October 2006

Patient #1 was a 64-year-old woman with chest discomfort provoked by exertion and emotional stress.

We evaluated the potential benefit of using myocardial perfusion scintigraphy as a gatekeeping technique prior to performing coronary angiography and revascularization procedures in patients with stable angina pectoris. Results showed that about half of all catheterizations and almost one fifth of coronary revascularizations could be avoided, assuming that only patients with reversible (stress-induced) myocardial ischemia and a minority of patients with "fixed" perfusion defects (present both at rest and during stress) would benefit from coronary revascularization.

The study by Høilund-Carlsen and Johansen evaluates the benefits of using myocardial perfusion scintigraphy (MPS) in a new way—as a gatekeeping technique for further invasive diagnostic and therapeutic procedures among patients with stable angina pectoris.

In a case-control substudy of the Veterans Affairs High-Density Lipoprotein Intervention Trial, therapy with gemfibrozil was shown to reduce the total number of low-density lipoprotein (LDL) particles, especially small, more oxidizable LDL particles, which was associated with a reduced risk of coronary heart disease (CHD) events. Gemfibrozil also increased small-sized high-density lipoprotein particle numbers, which also correlated with a decrease in CHD events. Notably, these changes in particle numbers were not associated with significant changes in lipoprotein cholesterol concentrations, which current guidelines have made the principal target of lipid therapy.

Conventional measurements of cardiac lipoprotein risk include cholesterol, triglyceride, and high-density lipoprotein (HDL) cholesterol levels. Low-density lipoprotein (LDL) cholesterol is estimated from these measurements.

We prospectively studied the relationship between C-reactive protein, obtained within 12 to 24 hours of symptom onset, and long-term risk of death and heart failure in survivors of acute myocardial infarction. The risk of death and heart failure increased progressively with increasing quartiles of C-reactive protein. We found a graded positive relationship between C-reactive protein levels and post-discharge mortality and heart failure.

Biomarkers seem to be proliferating everywhere, with at least 1 "major" new marker appearing each year.