Journal and News Scan

In this study, the authors identify a number of markers in cardiac stem cells obtained from 38 patients undergoing coronary artery bypass grafting which appear to predict positive myocardial remodelling at 12 months following surgery

Coronary artery bypass grafting (CABG) has been considered the standard of care for patients with three-vessel disease (3VD), but long-term comparative results from randomized trials of CABG vs. percutaneous coronary intervention (PCI) using drug-eluting stents (DES) remain limited. Five-year results of patients with 3VD treated with CABG or PCI using the first-generation paclitaxel-eluting DES suggest that CABG should remain the standard of care as it resulted in significantly lower rates of death, MI, and repeat revascularization, while stroke rates were similar. For patients with low SYNTAX scores, PCI is an acceptable revascularization strategy, although at a price of significantly higher rates of repeat revascularization.

Methods

• Patients with de novo 3VD or left main disease were randomly assigned to PCI with the paclitaxel-eluting first-generation stent or CABG in the SYNTAX trial.
• This pre-specified analysis presents the 5-year outcomes of patients with 3VD (n = 1095).

Results

• The rate of major adverse cardiac and cerebrovascular events (MACCE) was significantly higher in patients with PCI compared with CABG (37.5 vs. 24.2%, respectively; P < 0.001).
• Percutaneous coronary intervention as opposed to CABG resulted in significantly higher rates of the composite of death/stroke/myocardial infarction (MI) (22.0 vs. 14.0%, respectively; P < 0.001), all-cause death (14.6 vs. 9.2%, respectively; P = 0.006), MI (9.2 vs. 4.0%, respectively; P = 0.001), and repeat revascularization (25.4 vs. 12.6%, respectively; P < 0.001); however, stroke was similar between groups at 5 years (3.0 vs. 3.5%, respectively; P = 0.66).
• Results were dependent on lesion complexity (P for interaction = 0.12); in patients with a low (0–22) SYNTAX score, PCI vs. CABG resulted in similar rates of MACCE (33.3% vs. 26.8%, respectively; P = 0.21) but significantly more repeat revascularization (25.4% vs. 12.6%, respectively; P = 0.038), while in intermediate (23–32) or high (≥33) SYNTAX score terciles, CABG demonstrated clear superiority in terms of MACCE, death, MI, and repeat revascularization.
• Differences in MACCE between PCI and CABG were larger in diabetics [hazard ratio (HR) = 2.30] than non-diabetics (HR = 1.51), although the P for interaction failed to reach significance for MACCE (P for interaction = 0.095) or any of the other endpoints.

LVR using endobronchial therapies remains experimental.  This multicenter study tested LVR coils in 60 pts for safety and efficacy.  There were a total of 18 serious adverse events.  At 6 and 12 mos, dyspnea scores decreased 11%, 6 min walk increased 30-50 m, and FEV1 increased 0.11 L.  Pts with either heterogeneous or homogeneous emphysema appeared to improve.

This study assessed whether the application of a poly based hydrogel containing amioderone applied to the epicardium at the time of surgery reduced the incidence of post-operative atrial fibrillation. The study randomised 100 patients undergoing cardiac surgery to either receive the amioderone spray at the time of surgery or no intervention. Patients in who received epicardial amioderone had a significantly reduced incidence of post-operative AF (4/50, 8%) compared to the control group (13/50, 26%) up to 14 days post-surgery. Plasma amioderone levels remained below the detection limit for the duration of the study.