The safety and efficacy of drug-eluting stents remain controversial in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). In a multicenter trial, Räber and colleagues randomly assigned 1161 patients with STEMI to receive either a stent that elutes biolimus from a biodegradable polymer or a bare-metal stent. The authors report that use of the biolimus-eluting stent resulted in a lower rate of major adverse cardiac events (a composite of cardiac death, target vessel–related reinfarction, and ischemia-driven target-lesion revascularization) at 1 year. In an editorial, Cassese and Kastrati discuss the safety and efficacy of new-generation drug-eluting stents in patients with STEMI.
Two articles in this issue address whether the addition of novel cardiovascular risk markers to the Framingham Risk Score (FRS) improves cardiovascular risk assessment, particularly in patients at intermediate risk. In an analysis of data from 1330 adult participants in the Multi-Ethnic Study of Atherosclerosis, who were asymptomatic at baseline and were determined to be at intermediate risk of a cardiovascular event by the FRS, Yeboah and colleagues found that coronary artery calcium score, ankle-brachial index, high-sensitivity C-reactive protein level, and family history were independent predictors of incident coronary heart disease or cardiovascular disease and that the coronary artery calcium score provided superior discrimination and risk reclassification compared with the other examined markers. In a meta-analysis of data from 45 828 participants in 14 population-based cohort studies who had baseline assessments of common carotid intima-media thickness (CIMT), Den Ruijter and colleagues found that the addition of common CIMT measurements to the FRS was associated with a small, but likely clinically unimportant, improvement in 10-year risk prediction of first-time myocardial infarction or stroke. In an editorial, Gaziano and Wilson discuss implications of these findings for patient care.
Lipid-modifying therapies—both statins and fibrates—have been associated with a possible increased risk of pancreatitis. To further explore this relationship, Preiss and colleagues analyzed pooled data from 16 placebo- and standard care–controlled trials of statin therapy (113 800 participants), 5 dose-comparison statin trials (39 614 participants), and 7 randomized trials of fibrate therapy (40 162 participants). The authors report that use of statin therapy was associated with a lower risk of pancreatitis in patients with normal or mildly elevated triglyceride levels. Fibrate therapy was not associated with pancreatitis risk.
A 21-year-old man presents with an enlarging nodule on his chest, upper abdominal pain, diarrhea, and recent weight loss. Physical examination reveals supraclavicular and cervical lymphadenopathy, and endoscopy reveals gastrointestinal ulcers. What would you do next?
An upturn in the number of overdoses involving methadone has spurred health officials to call for more judicious prescribing of the drug.
Ending the tobacco epidemic
Preventing patient harms: a systems approach
Transforming care and improving outcomes after acute MI
Statistical analysis plans in observational research
“When parents of younger children develop cancer, inevitable questions focus on the children. What should we tell them?” From “Poolside.”
Join Philip Greenland, MD, Wednesday, September 19, from 2 to 3 PM eastern time to discuss novel risk markers to improve assessing patients at intermediate risk of cardiovascular disease. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.jamanetwork.com/multimedia.aspx#Weekly.
For your patients: Information about ectopic pregnancy.
This Week in JAMA. JAMA. 2012;308(8):739. doi:10.1001/jama.2012.3168