Most prior studies documenting a reduced restenosis rate with drug-eluting
vs bare metal stents have enrolled patients with relatively simple coronary
lesions. In this issue of JAMA, Stone and colleaguesArticle report results of a clinical trial in which the safety
and efficacy of paclitaxel-eluting stents vs bare metal stents were assessed
in patients with complex lesions. They found that patients receiving paclitaxel-eluting
stents had a lower risk of target vessel and target lesion revascularization
in 9 months’ follow-up. In an editorial, Colombo and CosgraveArticle discuss
these results in the context of other trials of drug-eluting stents for complex
Sabatine and colleaguesArticle report results
from the randomized placebo-controlled PCI-Clopidogrel as Adjunctive Reperfusion
Therapy (PCI-CLARITY) study, which assessed whether clopidogrel pretreatment—2
to 8 days—before percutaneous coronary intervention (PCI) in patients
with recent ST-segment elevation myocardial infarction is superior to clopidogrel
treatment at the time of PCI in preventing major adverse cardiovascular events.
They found that clopidogrel pretreatment significantly reduced the incidence
of cardiovascular death or ischemic complications both before and after PCI.
In an editorial, Moliterno and SteinhublArticle discuss
the implications of these results for patient care.
Disease recurrence is common among patients with localized prostate
cancer who receive radiation therapy. In a randomized trial to test whether
increasing the radiation dose from 70.2 Gy (conventional) to 79.2 Gy (high-dose)
would improve outcomes, Zeitman and colleaguesArticle found
that high-dose radiation was associated with a 49% lower risk of biochemical
evidence of treatment failure, reflected in increasing prostate-specific antigen
levels. In an editorial, DeWeese and SongArticle discuss
the risks and benefits of radiation dose escalation for localized low-risk
and high-risk prostate cancer.
Treatment with angiotensin-converting enzyme inhibitors, angiotensin
II receptor blockers, and β-adrenoreceptor antagonists are strongly associated
with reduced morbidity and mortality from heart failure, but whether patients
at highest risk of adverse outcomes are prescribed these agents is not clear.
Lee and colleagues evaluated administration rates for these medications at
hospital discharge and for 90 days after discharge in 9942 patients predicted
to be at low, intermediate, and high risk of death from heart failure within
1 year. They found an inverse relationship between prescription rates and
predicted and observed risks of death in patients with heart failure.
Patients are often discharged from emergency departments with serious
conditions requiring urgent follow-up. Asplin and colleagues explored the
association of timely ambulatory follow-up with insurance status by having
graduate students pose as new patients—with and without insurance—in
calls to ambulatory care clinics in 9 cities. Timely appointments were secured
by 64.4% of callers claiming to have private insurance, 34.2% having Medicaid,
25.1% uninsured and a cash limit of $20, and 62.8% uninsured with unlimited
Because physicians die by suicide more frequently than nonphysicians,
experts are recommending addressing factors in the profession that can deter
physicians with psychiatric conditions from seeking help.
Trends in death rates and number of deaths, 1970 to 2002, from leading
causes of death in the United States.
Clinical characteristics, diagnostic evaluation, pathophysiology, and
treatment of tumor-induced osteomalacia.
For your patients: Information about radiation therapy.
Research: State of the Science
This Week in JAMA . JAMA. 2005;294(10):1179. doi:10.1001/jama.294.10.1179