Circulation. 2005;112:1241
(Circulation. 2005;112:1241.)
© 2005 American Heart Association, Inc.
Issue Highlights
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INTERRUPTIONS OF CHEST COMPRESSIONS DURING EMERGENCY MEDICAL SYSTEMS RESUSCITATION, by Valenzuela et al.
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Survival to hospital discharge from out-of-hospital cardiac
arrest remains poor. Although there are many possible reasons
for this, efforts to uncover and address each factor may subsequently
lead to improved outcomes. In this issue of
Circulation, Valenzuela
and colleagues evaluate whether frequent interruptions of chest
compression during the resuscitation period may contribute to
low survival rates. In an analysis of automated external defibrillator–equipped
fire department first responders, the authors investigate the
precise timing of the delivery of automated external defibrillator
shock from the 9-1-1 call and the percentage of time that chest
compressions were performed during 61 cardiac arrests. Their
surprising findings highlight the need for a greater focus on
cardiopulmonary resuscitation performance as part of the resuscitation
effort. See p
1259.
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IMPACT OF A SINGLE INTRAVENOUS ADMINISTRATION OF NICORANDIL BEFORE REPERFUSION IN PATIENTS WITH ST-SEGMENT–ELEVATION MYOCARDIAL INFARCTION, by Ishii et al.
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Nicolandil is a hybrid between nitrates and KATP channel opener.
Nicolandil has venodilating properties due to nitrate group
in its chemical structure and causes smooth muscle relaxation
and subsequent vasodilation by increasing potassium flux through
sarcolemma ATP-sensitive potassium channels. Therefore, the
drug acts as a balanced arterial dilator and venodilator. Unlike
classical nitrates, hemodynamic tolerance to nicolandil has
been reported to be negligible. The potassium channel activation
also exerts direct cardioprotective effects by activating ectosolic
5’-nucleotide and mimicking ischemic preconditioning.
Infarct-limiting effects of nicolandil have been shown in a
number of animal models. Nicolandil has been studied extensively
in many patients with ischemic heart disease, both in placebo-controlled
studies and in comparative studies with other antiischemic agents.
Efficacy of intravenous nicolandil in conjunction with coronary
angioplasty has also been reported repeatedly. This study offers
additional evidence of persistent cardioprotective effects of
single intravenous administration of nicolandil not only in
the early stage but also in the chronic stage after reperfusion
therapy in ST-segment–elevation myocardial infarction.
Further studies will be needed to determine optimal doses and
timing and method of injection. See p
1284.
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C-REACTIVE PROTEIN AS A PREDICTOR OF CARDIOVASCULAR RISK IN A POPULATION WITH A HIGH PREVALENCE OF DIABETES: THE STRONG HEART STUDY, by Best et al.
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C-reactive protein (CRP) has been related to a wide array of
cardiovascular disease outcomes, including peripheral arterial
disease, stroke, myocardial infarction, and mortality. However,
most of the research examining the prognostic utility of CRP
has been based on predominantly white North American or Western
European study samples. There has been a paucity of data on
the prognostic performance of CRP in ethnic/racial minorities.
Best and colleagues from the Strong Heart Study examined the
relation of CRP to prognosis in more than 3200 American Indians.
The prevalence of obesity and diabetes in the cohort was high,
at
50%. The CRP levels were higher than reported from most other
studies, and 16% of participants exceeded 10 mg/L. The investigators
noted that although CRP was predictive of cardiovascular disease,
there was wide heterogeneity in its predictive ability by subgroup.
For instance, CRP was not prognostically useful in their participants
with diabetes. The study emphasizes that risk factors must be
validated and calibrated in other ethnicities/races and settings
before being widely utilized. See p
1289.
Visit http://www.circ.ahajournals.org:
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Clinician Update
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Ventricular Assist Devices for Durable Support. See p
e111.
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Images in Cardiovascular Medicine
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An Uncommon Complication of Nondissected Ascending Aortic Aneurysm.
See p
e116.
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Traumatic Aortic Valve Rupture. See p e118.
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Pericardiocentesis at 14 Weeks: Effective Treatment of Pericardial
Effusion Complicating Right Ventricular Diverticulum. See p
e120.
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Correspondence
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See p
e121.
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Impact of a Single Intravenous Administration of Nicorandil Before Reperfusion in Patients With ST-Segment–Elevation Myocardial Infarction
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Interruptions of Chest Compressions During Emergency Medical Systems Resuscitation
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