries). Overall survival rate to discharge
following ventricular assist device placement was 54.1%. Using
the earliest period (January 1995–June 1997) for reference,
the mortality odds ratio declined to 0.72 (July 1998–December
2000) and eventually to 0.41 (July 2002–December 2004)
(
P<0.0001). The combined mortality/morbidity odds ratio also
declined, to 0.84 and 0.48 over identical periods (
P<0.0001).
After adjustment for clinical characteristics of patients requiring
mechanical circulatory support, the rates of survival to hospital
discharge improved, and based upon these results, it can be
concluded that the insertion of a ventricular assist device
for post–cardiac surgery shock could be an important therapeutic
intervention for these patients. See p 606 (editorial p
586).
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STATIN USE IN PATIENTS WITH EXTREMELY LOW LOW-DENSITY LIPOPROTEIN LEVELS IS ASSOCIATED WITH IMPROVED SURVIVAL, by Leeper et al.
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Emerging randomized controlled studies support the lowering
of low-density lipoprotein (LDL) cholesterol levels to <70
mg/dL among patients with coronary heart disease, yet a plateau
effect has not yet been found. In this issue of
Circulation,
Leeper et al provide important observational data that evaluate
the safety and efficacy of statin therapy among more than 6000
high-risk patients with an LDL level <60 mg/dL. Mortality
outcomes were assessed among subgroups of patients already on
statins at baseline, those started on statins with LDL <60
mg/dL, those with LDL <40 mg/dL, and those without a history
of coronary heart disease. Safety was assessed by evaluating
the incidence of malignancy, transaminase elevation, and rhabdomyolysis.
While these data need to be confirmed by randomized trials,
their provocative findings provide increasing evidence to support
the lowering of LDL beyond presently recommended target levels.
See p
613.
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FAMILY HISTORY OF PREMATURE CORONARY HEART DISEASE AND CORONARY ARTERY CALCIFICATION: MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA), by Nasir et al.
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Family history is an established risk factor for coronary heart
disease events, but how family history relates to subclinical
coronary artery disease is less certain. Nasir and colleagues
examined the adjusted relations of family history of premature
coronary heart disease with coronary artery calcification by
computed tomography in the Multi-Ethnic Study of Atherosclerosis
(MESA). Although previously described in largely white, referral-based
cohorts, the investigators observed that family history of premature
coronary heart disease was associated with the presence (yes/no)
and severity (>75th percentile) of coronary calcification
accounting for coexistent risk factors. The increased risk was
observed in community-based Americans of European, African,
Chinese, and Hispanic descent. Of clinical interest, the association
between increased risk of family history of premature heart
disease and coronary calcification was observed in individuals
at low and intermediate Framingham risk of heart disease, providing
indirect support for the importance of family history in risk
assessment. See p
619.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Myocarditis and Sudden Cardiac Death in the Young: Extensive
Fibrosis Suggested by Cardiovascular Magnetic Resonance In Vivo
and Confirmed Post Mortem. See p e122. Partial Congenital Absence
of the Pericardium. See p
e126.
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Book Review
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Principles of Cerebrovascular Disease. See p
e130.
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Correspondence
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See p
e132.
Related Articles:
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Post–Cardiac Surgery Mechanical Support: A Tool for Decision Making
- Daniel Marelli and Richard J. Shemin
Circulation 2007 116: 586-587.
[Full Text]
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Partial Congenital Absence of the Pericardium
- Michaela Scheuermann-Freestone, Elizabeth Orchard, Jane Francis, Mark Petersen, Matthias Friedrich, Abbas Rashid, Darryl Shore, Saul Myerson, and Stefan Neubauer
Circulation 2007 116: e126-e129.
[Full Text]
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Principles of Cerebrovascular Disease
- Jason Viereck
Circulation 2007 116: e130-e131.
[Full Text]
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Letter by Pepe et al Regarding Article, "Use and Misuse of the Receiver Operating Characteristic Curve in Risk Prediction"
- Margaret S. Pepe, Holly Janes, and Jessie Wen Gu
Circulation 2007 116: e132.
[Full Text]
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Family History of Premature Coronary Heart Disease and Coronary Artery Calcification: Multi-Ethnic Study of Atherosclerosis (MESA)
- Khurram Nasir, Matthew J. Budoff, Nathan D. Wong, Maren Scheuner, David Herrington, Donna K. Arnett, Moyses Szklo, Philip Greenland, and Roger S. Blumenthal
Circulation 2007 116: 619-626.
[Abstract]
[Full Text]
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Statin Use in Patients With Extremely Low Low-Density Lipoprotein Levels Is Associated With Improved Survival
- Nicholas J. Leeper, Reza Ardehali, Emil M. deGoma, and Paul A. Heidenreich
Circulation 2007 116: 613-618.
[Abstract]
[Full Text]
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A DECADE OF SHORT-TERM...
STATIN USE IN PATIENTS...