ACC 2011 research highlights: A slideshow presentation


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The American College of Cardiology (ACC) 2011 Scientific Sessions took place in New Orleans and key trials presented at the sessions include: PARTNER cohort A, PARTNER cohort B cost analysis, RIVAL, STICH, MAGELLAN, OSCAR, EVEREST II, PRECOMBAT, RESOLUTE, PLATINUM, ISAR CABG and EXCELLENT.

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ACC 2011 research highlights: A slideshow presentation

  1. 1. ACC 2011 research highlights:A slideshow presentation
  2. 2. ACC 2011 Research Highlights The American College of Cardiology (ACC) 2011 Scientific Sessions took place in New Orleans, LA, from April 2 through April 5, 2011. Key trials presented at the sessions include: PARTNER cohort A: Transcatheter valves noninferior to surgery PARTNER cohort B cost analysis: TAVI cost-effective treatment in surgery-ineligible patients RIVAL: Radial RIVALs femoral access for invasive ACS treatment, but doesnt beat it STICH: "Hypothesis one" results support CABG in HF patients despite missing primary end point STICH substudy: Viability testing didnt affect treatment outcomes MAGELLAN: Rivaroxaban prevents VTE in medical patients, but bleeding an issueOSCAR: Antihypertensive choice in elderly should be guided by underlying diseaseEVEREST II: MitraClip less effective but safer than surgeryPRECOMBAT: PCI noninferior to CABG for left main disease, but questions lingerRESOLUTE: New zotarolimus stent data flesh out efficacy, safetyPLATINUM: Novel everolimus-eluting stent noninferior to Xience V stentISAR CABG: Drug-eluting stents reduce repeat revascularization in saphenous vein graftsEXCELLENT: Some patients can stop DAPT after six months following drug-eluting-stent implantationView our complete ACC coverage here.
  3. 3. PARTNER (Placement of Aortic Transcatheter Valve Trial) cohort A Results: Transcatheter-valve implantation was just as good as surgery in surgery-eligible patients for the primary end point of mortality, but major strokes were higher in the TAVI-treated patients, both at 30 days and one year. In a combined end point of all stroke or transient ischemic attack (TIA), the difference between groups was statistically significant. "These results indicate that [transcatheter aortic-valve replacement] TAVR is an acceptable alternative to AVR in selected high-risk operable patients," concluded principal investigator Dr Craig Smith (Columbia University, New York, NY). "Future randomized studies should focus on lower-risk patients who are candidates for operation." See: PARTNER cohort A: Transcatheter valves noninferior to surgery
  4. 4. PARTNER (Placement of Aortic Transcatheter Valve Trial) cohort B:cost analysis Results: Transcatheter aortic-valve implantation is a cost- effective treatment strategy in surgery-ineligible patients with severe aortic disease, with incremental costs per life-year gained within commonly accepted ranges for other cardiovascular technologies, according to a cost-effectiveness analysis presented at the American College of Cardiology 2011 Scientific Sessions. "There is a lot of cost up front now to do this, with the facility, the team, all the imaging techniques that we need to have, so this is only going to be done in major centers that can assemble teams like this, once the device gets approved," said Dr Michael Crawford (University of California, San Francisco), who is not affiliated with the PARTNER trial. "Its hoped that as we gain experience with this technique, this up-front cost will actually go down and the cost-effectiveness will actually get better." See: TAVI cost-effective treatment in surgery-ineligible patients: PARTNER cohort B cost analysis
  5. 5. RIVAL (Radial vs Femoral Access for Coronary Intervention) trial Results: A head-to-head comparison of radial vs femoral access for the treatment of patients with acute coronary syndromes has shown that treatment via the radial artery did not reduce the rate of death, MI, stroke, or non-coronary artery bypass graft (CABG)-related major bleeding at 30 days. Transradial access, however, did result in a 63% reduction in the risk of large vascular-access complications. "Interventional cardiologists should feel reassured that both radial and femoral procedures are safe and effective in the current era," said lead investigator Dr Sanjit Jolly (McMaster University, Hamilton, ON). "The second take-home point is that experience and expertise do matter, and the more procedures you do the better you get. Clinicians and patients may decide, with similar PCI efficacy, to use radial access because of the lower rates of vascular complications." See: Radial RIVALs femoral access for invasive ACS treatment, but doesnt beat it
  6. 6. Spotlight on Health Information Technology he Health Information Technology (IT) Spotlight at the ACC 2011 Scientific Sessions took place on Sunday, April 3, 2011. The session focused on opportunities and challenges in launching an electronic health record (EHR). Highlights included: The James T Dove Lecture: Meaningful Use from the Perspective of the Office of the National Coordinator for Health IT Presented by Farzad Mostashari, Washington, DC Meaningful use: Eligible providers and hospital compliance Presented by James E Tcheng, Durham, NC Meaningful use: Electronic quality reporting Presented by Floyd Eisenberg, Washington, DC
