Circulation. 2007;115:677
(Circulation. 2007;115:677.)
© 2007 American Heart Association, Inc.
Issue Highlights
 |
IMPACT OF PATIENT AND TARGET-VESSEL CHARACTERISTICS ON ARTERIAL AND VENOUS BYPASS GRAFT PATENCY: INSIGHT FROM A RANDOMIZED TRIAL, by Desai et al.
|
|---|
The excellent long-term patency rates for the left internal
thoracic artery have made it the bypass conduit gold standard.
The radial artery has emerged as an alternative coronary bypass
conduit to the saphenous vein in an attempt to achieve arterial
revascularization. Desai and colleagues report the results of
a multicenter randomized clinical trial to determine the impact
of patient and target-vessel characteristics on coronary bypass
graft patency. Angiographic data on 440 radial artery and 440
saphenous vein grafts were analyzed. Multivariable models were
constructed to determine predictors of graft occlusion. Radial
artery use was strongly protective against graft occlusion at
1 year, with a larger protective effect seen in women. Among
all grafts, diabetes and small target-vessel diameter were associated
with an increased risk of graft occlusion. Grafting to a target
vessel with more severe proximal stenosis was associated with
a decreased risk of graft occlusion. The authors concluded that
patients benefit from radial artery coronary artery bypass conduits
as opposed to saphenous vein conduits, and this effect is especially
strong in women. See p
684.
|
RANDOMIZED COMPARISON OF A HIGH CLOPIDOGREL MAINTENANCE DOSE IN PATIENTS WITH DIABETES MELLITUS AND CORONARY ARTERY DISEASE: RESULTS OF THE OPTIMIZING ANTIPLATELET THERAPY IN DIABETES MELLITUS (OPTIMUS) STUDY, by Angiolillo et al.
|
|---|
Platelet inhibition has been shown to reduce cardiovascular
events in high-risk patients. Inhibition of the P2Y12 platelet
receptor with clopidogrel has been shown to be variable, and
in some studies, a suboptimal response is associated with increased
risk. Inadequate dosing has been suggested as one of the reasons
for a suboptimal response. The study by Angiolillo et al was
a randomized trial conducted in patients with type 2 diabetes
mellitus and in whom platelet aggregation studies demonstrated
a suboptimal response. Patients were randomized to 30 days of
a standard maintenance dose (75 mg/day) or a high maintenance
dose (150 mg/day). Platelet aggregation was measured before,
30 days after randomization, and 1 month after returning to
standard maintenance dose. Those patients randomized to the
higher dose had an increase in platelet inhibition that returned
to baseline after resuming the standard dose. The present study
demonstrates that, in many patients, an increase in maintenance
dose can enhance platelet inhibition. The clinical implications
of the present study will require further investigation in large-scale
clinical trials. See p
708.
|
ASSOCIATION BETWEEN ANGIOTENSINOGEN, ANGIOTENSIN II RECEPTOR GENES, AND BLOOD PRESSURE RESPONSE TO AN ANGIOTENSIN-CONVERTING ENZYME INHIBITOR, by Su et al.
|
|---|
A key objective of pharmacogenetics is to use genetic information
to improve the efficacy/safety ratio of specific pharmacological
therapies. In this issue of
Circulation, Su et al report results
from the Chinese Community-Based Comprehensive Prevention and
Control of Hypertension project, which indicate that blood pressure
lowering in hypertensive patients produced by the angiotensin-converting
enzyme inhibitor benazepril was greater in those with certain
nucleotide polymorphism in the angiotensinogen receptor 1 and
angiotensinogen receptor 2 genes. Although these results are
too preliminary to use to direct individual patient therapy,
they do underscore another potential clinical application of
genetics. See p
725.
Visit http://circ.ahajournals.org:
|
Clinician Update
|
|---|
Pulmonary Embolism and Fever: When Should Right-Sided Infective
Endocarditis Be Considered? See p
e173.
|
Images in Cardiovascular Medicine
|
|---|
Ebstein’s Malformation With Imperforate Tricuspid Valve.
See p
e177.
An Electrocardiogram Triad in Thyrotoxic Hypokalemic Periodic Paralysis. See p e179.
Common Carotid Dissection: A Sign of Emergency. See p e181.
|
Correspondence
|
|---|
See p
e186.
Related Articles:
-
Pulmonary Embolism and Fever: When Should Right-Sided Infective Endocarditis Be Considered?
- Gaetano Nucifora, Luigi Badano, Fjoralba Hysko, Giuseppe Allocca, Pasquale Gianfagna, and Paolo Fioretti
Circulation 2007 115: e173-e176.
[Full Text]
-
Ebstein’s Malformation With Imperforate Tricuspid Valve
- Gunter Kerst, Renate Kaulitz, Ludger Sieverding, Gerhard Ziemer, and Michael Hofbeck
Circulation 2007 115: e177-e178.
[Full Text]
-
An Electrocardiogram Triad in Thyrotoxic Hypokalemic Periodic Paralysis
- Zachary D. Goldberger
Circulation 2007 115: e179-e180.
[Full Text]
-
Common Carotid Dissection: A Sign of Emergency
- Martin Sojer, Heike Stockner, Birgit Biedermann, Michael Spiegel, and Christoph Schmidauer
Circulation 2007 115: e181-e185.
[Full Text]
-
Letter by Krishnan et al Regarding Article, "Platelet Expression Profiling and Clinical Validation of Myeloid-Related Protein-14 as a Novel Determinant of Cardiovascular Events"
- Unni Krishnan, Alison H. Goodall, and Peter Bugert
Circulation 2007 115: e186.
[Full Text]
-
Impact of Patient and Target-Vessel Characteristics on Arterial and Venous Bypass Graft Patency: Insight From a Randomized Trial
- Nimesh D. Desai, C. David Naylor, Alexander Kiss, Eric A. Cohen, Randi Feder-Elituv, Senri Miwa, Sam Radhakrishnan, James Dubbin, Leonard Schwartz, Stephen E. Fremes for the Radial Artery Patency Study Investigators
Circulation 2007 115: 684-691.
[Abstract]
[Full Text]
-
Association Between Angiotensinogen, Angiotensin II Receptor Genes, and Blood Pressure Response to an Angiotensin-Converting Enzyme Inhibitor
- Xiaowen Su, Liming Lee, Xiaohui Li, Jun Lv, Yonghua Hu, Siyan Zhan, Weihua Cao, Ling Mei, Yong-Ming Tang, Dai Wang, Ronald M. Krauss, Kent D. Taylor, Jerome I. Rotter, and Huiying Yang
Circulation 2007 115: 725-732.
[Abstract]
[Full Text]
-
Randomized Comparison of a High Clopidogrel Maintenance Dose in Patients With Diabetes Mellitus and Coronary Artery Disease: Results of the Optimizing Antiplatelet Therapy in Diabetes Mellitus (OPTIMUS) Study
- Dominick J. Angiolillo, Steven B. Shoemaker, Bhaloo Desai, Hang Yuan, Ronald K. Charlton, Esther Bernardo, Martin M. Zenni, Luis A. Guzman, Theodore A. Bass, and Marco A. Costa
Circulation 2007 115: 708-716.
[Abstract]
[Full Text]
Top
IMPACT OF PATIENT AND...
RANDOMIZED COMPARISON OF A...