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This Week in JAMA
JAMA. 2005;294:1179.
JAMA-EXPRESS
Paclitaxel-Eluting Stents in Complex Coronary Lesions
Most prior studies documenting a reduced restenosis rate with drug-eluting vs bare metal stents have enrolled patients with relatively simple coronary lesions. In this issue of JAMA, Stone and colleagues (SEE ARTICLE) report results of a clinical trial in which the safety and efficacy of paclitaxel-eluting stents vs bare metal stents were assessed in patients with complex lesions. They found that patients receiving paclitaxel-eluting stents had a lower risk of target vessel and target lesion revascularization in 9 months’ follow-up. In an editorial, Colombo and Cosgrave (SEE ARTICLE) discuss these results in the context of other trials of drug-eluting stents for complex lesions.
JAMA-EXPRESS
Clopidogrel Before PCI in ST-Elevation MI
Sabatine and colleagues (SEE ARTICLE) report results from the randomized placebo-controlled PCI-Clopidogrel as Adjunctive Reperfusion Therapy (PCI-CLARITY) study, which assessed whether clopidogrel pretreatment—2 to 8 days—before percutaneous coronary intervention (PCI) in patients with recent ST-segment elevation myocardial infarction is superior to clopidogrel treatment at the time of PCI in preventing major adverse cardiovascular events. They found that clopidogrel pretreatment significantly reduced the incidence of cardiovascular death or ischemic complications both before and after PCI. In an editorial, Moliterno and Steinhubl (SEE ARTICLE) discuss the implications of these results for patient care.
High-Dose Radiation Therapy in Prostate Cancer
Disease recurrence is common among patients with localized prostate cancer who receive radiation therapy. In a randomized trial to test whether increasing the radiation dose from 70.2 Gy (conventional) to 79.2 Gy (high-dose) would improve outcomes, Zeitman and colleagues (SEE ARTICLE) found that high-dose radiation was associated with a 49% lower risk of biochemical evidence of treatment failure, reflected in increasing prostate-specific antigen levels. In an editorial, DeWeese and Song (SEE ARTICLE) discuss the risks and benefits of radiation dose escalation for localized low-risk and high-risk prostate cancer.
Risk-Treatment Mismatch in Heart Failure Therapy
Treatment with angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and  -adrenoreceptor antagonists are strongly associated with reduced morbidity and mortality from heart failure, but whether patients at highest risk of adverse outcomes are prescribed these agents is not clear. Lee and colleagues evaluated administration rates for these medications at hospital discharge and for 90 days after discharge in 9942 patients predicted to be at low, intermediate, and high risk of death from heart failure within 1 year. They found an inverse relationship between prescription rates and predicted and observed risks of death in patients with heart failure.
(SEE ARTICLE)
Insurance and Access to Urgent Ambulatory Care
Patients are often discharged from emergency departments with serious conditions requiring urgent follow-up. Asplin and colleagues explored the association of timely ambulatory follow-up with insurance status by having graduate students pose as new patients—with and without insurance—in calls to ambulatory care clinics in 9 cities. Timely appointments were secured by 64.4% of callers claiming to have private insurance, 34.2% having Medicaid, 25.1% uninsured and a cash limit of $20, and 62.8% uninsured with unlimited cash.
(SEE ARTICLE)
Medical News & Perspectives
Because physicians die by suicide more frequently than nonphysicians, experts are recommending addressing factors in the profession that can deter physicians with psychiatric conditions from seeking help.
(SEE ARTICLE)
Causes of Death
Trends in death rates and number of deaths, 1970 to 2002, from leading causes of death in the United States.
(SEE ARTICLE)
CLINICIAN’S CORNER
Tumor-Induced Osteomalacia
Grand Rounds
Clinical characteristics, diagnostic evaluation, pathophysiology, and treatment of tumor-induced osteomalacia.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about radiation therapy.
(SEE ARTICLE)
NEXT WEEK
JAMA Theme Issue
Medical Research: State of the Science
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