  7. 7. STICH (Surgical Treatment for Ischemic Heart Failure) Results: The five-year results of a randomized comparison of medical therapy with or without bypass surgery for ischemic heart disease in patients with LV systolic dysfunction found that CABG did not beat medical therapy alone in the primary end point of all-cause death. There was, however, a slight advantage for CABG in cardiovascular-specific causes of death and in some of the composite secondary end points. "The take-home message for me is that the STICH trial supports bypass surgery on top of best medical therapy vs medical therapy alone to reduce cardiovascular morbidity and mortality and that many patients who are now treated for heart failure without ever being assessed for the potential of having angiographic coronary disease should be evaluated for that, because [coronary disease] does not present the same way in every patient," said Dr Eric Velazquez (Duke Clinical Research Institute, Durham, NC). See: Docs say STICH "hypothesis one" supports CABG in HF patients despite missing primary end point
  8. 8. STICH (Surgical Treatment for Ischemic Heart Failure):Viability substudy Results: A substudy of STICH found that: overall, substantial viable myocardium evident at baseline imaging had no independent bearing on all-cause mortality over five years; and such viability didnt influence the relative effectiveness of the two treatment strategies, either for all-cause mortality or the secondary end points of CV mortality and CV hospitalization. During a press conference on the STICH presentations, interventionalist Dr Ted Feldman (Evanston Hospital, IL), who was not connected with the trial, said: "I dont take away from this [study] that viability testing doesnt help. What I take away is, if theres viability, I really want to be sure to revascularize. But prior to seeing these results, I was inclined to say if there isnt viability, [do not] revascularize. And the results of the trial challenge that historic bias." See: STICH substudy: Viability testing didnt affect treatment outcomes
  9. 9. MAGELLAN (Venous Thromboembolic Event [VTE]Prophylaxis in Medically Ill Patients) Results: Taking the new oral anticoagulant rivaroxaban (Xarelto, Bayer/Johnson & Johnson) once daily for 35 days was associated with a reduction in the risk of venous thrombosis, compared with standard 10-day treatment with enoxaparin (Lovenox, Sanofi-Aventis) by subcutaneous injection, in acutely ill medical patients. But bleeding rates were significantly increased with rivaroxaban, and the new factor Xa inhibitor did not show a net clinical benefit across the whole population. "The drug has been shown to be noninferior to standard treatments in other settings, and this was what was seen in the first part of this trial. Also, since the extended-treatment arm compared the drug with placebo, it is not surprising that bleeding complications were increased. A better comparison would have been to extend treatment with enoxaparin or warfarin," said Dr Roy Silverstein (Cleveland Clinic, OH). See: MAGELLAN: Rivaroxaban prevents VTE in medical patients, but bleeding an issue
  10. 10. Poster sessions The Best Fellows-in-Training Poster Awards included: Heterogeneous upregulation of apamin-sensitive currents (IKAS) in failing human ventricles. Po-Cheng Chang et al, Indiana University School of Medicine, Indianapolis, IN Is the gender-specific risk of ischemic stroke in atrial fibrillation related to differences in anticoagulation? Renee Sullivan et al, University of Iowa Hospitals and Clinics, and University of Birmingham, UK Enhanced external counter pulsation improves endothelial function, inflammatory markers and depression. Deepak Hooda et al, West Virginia University Heart Institute, Morgantown, WVMolecular Imaging demonstrates ID3 modulates B lymphocyte homing to atherosclerosis-prone regions of the aorta.Michael Lipinski et al, University of Virginia Health System, Charlottesville, VAUse Of 320-detector computed-tomography coronary angiography for evaluating patients with chest pain in the emergency department:Impact on duration of stay and coronary artery disease detection.David E Winchester et al, University of Florida, GainesvilleReverse-use dependence of antiarrhythmic drugs: Role of late sodium current.Chinmay Patel et al, Lankenau Medical Center and Lankenau Institute of Medical Research, Wynnewood, PAInfluence of myocardial ischemia on outcomes in patients with systolic versus nonsystolic heart failure.Thomas E Vanhecke et al, William Beaumont Hospital, Royal Oak, MIThe correlation of fragmented QRS complexes on 12-lead ECG and myocardial infarct size determined by cardiac magnetic resonanceimaging.Waddah Maskoun et al, Medical College of Wisconsin, Milwaukee, and Northwestern University Feinberg School of Medicine, Chicago, IL
  11. 11. OSCAR (Olmesartan and Calcium AntagonistsRandomized Study) Results: Treating elderly hypertensive patients with a combination of an angiotensin receptor blocker (ARB) and a calcium antagonist is better at reducing BP than using a high (double) dose of an ARB alone, particularly if they have CV disease, according to a new study. "The OSCAR study provides the first evidence showing that a standard dose of ARB plus CCB combination is superior to high-dose ARB in reducing adverse events in elderly hypertensive patients with cardiovascular disease," said study investigator Dr Hisao Ogawa (Kumamoto University, Japan). See: OSCAR: Antihypertensive choice in elderly should be guided by underlying disease
