(Circulation. 2004;110:471.)
© 2004 American Heart Association, Inc.
Issue Highlights |
MODERN PACEMAKER AND IMPLANTABLE CARDIOVERTER/DEFIBRILLATOR SYSTEMS CAN BE MAGNETIC RESONANCE IMAGING SAFE: IN VITRO AND IN VIVO ASSESSMENT OF SAFETY AND FUNCTION AT 1.5 T, by Roguin et al.
Magnetic resonance imaging applications are expanding. An increasing number of patients have an implanted pacemaker or defibrillator, which by current guidelines generally precludes exposure to strong magnetic fields. Damage to the implanted device and injury to the patient have been previously described, but newer devices are smaller, have less magnetic material, and are better protected against electromagnetic interference. This study assessed the effects of 1.5-Tesla magnetic resonance imaging on several newer defibrillators and pacemakers in vitro and after implantation in animals. The observations illustrate potential effects and concerns but provide a basis for studies of safety in humans. See p 475.
COMPARING WARFARIN WITH ASPIRIN AFTER BIOLOGICAL AORTIC VALVE REPLACEMENT: A PROSPECTIVE STUDY, by Gherli et al.
The best regimen to prevent valve thrombosis and arterial thromboembolism after biological aortic valve replacement is unclear. Gherli and colleagues prospectively compared a regimen of postoperative aspirin with warfarin after valve replacement in 249 patients. After 3 months, there was no difference in the incidence of cerebral ischemia, major bleeding events, stroke-free survival, or overall survival between the two groups. Although a small study, these findings suggest that early anticoagulation offers no significant benefit over aspirin after biological aortic valve replacement. See p 496.
COST-EFFECTIVENESS OF SIROLIMUS-ELUTING STENTS FOR TREATMENT OF COMPLEX CORONARY STENOSES: RESULTS FROM THE SIROLIMUS-ELUTING BALLOON EXPANDABLE STENT IN THE TREATMENT OF PATIENTS WITH DE NOVO NATIVE CORONARY ARTERY LESIONS (SIRIUS) TRIAL, by Cohen et al.
With the cost of care rising, attention to the value of expensive clinical strategies is increasing. Drug-eluting stents, which can cost almost $3000, are an innovation that is both expensive and effective. Questions have been raised about whether the benefits of the drug-eluting stents are worth the costs. To put the value of this approach in perspective, Cohen and others performed a prospective economic evaluation as part of the randomized SIRIUS trial, a study that compared the sirolimus-eluting Bx VELOCITY stent (Cypher, Cordis Corp,Warren, NJ) with conventional bare-metal stent. They considered the cost of the initial hospital care and up to 1 year of follow-up. They demonstrate that the sirolimus-eluting stent strategy is economically attractive by current standards and show how the initial costs are offset by longer-term savings. See p 508.
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Clinician Update
Should Radial Arteries Be Used Routinely for Coronary Artery Bypass Grafting? See p e40.
Image in Cardiovascular Medicine
Marked Malapposition and Aneurysm Formation After Sirolimus-Eluting Coronary Stent Implantation. See p e47.
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