Обзор американских кардиологических журналов за неделю (ссылки)

[Chevychelov]

Title: 5-Year Clinical Outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the Sirolimus-Eluting Stent in the Treatment of Patients With Multivessel De Novo Coronary Artery Lesions
Topic: Interventional Cardiology
Date Posted: 3/26/2010
Author(s): Serruys PW, Onuma Y, Garg S, et al., on behalf of the ARTS II Investigators.
Citation: J Am Coll Cardiol 2010;55:1093-1101.
Clinical Trial: yes
Related Resources
JACC Article: 5-Year Clinical Outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the Sirolimus-Eluting Stent in the Treatment of Patients With Multivessel De Novo Coronary Artery Lesions
Trial: Arterial Revascularization Therapies Study II: Sirolimus-Eluting Stent in the Treatment of Patients With Multivessel De Novo Coronary Artery Lesions (ARTS II: 5-Year Results)

Study Question: What are 5-year clinical outcomes, safety, and efficacy of sirolimus-eluting stents (SES) in the ARTS II (Arterial Revascularization Therapies Study II) compared with the outcomes of coronary artery bypass grafting (CABG) and bare-metal stenting (BMS) from the ARTS I trial?
Methods: The ARTS I study was a randomized trial of 1,205 patients with multivessel disease comparing CABG and BMS. The ARTS II study was a nonrandomized trial with the Cypher SES, applying the same inclusion and exclusion criteria, endpoints, and protocol definitions. The ARTS II trial enrolled 607 patients, with an attempt to enroll at least one-third of patients with three-vessel disease. The primary objective of ARTS II was to compare the safety and effectiveness of coronary stent implantation using the SES with the surgical arm of ARTS I.
Results: At 5 years, the death/stroke/myocardial infarction event-free survival rate was 87.1% in ARTS II SES, versus 86.0% (p = 0.1) and 81.9% (p = 0.007) in ARTS I CABG and BMS cohorts, respectively. The 5-year major adverse cardiac and cerebrovascular event (MACCE) rate in ARTS II (27.5%) was significantly higher than ARTS I CABG (21.1%, p = 0.02), and lower than in ARTS I BMS (41.5%, p < 0.001). The cumulative incidence of definite stent thrombosis was 3.8%. Thirty-two percent (56 of 176) of major adverse cardiac events (MACE) at 5 years were related to possible, probable, or definite stent thrombosis.
Conclusions: The authors concluded that at 5 years, SES had a safety record comparable to CABG and superior to BMS, and a MACCE rate that was higher than in patients treated with CABG, and lower than in those treated with BMS.
Perspective: The study reports that the 5-year composite safety endpoint of death, stroke, and myocardial infarction in the SES group was comparable to the CABG group, and lower than the BMS group. The MACCE rate in the SES group on the other hand was higher than the CABG group, which was mainly driven by a higher rate of repeat revascularization in the SES group; however, the MACCE rate of the SES group remained lower than that of the BMS group. Baseline SYNTAX score had a role in the prediction of 5-year MACCE events and suggests that patients with multivessel disease and a low SYNTAX score may be adequately treated with PCI, whereas those patients with high SYNTAX scores benefit from CABG. Debabrata Mukherjee, M.D., F.A.C.C.

Title: Impact of Olmesartan on Progression of Coronary Atherosclerosis: A Serial Volumetric Intravascular Ultrasound Analysis From the OLIVUS (Impact of OLmesartan on progression of coronary atherosclerosis: evaluation by IntraVascular UltraSound) Trial
Topic: Prevention/Vascular
Date Posted: 3/26/2010
Author(s): Hirohata A, Yamamoto K, Miyoshi T, et al.
Citation: J Am Coll Cardiol 2010;55:976-982.
Clinical Trial: yes
Related Resources
JACC Article: Impact of Olmesartan on Progression of Coronary Atherosclerosis: A Serial Volumetric Intravascular Ultrasound Analysis From the OLIVUS Trial

Study Question: What is the effect of the angiotensin II receptor blocker, olmesartan, on the progression of coronary atherosclerosis?
Methods: A prospective, randomized, multicenter trial—Impact of OLmesartan on progression of coronary atherosclerosis: evaluation by IntraVascular UltraSound (OLIVUS)—was performed in 247 stable angina pectoris patients with native coronary artery disease (CAD). IVUS was performed at the time of percutaneous transluminal coronary angioplasty in nonculprit vessels (without angiographically significant lesions). Patients were randomly assigned to receive 10-40 mg of olmesartan or control drug, and were otherwise treated as per physician’s discretion. Serial IVUS examinations (baseline and 14-month follow-up) were performed to assess coronary atheroma volume. Volumetric IVUS analyses included lumen, plaque, vessel volume, percent atheroma volume (PAV), and percent change in total atheroma volume (TAV).
Results: Patient characteristics and blood pressure control were identical between the two groups. However, follow-up IVUS showed significantly decreased TAV and PAV in the olmesartan group (5.4% vs. 0.6 % for TAV and 3.1% vs. -0.7% for percent change in PAV, control vs. olmesartan, p < 0.05 for all).
Conclusions: Omesartan reduced the rate of coronary atheroma progression in patients with stable angina pectoris.
Perspective: Many preclinical studies have shown that blockade of the renin-angiotensin-aldosterone system (RAAS) leads to cardiovascular protection. However, studies looking at the effect of RAAS inhibition on clinical events in patients with CAD and preserved left ventricular function have been inconsistent. The reduction in atheroma progression observed in this study with olmesartan supports possible beneficial vascular effects of angiotensin II receptor inhibition on the background of modern medical therapy. Whether these IVUS changes translate into reduced coronary events will require further study. Daniel T. Eitzman, M.D., F.A.C.C.