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Introduction: The use of stents in percutaneous coronary intervention (PCI) improves procedural success and reduces restenosis. However, few studies have had a sufficient sample size or adequate follow-up to determine whether this advantage results in a positive effect on mortality. Methods: A total of 3399 patients undergoing PCI (stented [with dual antiplatelet therapy]: n = 2456, nonstented [balloon PCI or rotational atherectomy]: n = 942) at a single institution from 1994 to 2001 were followed up prospectively (43 ± 22 and 54 ± 25 months, respectively) for acute and long-term clinical outcomes. Results: Angiographic success (<50% residual stenosis) (99.7% vs 97.7%, P < .001) and acute gain (3.02 ± 0.55 vs 2.08 ± 0.62 mm, P < .001) were both greater for stented lesions. Likewise, procedural complications of death (0.04% vs 0.4%, P = .02) and dissection (4.9% vs 8.0%, P = .001) were lower in the stent group, as were rates of 6-month clinical restenosis (10.3% vs 16.3%, P < .001). Eight-year mortality (12.0% vs 18.2%, hazard ratio = 0.78, P = .009) was lower among the stent group, as was long-term major adverse cardiac events (36.2% vs 50.6%, P < .001), but no difference in long-term myocardial infarction was found (6.5% vs 7.6%, P = .28). In multivariable Cox regression, stent use (hazard ratio = 0.76, 95% CI [0.58-0.99], P = .04) remained associated with significantly reduced mortality. Conclusion: This large prospective study demonstrates that, in addition to a general improvement in procedural success and a reduced need for repeat revascularization, the use of stents with dual antiplatelet therapy was associated with a significant reduction in long-term mortality. Consideration should be given for the use of stents whenever feasible during PCI. [Copyright &y& Elsevier]

The author discusses treatment for heart failure and reverse remodeling. Statistics relating to a study regarding the effectiveness of ventricular devices are provided. The author questions which medications utilized in the study were the most effective, and whether or not the patients in the study genuinely had end-stage heart failure. The effectiveness of medications such as inotropic agents and beta-blockers is discussed. The author suggests that the results of the study require corroboration, but do provide hope for patients with stage D heart failure.

The article discusses the stages of the progression of heart failure, its prevention and treatment. Prevention strategies are recommended for patients with risk factors for developing heart failure. Patients with Stage B heart failure are difficult to diagnose but treatment options are available. Stage C heart failure patients manifest a number of symptoms but may be improved through appropriate therapeutic approach. Heart failure patients with end-stage disease should be given palliative care.

The article offers clinical information on heart failure. Heart failure is the leading cause of hospitalizations in the U.S. Its treatment includes medications and device therapies. The risk factors for and common symptoms of heart failure are highlighted. The preventive measures and treatment options for heart failure are also discussed.

Beta-blocker therapy has been shown to benefit patients who have coronary artery disease and present with acute myocardial infarction (AMI) and/or congestive heart failure (HF). However, whether β-blocker therapy provides a similar benefit in patients who have coronary artery disease but not AMI or HF is unknown. A population of 4,304 patients who did not have HF but did have angiographically confirmed coronary artery disease (≥1 stenosis of ≥70%) without AMI at hospital presentation was evaluated. Baseline demographics, cardiac risk factors, clinical presentation, therapeutic procedures, and discharge medications were recorded. Patients were followed for a mean of 3.0 ± 1.9 years (range 1 month to 6.9 years) for outcomes of all-cause death or AMI. Patients'' average age was 65 ± 11 years and 77% were men. Overall, 10% died and 5% had a nonfatal AMI. Discharge β-blocker prescription was associated with an increased event-free AMI survival rate for all-cause death (no β blocker 88.3%, β blocker 94.5%, p &#60;0.001) and death/AMI (no β blocker 83.4%, β blocker 89.2%, p &#60;0.001) but not non-fatal AMI (no β blocker 93.6%, β blocker 94.1%, p = 0.60). After adjustment for 16 covariates, including statin prescription, angiotensin-converting enzyme inhibitor prescription, and type of baseline therapy, the effect of β blockers on the combination end point of death/AMI was eliminated. However, the effect of β blockers on death remained (hazard ratio 0.66, 95% confidence interval 0.47 to 0.93, p = 0.02). Thus, β blockers are clearly indicated for most patients who have HF or AMI, and our results suggest that patients who have coronary artery disease without these conditions have approximately the same protective benefit against death. No effect was observed on longitudinal incidence of AMI or the combination of death/nonfatal MI. [Copyright &y& Elsevier]