LITERATURE REVIEW 491 MYOCARDIAL ISCHEMIA Weintraub WS, Stein B, Kosinski A, et al: Outcome of coronary bypass surgery versus coronary angio- plasty in diabetic patients with multivessel coronary artery disease. J Am Coil Cardio131:10-19, 1998 There is controversy as to the optimal management of patients with diabetes and multivesset coronary artery disease requiring revasculariza- tion. This study was undertaken to compare the outcomes of patients with diabetes who underwent either percutaneous translumina[ coronary angioplasty (PTCA; n = 834) or coronary artery bypass graft surgery (CABG; n = 1,805). Data were collected prospectively b 7 using a computerized database from 1981 through 1994. The ia-hospital mortality rate was greater in the CABG group (4.99% v 0.36%; p < 0.0001) and there was a trend toward more Q wave infarctions in this group. There was no difference in the 5-year and 10-yeer survival rates for either procedure (76% v 78% and 48% v 45%, respectively). Using multivariate analysis, there was a higher mortality rate in the insulin-dependent subgroup for PTCA than for CABG (hazards ratio, 1.35; 95% confidence interval, 1.01 to 1.79; p = 0.045). Additional revascularization was more common after PTCA. Confirming that morbidity and mortality are prevalent in diabetic patients, this study raises further questions about PTCA in insulin-dependent diabetic patients with multivessel coronary artery disease. Stone GW, Brodie BR, Griffin J J, et al: Prospective, multicenter study of the safety and feasibility of primary stenting in acute myocardial infarction: In- hospital and 30-day results of the PAMI stent pilot trial. J Am Coil Cardiol 31:23-30, 1998 After initial percutaneous transluminal coronary angioplasty (PTCA), 20% of patients require either repeated PTCA or coronary artery bypass surgery within 6 months of discharge. Elective stenting of diseased coronary arteries has been shown to reduce the angiographic restenosis rate and improve late clinical outcomes. This study was undertaken to examine the safety and feasibility of primary stenting in 312 consecu- tive patients undergoing PTCA for acute myocardial infarctioa. Ninety- eight percent of the lesions that were eligible for stenl:ing were successfully stented. Results show that patients with stent~,, had low rates of in-hospital death (0.8%), reinfarction (1.7%), recurrent isch- emia (3.8%), and no additional deaths or reinfarctions at 30-day follow-up. These short-term results are favorable when compared with the results of conventional PTCA in patients with acute myocardial infarction. Gurne O, Chenu P, Timmermans P, et ah Evalua- tion in vivo of the endothelial function of the native gastroepiploic artery. Am Heart J 135:146-151, 1998 During cardiac catheterization, selective injection of the gastroepi- ploic artery (GEA) was performed in 16 patients and the artery size was measured in response to varying doses of acetylcholine and to nitrates. Blood pressure and heart rate did not change significantly <luting the injection of any drug. The arterial size increased 18% in response to the highest dose of aeetylcholine (20 g/rain) and increased 36% in response to nitrate injection. There were no differences in GEA responsiveness between patients with and without coronary artery disease. The native GEA has a preserved vasodilatory response and thus may have better patency rates than other arterial grafts used for coronary revasculariza- tiou. POSTOPERATIVE/INTENSIVE CARE Higgins TL, Estafanous FG, Loop FD, et ah ICU admission score for predicting morbidity and mortal- ity risk after coronary artery bypass grafting. Ann Thorac Surg 64:1050-1058, 1997 Risk factors for morbidity and mortality were measured in 4,918 patients undergoing coronary artery bypass grafting. Data were col- lected preoperatively and on intensive care unit (ICU) arrival. Using the risk factors significant for morbidity and mortality, multivariate logistic regression models were used to derive a risk stratification score that included preoperative, intraoperative, and ICU variables. The score was based on a study group of 2,793 patients and was validated in a group of 2,125 patients. Receiver operating characteristic curves between 0.80 and 0.87 showed accurate predictability. Risk should be reassessed at ICU admission to accurately identify patients at risk for mortality or prolonged length of stay. Daoud EG, Strickberger SA, Man KC, et al: Preop- erative amiodarone as prophylaxis against atrial fibril- lation after heart surgery. N Engl J Med 337:1785- 1791, 1997 Patients undergoing revascularization and valvular heart surgery were randomly assigned to receive oral amiodarone or placebo for 7 days before surgery and until hospital discharge. The prevalence of atrial fibrillation occurred (at approximately 2 to 3 days postopera- tively) in 42% of patients in the placebo group and in 23% of patients in the study group (p = 0.03). In patients who had atrial fibrillation, amiodarone was significantly associated with a reduced ventricular rate. After hospital discharge, atrial fibrillation was also more prevalent in patients treated with placebo. Patients in the study group had shorter hospital stays and lower hospital costs, although this is difficult to interpret because the treatment of atrial fibrillation was not standard- ized. Malacrida R, Genoni M, Maggioni AP, et ah A comparison of the early outcome of acute myocardial infarction in women and men. N Engl J Med 338:8-14, 1998 As part of the International Study of Infarct Survival (ISIS-3) trial, data were collected on 9,600 women and 26,480 men to determine whether the apparent increased risk in women with myocardial infarc- tion is accurate or a result of confounding variables. Patients were eurolled because of symptoms of myocardial infarction that indicated a need for fibrinolytic therapy and were followed for 35 days after admission. When adjustments for age and other presenting characteris- tics were made, the odds ratio for mortality in women was reduced from 1.73 (95% confidence, 1.61 to 1.86) to 1.14 (95% confidence, 1.05 to 1.23). Similar reductions occurred in the risk of major adverse events, and the odds ratio 95% confidence interval included 1.0. It is likely that female gender confers only a small independent risk of mortality and morbidity after myocardial infarction.