No abstract

Background-Numerous studies have compared the outcomes of coronary artery bypass grafting (CABG) surgery and coronary stenting for the treatment of multivessel coronary disease. In 2003, drug-eluting stents were introduced with the hope of reducing restenosis. However, limited information exists on the comparison of drug-eluting stents and CABG surgery. The long-term outcome of drug-eluting stents compared with that of CABG surgery is also unclear. Methods and Results-We identified 3720 consecutive patients with multivessel disease who underwent isolated CABG surgery or received drug-eluting stents between April 1, 2004, and December 31, 2005, and we compared safety (total mortality, myocardial infarction, and stroke) and efficacy (target-vessel revascularization) during a 3-year follow-up. These outcomes were compared after adjustment for differences in baseline risk factors. Patients who underwent CABG (nϭ1886) were older and had more comorbidities than patients who received drug-eluting stents (nϭ1834). Patients receiving drug-eluting stents had considerably higher 3-year rates of target-vessel revascularization. Drug-eluting stents were also associated with higher rates of death (adjusted hazard ratio, 1.62; 95% confidence interval, 1.07 to 2.47) and myocardial infarction (adjusted hazard ratio, 1.65; 95% confidence interval, 1.15 to 2.44). The risk adjusted rate of stroke was similar in the 2 groups (hazard ratio, 0.92; 95% confidence interval, 0.69 to 1.51). Conclusions-In a cohort of patients with multivessel disease, CABG was associated with lower rates of death, myocardial infarction, and target-vessel revascularization than drug-eluting stents.

EuroSCORE model does not accurately predict outcomes in this group of Chinese CABG patients. Therefore, caution should be exercised when using it for risk prediction in China. Creation of a new model, which accurately predicts outcomes in Chinese CABG patients, is warranted.

Background: MicroRNAs (miRNAs) may serve as potential diagnostic biomarkers and therapeutic targets in cardiovascular research. However, the association between miRNAs and heart remodeling/reverse remodeling has not been evaluated. Methods: Lewis rats were divided into three groups: control animals, animals subjected to abdominal aortic constriction (AAC) and those with heterotopic transplantation of abdominal aortic constriction (AAC-HT), respectively. The cardiomyocyte cross-sectional area and changes in the heart cavity were determined. miRNA microarray was used to search for changes in miRNAs during hypertrophy and in the unloading heart, which was also verified using real-time quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). Results: The AAC-HT group exhibited a 54% decrease in the cardiomyocyte cross-sectional area compared to the AAC group. In the two test groups, miRNA microarrays revealed changes in 293 miRNAs, among which 40 miRNAs changed >2-fold. Some major changes were also confirmed using qRT-PCR primers. The results indicated that changes in miR-23a and miR-29a were most significant, thus suggesting that these miRNAs may play important roles in heart remodeling and reverse remodeling. Conclusions: The changes observed in miRNA expression during hypertrophy and reverse remodeling may indicate possibly meaningful targets for regulating the remodeling or reverse remodeling of the heart.