Обзор американских кардиологических журналов за неделю (ссылки)

[Chevychelov]

Drug-eluting stents reduced major adverse cardiac event rate
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Drug-eluting stents in patients with STEMI reduced the long-term rate of major adverse cardiac events vs. bare metal stents, according to the 3-year follow-up findings of the DEDICATION trial.

The study population consisted of 626 patients with STEMI referred within 12 hours who were randomly assigned to have a drug-eluting stent or a bare metal stent implanted in the infarct-related lesion with or without distal protection during primary percutaneous coronary intervention.
After 3 years, target lesion revascularization was 6.1% in the drug-eluting stent group vs. 16.3% in the bare metal stent group (P<.001), and the rate of major adverse cardiac events was 11.5% vs. 18.2%, respectively (P=.02). Although all-cause mortality did not differ significantly, the rate of cardiac death was higher in the drug-eluting stent group, 6.1% vs. 1.9%, than for the bare metal stent group (P=.01). Reinfarction, stroke and stent thrombosis occurrence was similar between groups.
This study, researchers wrote, “shows that in patients with STEMI, implantation of a drug-eluting stent, compared with a bare metal stent, significantly reduces the rate of major adverse cardiac events and the need for revascularization. Despite this reduction, patients with STEMI who have a drug-eluting stent implanted seem to have a higher risk of cardiac death that cannot be attributed to reinfarction or stent thrombosis.” – by Brian Ellis

Kaltoft A. J Am Coll Cardiol. 2010;56:doi:10.1016/j.jacc.2010.05.009.

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WISE: Coronary flow reserve improved adverse outcome prediction over angiographic CAD severity
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Coronary microvascular reactivity to adenosine improved the prediction of major adverse outcomes over angiographic coronary artery disease severity among women with suspected ischemia and atherosclerosis risk factors, results from the WISE study suggested.

Researchers from several U.S. cities investigated relationships between major adverse outcomes and baseline coronary flow reserve after intracoronary adenosine in 189 women referred for suspected ischemia. Baseline evaluation included a physical examination and the collection of clinical and laboratory data. Researchers observed associations between coronary flow reserve and major adverse outcomes, such as death, nonfatal MI, nonfatal stroke or hospital stay for HF, at a mean follow-up of 5.4 years.

During follow-up, 79 women (42%) had an adverse outcome, and there were 138 events, which included 11 deaths. An exploratory receiver-operator characteristic analysis suggested that coronary flow reserve <2.32 was the best discriminating threshold for adverse outcomes (event rate, 26.7%; and ≥2.32 event rate, 12.2%; P=.01). Lower coronary flow reserve was associated with increased risk for major adverse outcomes (HR=1.16; 95% CI, 1.04-1.30), a finding that held true among the 152 women without obstructive CAD (HR=1.20; 95% CI, 1.05-1.38).
“In women undergoing coronary angiography to further evaluate suspected ischemia, a limited coronary microvascular response to adenosine is associated with increased risk for major adverse outcomes, even in the absence of significant obstructive CAD,” the researchers wrote. “This finding supports the need for more investigation of altered coronary smooth muscle reactivity and the smaller vessels in women with suspected ischemia. Long-term follow-up of new cohorts of women should help to determine whether coronary microvascular dysfunction and its link with adverse outcomes can be confirmed and modified.”

Pepine C. J Am Coll Cardiol. 2010;55:2825-2832.