1. Miracle, Vickie A. RN, EdD, CCRN, CCNS, CCRC


Cardiovascular disease is still the leading cause of death in the United States, but the number of deaths is decreasing as new innovations in treatment are developed. Among the recent advances are coated stents, a second look at hypertension drugs, and new ways to assess risk and extent of coronary artery disease (CAD).


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Stents coated with medication-the latest weapons in the war again restenosis after percutaneous transluminal coronary angioplasty (PTCA)-are in clinical trials and may be nearing FDA approval. These devices may help increase success rates for PTCA, reducing the need for later coronary artery bypass grafting (CABG) surgery. 1


Sirolimus-The SIRIUS study examined the effects of a stent coated with sirolimus, an antirejection agent. Sirolimus appears to reduce the growth of cells at the PTCA site. Results from the study show that patients who received the sirolimus-coated stents had a restenosis rate of 3.2%, compared with 35.4% for patients who received uncoated stents. The FDA is expected to approve this stent for general use soon. 1


Pacilitexel is used to treat cancer and acts as an antiinflammatory agent, so it also works against the growth of abnormal blood cells at PTCA sites. Early results from this ongoing study look promising. 1



For years, healthcare providers have been treating hypertension with expensive medications-such as calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors-without focusing on the older medications such as diuretics. However, a recent study of various hypertension treatments found that a generic diuretic alone reduced blood pressure (BP) in a slightly greater number of patients, compared to those who received the other two medications. Because the generic diuretic is less expensive, the researchers recommend that, when appropriate for the patient, diuretics should be the first-line medication for hypertension. 2



In the future, primary care providers may order a C-reactive protein level with routine lab work in an effort to identify patients at a higher risk for CAD. 3


Recent research has shown that inflammation may lead to CAD development by weakening plaque buildup in the arterial walls, leading to thrombus formation. Determining the level of C-reactive protein in the blood can measure inflammation, but the test is not specific for CAD. Any chronic infection can produce C-reactive protein, and the protein's serum levels also are elevated in patients with hypertension, other inflammatory processes, and patients who smoke. A level 0.7 mg/dl is considered low-risk for heart disease; a level Patients can reduce their C-reactive protein level with a low-fat, low-cholesterol diet; exercise; smoking cessation; and certain medications such as cholesterol-lowering agents and aspirin. 3



Electron beam computed tomography (EBCT) is not new, but now it is being used to assess a patient's risk for CAD. Some studies have shown that EBCT can identify the risk before symptoms occur.


This technology provides a three-dimensional view of the heart and blood vessels and is much faster and clearer than a standard computed tomography scan. Although it should not be the only screening tool used for CAD, it is a valuable addition to the lineup. 4


The EBCT scan shows the amount of calcium present in the coronary arteries. Calcium normally appears in the arteries as a part of the aging process, and is one of the many components of plaque. The cardiologist assigns a numerical score to each artery, based on the location and amount of calcium found, and the total score determines the patient's risk category. For example, a patient with a score below 10 is at very low risk for CAD; a patient with a score of 11 to 100 is at mild to moderate risk; a patient with a score of 101-400 is at moderate to high risk; and a patient with a score over 400 is at a very high risk. 4


Although not as specific as cardiac catheterization for showing the degree of vessel blockage, EBCT has distinct advantages: It is noninvasive and takes just 10 minutes.


Stents coated with medication may be the latest weapon in our arsenal to treat coronary artery disease.




1. Bolin R. Hospital Clinical Trials Target Angioplasty. Business First. 2002; December 6. [Context Link]


2. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The antihypertensive and lipid-lowering treatment to prevent heart attack. Major outcomes in high-risk hypertensive patients randomized to angiotension-converting enzyme inhibitor or calcium channel blocker versus diuretic. JAMA. 2002; 288( 23):2981-2997. [Context Link]


3. Futterman L, Lemberg L. High-sensitivity C-reactive protein is the most effective prognostic measurement of acute coronary events. AJCC. 2002; 11( 5):482-486. [Context Link]


4. Ayers D. EBCT: Beaming in on coronary artery disease. Nurs2002. 2002; 32( 4):81. [Context Link]


Key word: Diagnosis