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(Circulation. 2004;110:765.)
© 2004 American Heart Association, Inc.
Issue Highlights |
ELECTROCARDIOGRAPHIC PREDICTORS OF ARRHYTHMIC DEATH AND TOTAL MORTALITY IN THE MULTICENTER UNSUSTAINED TACHYCARDIA TRIAL, by Zimetbaum et al.
A simple, widely available test that identifies patients at risk for arrhythmic mortality is of great interest for screening patients for protection with an implantable defibrillator (ICD). The ECG finding of interventricular conduction delay has been suggested to be such a marker and is incorporated into present indications for ICD implantation. Left ventricular hypertrophy that is detectable from the ECG is associated with electrophysiological changes that predispose to arrhythmias, but it has received less attention. The MUSTT investigators have assessed the relation of interventricular conduction abnormalities and left ventricular hypertrophy to mortality and cardiac arrest in their cohort of patients with coronary artery disease, depressed ventricular function, and nonsustained ventricular tachycardia who were not treated with antiarrhythmic therapy. The findings provide further support for the potential use of the ECG to identify high-risk patients. A useful analysis of specific types of conduction delay is provided. ECG findings of left bundle-branch block and left ventricular hypertrophy are worrisome findings that should prompt review of ventricular function and consideration for ICD implantation in patients with coronary artery disease. See p 766.
IS THE IMPACT OF HOSPITAL AND SURGEON VOLUMES ON THE IN-HOSPITAL MORTALITY RATE FOR CORONARY ARTERY BYPASS GRAFT SURGERY LIMITED TO PATIENTS AT HIGH RISK? by Wu et al.
Experts disagree about whether hospital and surgeon volume should influence referrals for bypass surgery, and this remains quite controversial. New York State has publicly reported an ongoing prospective registry of bypass surgery for many years. Investigators used this database, which contains detailed information about patients and surgeons, to determine whether hospital volume is more important for high-risk patients. The policy question is whether the selective referral of certain types of patients might be better than a recommendation to regionalize care to higher-volume centers for all patients. See p 784.
RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL OF ORAL SIROLIMUS FOR RESTENOSIS PREVENTION IN PATIENTS WITH IN-STENT RESTNOSIS: THE ORAL SIROLIMUS TO INHIBIT RECURRENT IN-STENT STENOSIS (OSIRIS) TRIAL, by Hausleiter et al.
Treatment of in-stent restenosis remains a therapeutic challenge. The use of oral sirolimus, as an adjunctive therapy, was evaluated in the Oral Sirolimus to Inhibit Recurrent In-Stent Stenosis (OSIRIS) Trial. This randomized, double-blind, placebo-controlled study examined the effect of usual- or high-dose oral sirolimus on angiographic restenosis at 6 months in 300 patients with symptomatic in-stent restenosis. Restenosis was reduced significantly in patients treated with usual- or high-dose sirolimus compared with placebo-treated patients, and there was a trend toward decreased target-vessel revascularization. Furthermore, blood levels of sirolimus on the day of the procedure were correlated with late lumen loss at follow-up angiography. The authors conclude that adjunctive oral sirolimus with a high-dose loading regimen decreases angiographic restenosis. See p 790.
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Images in Cardiovascular Medicine
Double Aortic Arch With a Compressed Trachea Demonstrated by Multislice Computed Tomography. See p e68.
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Related Articles:
Circulation 2004 110: 784-789.
Circulation 2004 110: 790-795.
Circulation 2004 110: 766-769.
Circulation 2004 110: e68-e69.
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