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In This Issue of JAMA |

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JAMA. 2014;312(19):1945-1947. doi:10.1001/jama.2013.279837.
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Philip Greenland, MD, Michael Gaziano, MD, MPH, and Eric D. Peterson, MD, MPH


In a multicenter randomized clinical trial involving 4524 patients undergoing transfemoral coronary artery angiography, Schulz-Schüpke and colleagues found that femoral artery closure with vascular closure devices was noninferior to manual compression in terms of a composite of vascular access-site complications assessed 30 days after the procedure. Time to hemostasis was shorter when a vascular closure device was used.

Reddy and colleagues assessed the efficacy and safety of percutaneous left atrial appendage closure vs warfarin therapy for stroke prophylaxis in a randomized trial of 707 patients with nonvalvular atrial fibrillation (AF) and an elevated risk of stroke. The authors report that compared with warfarin, percutaneous left atrial appendage closure met prespecified noninferiority and superiority criteria for preventing a composite outcome of stroke, systemic embolism, and cardiovascular death during a mean 3.8 years’ follow-up.

In an analysis of 2008-2011 California hospital discharge data, Kaul and colleagues examined treatment and outcomes among patients who developed ST-segment elevation myocardial infarction (STEMI) while hospitalized for a non–acute coronary syndrome condition (n=3068) compared with patients who experienced outpatient-onset STEMI (n=58 953). Among the authors’ findings was that patients with inpatient-onset STEMI had higher in-hospital mortality and a lower likelihood of undergoing invasive testing or intervention.

In an analysis of Swedish administrative data from 8244 propensity score–matched patients with heart failure with preserved ejection fraction, Lund and colleagues found that β-blocker use was associated with reduced all-cause mortality but not reduction in a composite of all-cause mortality or heart failure hospitalization. In an Editorial, Cheng and Pfeffer discuss limitations of administrative data to explore the possible effectiveness of a therapeutic intervention.

Park and colleagues assessed the incidence, extent, and location of obstructive non–infarct-related coronary artery disease (CAD) and its relationship to mortality in a pooled analysis of angiographic data from 28 282 patients enrolled in 8 clinical trials of ST-segment elevation myocardial infarction (STEMI). The authors found that obstructive non–infarct-related CAD was common among patients presenting with STEMI and associated with a modest increase in 30-day mortality.


An article in JAMA Internal Medicine reported that compared with percutaneous coronary intervention, coronary artery bypass graft surgery leads to greater reductions in long-term mortality, myocardial infarction, and repeat revascularizations among patients with multivessel coronary artery disease. In this From The JAMA Network article, Sherwood and Peterson discuss reasons that randomized clinical trial evidence may not apply to individual patients.

This JAMA Clinical Evidence Synopsis by Huffman and colleagues summarizes a Cochrane review of 9 clinical trials (7047 participants) that examined the efficacy and safety of fixed-dose combination therapy (polypills) for prevention of cardiovascular disease (CVD). Among the findings was that compared with usual care, placebo, or active comparators, polypills are associated with greater reductions in systolic blood pressure and total cholesterol but also a higher risk of adverse events.

In this JAMA Diagnostic Test Interpretation article, Paixao and de Lemos present the case of a 52-year-old woman with a history of hypertension who experienced chest pain, diaphoresis, and shortness of breath while sitting at work. On examination, her blood pressure was 247/130 mm Hg. An electrocardiogram showed left ventricular hypertrophy and inferior T-wave inversion. Cardiac troponin T levels were elevated and coronary angiography revealed mild, nonobstructive coronary artery disease. How would you interpret these findings?



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