Articles in 2010

The two CHAMPION trials failed to show superiority of cangrelor (a rapid-acting, reversible intravenous platelet P2Y₁₂ adenosine receptor antagonist) versus clopidogrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention. The CHAMPION PCI trial, however, did show a significant reduction in death and stent thrombosis suggesting benefit in those without clopidogrel pretreatment.

Although currently available anticoagulants, such as warfarin, can prevent stroke in patients with atrial fibrillation, the drug-related bleeding risk remains unacceptably high, and therapy could be contraindicated if the risk exceeds that for stroke. In this Review, Freek Verheugt assesses the performance of new anticoagulants that directly inhibit different stages of the coagulation cascade.

Atrial fibrillation (AF) has multifactorial intracardiac and extracardiac causes. Current development of anti-AF agents is focused on modulation of ion channel activity as well as on upstream therapies that reduce structural substrates. In this Review, Burashnikov and Antzelevitch examine new and emerging pharmacological approaches to rhythm control in patients with AF and summarize the available data on these drugs.

As part of our focus issue on atrial fibrillation, Dewire and Calkins review current strategies and emerging technologies for catheter ablation of patients with this arrhythmia. The authors also discuss the current clinical role of AF ablation in various high-risk groups of patients, such as the elderly and those with concomitant heart failure.

Cell therapy could improve cardiac function in patients with coronary heart disease. In this article, the authors provide an overview of the clinical trials in this field and highlight the limitations of cardiac cell therapy. They also discuss how these issues are being addressed and what the future may hold for this therapy.

Sudden cardiac arrest causes more than 60% of all deaths from cardiovascular disease. In this Review, Adabag and colleagues discuss trends in the incidence of sudden cardiac death (SCD), and the risk factors and triggers of this devastating event. The authors also highlight the lack of a concise definition for SCD and suggest that prospective community surveillance programs, using multiple sources to identify cases, would enable more accurate determination of SCD burden. They also review the growing evidence for the role of public-access defibrillators in improving survival after sudden cardiac arrest.

Tibaldi et al. have addressed the feasibility of 'hospital-at-home' care as an alternative to hospitalization for elderly patients with chronic heart failure. Although this study addresses an important subject, and the results are intriguing, extrapolation to other settings may not be easy. The study should, therefore, be regarded as hypothesis-generating rather than definitive.

Two large trials were conducted to evaluate the effects of an angiotensin-converting-enzyme inhibitor, an angiotensin-receptor blocker or a combination of both in high cardiovascular risk patients. A decrease in the prevalence of left ventricular hypertrophy (LVH) was reported, but this did not translate into a prognostic benefit. New-onset LVH was associated with an increase in cardiovascular events.

Defibrillators, with or without cardiac resynchronization therapy, can reduce the rate of sudden death. However, shocks are unpleasant, often unnecessary, and can damage myocardium or defibrillator leads, thereby increasing morbidity and mortality and detracting from the benefits of this therapy. Conservative programming of devices may reduce such risks.

Despite angiographically successful primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction, microcirculatory failure is common and leads to an increased risk of morbidity and mortality. The administration of intracoronary streptokinase immediately after PCI may improve outcomes and provides a promising potential therapy for the future.

The ROOBY investigators found off-pump CABG surgery to be significantly inferior to on-pump surgery with regard to 1 year mortality, revascularization, or new myocardial infarction. This unexpected finding could be related to the fact that most of the participating surgeons were experienced in on-pump CABG surgery, but relatively inexperienced in the off-pump procedure.