Circulation. 2005;112:3025
(Circulation. 2005;112:3025.)
© 2005 American Heart Association, Inc.
Issue Highlights
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OPTIMAL TIMING OF INTERVENTION IN NON–ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROMES: INSIGHTS FROM THE CRUSADE (CAN RAPID RISK STRATIFICATION OF UNSTABLE ANGINA PATIENTS SUPPRESS ADVERSE OUTCOMES WITH EARLY IMPLEMENTATION OF THE ACC/AHA GUIDELINES) REGISTRY, by Ryan et al.
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An early invasive strategy for patients with non–ST-segment
elevation acute coronary syndromes has been shown to improve
outcomes in most (but not all) recent studies. The optimal timing
of intervention has not been determined. Should patients be
triaged, as with primary angioplasty for ST-segment elevation,
and have a door-to- balloon time of <90 minutes, or should
"passivation" of the plaque with intensive antithrombotic therapy
be administered for a period of perhaps 12 to 24 hours before
angioplasty? In this issue of
Circulation, Ryan et al report
findings from the CRUSADE Registry, where they compared outcomes
of patients presenting on weekends, who experienced a delay
to angiography of 46.3 hours, to patients presenting during
the week, who experienced a delay to angiography of 23.4 hours.
Increased delay was not associated with adverse outcomes. Thus,
increasing access to invasive therapy on weekends across the
community may not improve population outcomes. See p
3049.
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AMBIENT AIR POLLUTION IS ASSOCIATED WITH INCREASED RISK OF HOSPITAL CARDIAC READMISSIONS OF MYOCARDIAL INFARCTION SURVIVORS IN FIVE EUROPEAN CITIES, by von Klot et al.
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Air pollution is increasingly recognized as a risk factor for
cardiovascular events. In a European study, investigators determined
the risk of ambient nitrogen dioxide, carbon monoxide, ozone,
and mass of particles <10 µm on the risk of recurrent
events in individuals who had survived an acute myocardial infarction.
The study sample included 22 006 patients from Augsburg, Barcelona,
Helsinki, Rome, and Stockholm from 1992 to 2000. The authors
report how daily pollution levels affect risk of cardiac readmissions.
See p
3073.
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CONTINUOUS AORTIC FLOW AUGMENTATION: A PILOT STUDY OF HEMODYNAMIC AND RENAL RESPONSES TO A NOVEL PERCUTANEOUS INTERVENTION IN DECOMPENSATED HEART FAILURE, by Konstam et al.
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Despite therapy with inotropic and vasodilator agents, some
patients continue to have left ventricular failure such that
they have hemodynamic instability. Intra-aortic balloon counter-pulsation
and left ventricular assist devices are options in many such
patients. Konstam et al report the early clinical experience
with a new hemodynamic support device that uses a magnetically
levitated and driven centrifugal pump to remove blood from the
femoral artery and return it to the thoracic aorta. This initial
report demonstrates that the external pump causes reductions
in systemic vascular resistance and pulmonary capillary wedge
pressure associated with an increase in cardiac output. Future
clinical trials will be needed to determine the clinical value
of these hemodynamic effects and the overall safety profile
of this new device. See p
3107.
Visit http://circ.ahajournals.org:
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Cardiology Patient Page
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Learn, Take Action, and Live: A Guide to Using Online Tools
to Prevent and Manage Heart Disease and Stroke. See p
e318.
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Images in Cardiovascular Medicine
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Multislice Computed Tomography for Preinterventional Mapping
of Complicated Coronary Artery Injury. See p
e320.
Transient Giant Negative T Waves Associated with Cardiac Involvement of Diffuse Large B-Cell Lymphoma. See p e322.
Systemic Complications of Infective Endocarditis. See p e324.
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Correspondence
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See p
e325.
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