Time to consider a STEMI sleepover?: Measuring the “value” of an in‐house STEMI team

• This study demonstrates that the presence of an in‐hospital STEMI team significantly reduces D2B times
• PCI centers should consider the “value” (outcomes relative to cost) of an in‐house STEMI team
• Larger studies are required to assess the cost effectiveness and clinical effectiveness attributable to an in‐house STEMI team

     

Is the “candy‐wrapper” effect of 32P radioactive β‐emitting stents due to remodeling or neointimal hyperplasia?: Insights from Intravascular Ultrasound

A recognized limitation of radioactive stents is the development of restenosis at the stent edges, known as the "candy-wrapper" effect. The mechanisms of this effect remain incompletely understood and controversial. The aim of this study is to assess the effect of endovascular irradiation on neointima formation and vascular remodeling. (32)P Palmaz-Schatz stents (1.5-4 microCi) were implanted in 11 patients with restenosis after previous percutaneous transluminal coronary angioplasty (PTCA). Intravascular ultrasound (IVUS) images of target sites and adjunct vessel segments were acquired both during intervention and after 6 months. The angiographic restenosis rate was 54%, and the MLD decreased from 2.21 +/- 0.6 mm to 1.38 +/- 0.4 mm at follow-up (P < 0.01). IVUS analysis demonstrated that late lumen loss was the result of neointimal tissue proliferation, which was nonuniformly distributed and exaggerated at both the central articulation and the distal stent edges. Negative remodeling did not contribute to restenosis. In contrast, we found a linear relationship between increase of area stenosis and a positive remodeling index (r = 0.84, P < 0.0001). Restenosis after implantation of (32)P Palmaz-Schatz stents was mainly the result of neointimal tissue proliferation which tended to be nonuniformly distributed in the stent articulation and edges. Negative remodeling or stent recoil was not observed. Cathet Cardiovasc Intervent 2001;54:41-48.     

The Hispanic Americans Baseline Alcohol Survey (HABLAS): Is the “Prevention Paradox” Applicable to Alcohol Problems Across Hispanic National Groups?

Background: The “prevention paradox,” a notion that most alcohol‐related problems are generated by nonheavy drinkers, has significant relevance to public health policy and prevention efforts. The extent of the paradox has driven debate over the type of balance that should be struck between alcohol policies targeting a select group of high‐risk drinkers versus more global approaches that target the population at‐large. This paper examines the notion that most alcohol problems among 4 Hispanic national groups in the United States are attributable to moderate drinkers. Methods: A general population survey employing a multistage cluster sample design, with face‐to‐face interviews in respondents’ homes was conducted in 5 metropolitan areas of the United States. Study participants included a total of 2,773 current drinkers 18 years and older. Alcohol consumed in the past year (bottom 90% vs. top 10%), binge drinking (binge vs. no binge), and a 4‐way grouping defined by volume and binge criteria were used. Alcohol‐related harms included 14 social and dependence problems. Results: Drinkers at the bottom 90% of the distribution are responsible for 56 to 73% of all social problems, and for 55 to 73% of all dependence‐related problems reported, depending on Hispanic national group. Binge drinkers are responsible for the majority of the social problems (53 to 75%) and dependence‐related problems (59 to 73%), also depending on Hispanic national group. Binge drinkers at the bottom 90% of the distribution are responsible for a larger proportion of all social and dependence‐related problems reported than those at the top 10% of the volume distribution. Cuban Americans are an exception. Conclusions: The prevention paradox holds when using volume‐based risk groupings and disappears when using a binge‐drinking risk grouping. Binge drinkers who drink moderately on an average account for more harms than those who drink heavily across all groups, with exception of Cuban Americans.     

Finding the “PR‐fect” Solution: What Is the Best Tool to Measure Fetal Cardiac PR Intervals for the Detection and Possible Treatment of Early Conduction Disease?

In the absence of structural heart disease, the great majority of cases with complete congenital heart block will be associated with the maternal autoantibodies directed to components of the SSA/Ro—SSB/La ribonucleoprotein complex. Usually presenting in fetal life before 26 weeks' gestation, once third‐degree (complete) heart block develops, it is irreversible. Therefore, investigators over the past several years have attempted to predict which fetuses will be at risk for advanced conduction abnormalities by identifying a biomarker for less severe or incomplete disease, in this case, PR interval prolongation or first‐degree atrioventricular block. In this state‐of‐the‐art review, we critically analyze the various approaches to defining PR interval prolongation in the fetus, and then analyze several clinical trials that have attempted to address the question of whether complete heart block can be predicted and/or prevented. We find that, first and foremost, definitions of first‐degree atrioventricular block vary but that the techniques themselves are all similarly valid and reliable. Nevertheless, the task of predicting those fetuses at risk, and who are therefore candidates for treatment, remains challenging. Of concern, despite anecdotal evidence, there is currently no conclusive proof that a prolonged PR interval predicts complete heart block.