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Silent ischemia is associated with a worse prognosis in patients after myocardial infarction. Whether percutaneous coronary intervention (PCI) improves the long-term prognosis for these patients is not known. In the Swiss Interventional Study on Silent Ischemia Type II (SWISSI II), patients with a recent myocardial infarction, silent ischemia, and 1- or 2-vessel coronary artery disease were randomly assigned to receive either PCI or intensive treatment with anti-ischemia medications, in addition to 100 mg/d of aspirin and statin therapy. Erne and colleagues report that during a mean follow-up of 10.2 years, patients who received PCI had a significantly reduced risk of major cardiac events compared with patients who received intensive anti-ischemia medical therapy.
Clinical use of drug-eluting stents in percutaneous coronary interventions has expanded beyond the original US Food and Drug Administration approved indications. Data relating to the safety and efficacy of drug-eluting stents for off-label or untested uses are reported by 2 groups of investigators in this issue of JAMA. In the first article, Beohar and colleagues Article report that patients with off-label or untested use vs on-label indications for drug-eluting stent placement had comparable in-hospital and 1-year risks of a composite outcome of death, myocardial infarction, or stent thrombosis, but this risk was significantly higher at the 30-day follow-up point among patients with an off-label use. At 1 year, patients with off-label or untested use vs on-label had a higher likelihood of target vessel revascularization. In the second article, Win and colleagues Article report that patients who had drug-eluting stent placement for an off-label indication had higher rates of the composite outcome of death, myocardial infarction, or target vessel revascularization during the index hospitalization and at 1 year compared with patients receiving a stent for an on-label indication. In an editorial, Harrington and Ohman Article discuss potential explanations for the different event rates in the 2 studies and the importance of systematic data collection to improve device safety surveillance.
Hepatitis C virus (HCV) infection causes liver cancer, and some data suggest HCV infection is associated with an increased risk of other tumors. In a retrospective cohort study of US veterans infected with HCV and uninfected veteran controls, Giordano and colleagues tested the hypothesis that HCV infection is associated with an increased risk for hematological malignancies, related lymphoproliferative disorders, and thyroid cancer. The authors found that HCV infection was associated with a 20% to 30% increased risk of non-Hodgkin lymphoma overall, a 3-fold higher risk of Waldenström macroglobulinemia, and an increased risk of cryoglobulinemia, but not a higher risk of thyroid cancer.
Aspirin in a dose greater than 75 to 81 mg/d is not associated with enhanced cardiovascular disease (CVD) prevention but is associated with an increased risk of gastrointestinal bleeding.
Scientists and others recently gathered to discuss practical strategies and research innovations to help ensure that patients get needed pain relief, while also preventing abuse of opioid pain medications.
Greater understanding of the biology and ecology underlying host-switching events will improve prediction of pandemic influenza.
Join Jan L. Brandes, MD, Wednesday May 16, 2007, from 2 to 3 PM eastern time to discuss sumatriptan-naproxen for acute treatment of migraine. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
For your patients: Information about lymphoma.
This Week in JAMA . JAMA. 2007;297(18):1955. doi:10.1001/jama.297.18.1955