lating properties, antiproliferative properties, and antioxidant proper-ties. In the EUROCARE trial, patients with a single lesion undergoingdirectional coronary atherectomy were eligible for inclusion. Patientsreceived either a maximal carvedilol dose or a placebo from 24 hoursbefore directional coronary atherectomy until 5 months after the pro-cedure. Outcomes assessed were minimum luminal diameter and ad-verse events. There were no differences in minimum luminal diameter(1.99 � 0.73 v 2.00 � 0.74), restenosis rate (23.4% v 23.9%), oradverse event rate between the study and control groups.

Implication: Although antioxidants such as vitamin E and probucolhave been shown to reduce restenosis after angioplasty, no beneficialeffect was shown in restenosis rate after coronary atherectomy. Themechanism of protection from coronary restenosis needs further eval-uation.

Wei S, Chow LT, Sanderson JE: Effect of carve-dilol in comparison with metoprolol on myocardialcollagen postinfarction. J Am Coll Cardiol 36:276-281, 2000

In a rat model of myocardial infarction using left coronary arteryocclusion, two �-adrenergic blocking drugs (carvedilol and metoprolol)and an angiotensin-converting enzyme inhibitor (captopril) were givenfor 11 weeks and were compared for their effects on collagen deposi-tion and ventricular modeling after myocardial infarction. Carvediloland metoprolol were administered at equipotent �-blocking doses.Parameters studied included tissue weight, collagen fraction, and hy-droxyproline content. Carvedilol and captopril attenuated the increasein collagen deposition in noninfarcted tissue and minimized the in-crease in ventricular weight. Metoprolol treatment resulted in an in-crease in ventricular weight.

Implication: Because of its antiproliferative properties, the�-blocker carvedilol prevented myocardial collagen deposition andmay have protective effects during ventricular healing and remodelingafter myocardial infarction.

Kaluza GL, Joseph J, Lee JR, et al: Catastrophicoutcomes of noncardiac surgery soon after coronarystenting. J Am Coll Cardiol 35:1288-1294, 2000

Myocardial revascularization procedures in the form of angioplastyor intracoronary stent (ICS) placement purportedly reduce periopera-tive risk. In a retrospective chart review, the records of 40 patients whounderwent a single ICS procedure �6 weeks before major noncardiacsurgery were evaluated for stent thrombosis, myocardial infarction, andbleeding complications. There were 7 myocardial infarctions and 8

deaths, all of which occurred within 2 weeks of the ICS implantation.There were 11 major bleeding complications, attributed to the use oforal antiplatelet therapy after ICS. Of these bleeding complications,73% also occurred within 2 weeks of the procedure date.

Implication: Patients undergoing ICS implantation are at great riskfor stent thrombosis and are maintained for 2 to 4 weeks on antiplatelettherapy. The perioperative period represents a time of increasedthrombotic risk, and antiplatelet therapy should be continued. If pos-sible, major surgery should be postponed so that antiplatelet therapycan be completed and bleeding complications avoided.

Gyongyosi M, Yang P, Khorsand A, Glogar D:Longitudinal straightening effect of stents is an addi-tional predictor for major adverse cardiac events.Austrian Wiktor Stent Study Group and EuropeanParagon Stent Investigators. J Am Coll Cardiol 35:1580-1589, 2000

Intracoronary stent deployment has an incidence of stent restenosisand major adverse cardiac events (MACE), such as myocardial infarc-tion, need for revascularization, or death. In a multivariate analysis in404 patients having a single intracoronary stent, angiographic param-eters were evaluated for their predictive accuracy for MACE. Sixty-sixpatients (16.3%) had a MACE. The highest predictive accuracies forMACE, by receiver operating characteristic curves, were found forpoststent minimum luminal diameter, follow-up minimum luminaldiameter, prestent vessel angle, and poststent change in vessel angle.These were the same variables that were found to be independentpredictors of stent restenosis severity in a multiple linear regressionanalysis.

Implication: In addition to luminal diameter, which is a well-knownpredictor of restenosis, the straightening effect of stents on angledcoronary arteries is predictive of restenosis. This effect may play a rolein the location of stent deployment or their future design.

ACKNOWLEDGMENT

Papers reviewed in this issue were selected from those published inthe following journals: Anesthesia and Analgesia, British Journal ofAnaesthesia, Circulation, Journal of the American College of Cardi-ology, and Journal of the American Society of Echocardiography.

Contributions to the thoracic section of this review were made by Dr.Paul S. Myles, Department of Anaesthesiology and Pain Management,Alfred Hospital, Prahran, Victoria, Australia.

doi: 10.1053/jcar.18670

756 LITERATURE REVIEW