  12. 12. EVEREST II (Pivotal Study of a Percutaneous Mitral ValveRepair System) Results: One- and two-year results show that percutaneous repair of the mitral valve with the MitraClip (Abbott) device was significantly less effective at reducing mitral regurgitation than surgery, but the procedure was associated with superior safety and similar improvements in clinical outcomes."It looks as though the MitraClip might be an alternative strategy for reducing regurgitation in older people with lots ofcomorbidities who are not good candidates for surgery. With the two-year data we have just seen, I would say the clip isfine for an 80-year-old with heart failure, but a younger patient needs a 20-year fix, and we get this from surgery," said DrRobert Bonow (Northwestern University, Chicago, IL). "We dont know if we get this from the clip. Perhaps patients cantolerate low levels of regurgitation long term. Perhaps not."See: Latest from EVEREST II: MitraClip less effective but safer than surgery
  13. 13. PRECOMBAT (Premier of Randomized Comparison of Bypass Surgery versus AngioplastyUsing Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) Results: Either PCI using a sirolimus-eluting stent or coronary artery bypass graft (CABG) surgery for unprotected left main coronary artery stenosis yield similar rates of major adverse cardiac or cerebrovascular events at one year, although study investigators acknowledge that the study was underpowered as a result of unexpectedly low event rates. "Overall, this trial is a modest advance on what we already recognize from the existing—and limited—randomized data and, more broadly, the observational data of left main PCI," said Dr David Kandzari (Piedmont Heart Institute, Atlanta, GA). "That is, we have a remarkable consistency across trials of equipoise with regard to the so-called hard end points—death, myocardial infarction, and stroke—and at the same time we have seemingly consistent data showing that with existing drug- eluting stents, at least first-generation drug-eluting stents, repeat revascularization is still higher when compared with bypass surgery." See: PRECOMBAT: PCI noninferior to CABG for left main disease, but questions linger
  14. 14. Real World Cases in Sports Cardiology The Clinical Cardiology Spotlight at the ACC 2011 Scientific Sessions focused on "Real-World Cases in Sports Cardiology." Four cases were presented: Case I: Abnormal ECG in a 17-year old from the major league soccer screening program Presented by Ira Smith, Toronto, ON Case II: Adolescent athlete with exertional syncope/chest pain Presented by Wayne J Franklin, Houston, TX Case III: Collegiate athlete with ICD Presented by Renee Sullivan, Iowa City, IA Case IV: 20-Yyar-old with aortic disease wants to continue to swim at NCAA level Presented by Sandeep Mangalmurti, Chicago, IL Spotlight panelists included: Christine Lawless, Chicago, IL; Rachel Lampert, New Haven, CT; Barry Maron, Minneapolis, MN; Luigi Padeletti, Florence, Italy; Paul Thompson, Hartford, CT; and Jeffrey Towbin, Cincinnati, OH.
  15. 15. RESOLUTE RESOLUTE US Results: The single-arm study shows the new Resolute stent to yield lower rates of restenosis at one year than historical controls made up of studies testing the predecessor stent, Endeavor, also made by Medtronic. RESOLUTE AC Results: At two years, rates of "patient-related outcomes" and "stent-related outcomes" were no different between patients randomized to the Resolute or to the Xience everolimus-eluting stent, nor were rates of any major clinical events different between the two groups. Stent-thrombosis rates at one year were reportedly higher for Resolute stent than for the Xience. "No matter how you look at these data, from effectiveness or safety, theyre very, very strong. Theyre as good as weve seen with a next-generation drug-eluting stent, and its also a platform that physicians like using; they like using the driver platform," said Dr Martin Leon (Columbia University, New York, NY). See: New Resolute zotarolimus stent data flesh out efficacy, safety
  16. 16. PLATINUM (Clinical Trial to Assess the PROMUS Element StentSystem for Treatment of De Novo Coronary Artery Lesions) Results: A novel everolimus-eluting stent containing a new metallic alloy, platinum, as part of a modified design has been shown to be noninferior to the widely used Xience V stent (Abbott Vascular)—also known as Promus (Boston Scientific)— in a pivotal trial presented during a late-breaking clinical-trials session at the American College of Cardiology 2011 Scientific Sessions. "Our procedures continue to get safer; our equipment and devices are getting better. New stents will have to be as safe as approved devices, and when it comes to deciding which stent is better than another, it will come down to nuanced aspects, and these dont come to light until you are using these devices in lots and lots of people, not in these small trials designed for regulatory approval. This is the sort of information you get from large registries and from feedback from operators," said Dr Edward J McNulty (University of California, San Francisco). See: Everolimus-eluting stent performs well in PLATINUM
  17. 17. ISAR CABG (Is Drug-Eluting Stenting Associated With ImprovedResults in Coronary Artery Bypass Grafts) Results: Drug-eluting stents (DES) reduced repeat revascularization compared with bare-metal stents in saphenous vein grafts (SVGs) for high-risk patients with at least one lesion in a previously implanted saphenous vein bypass graft. The ISAR-CABG trial was designed to compare DES and bare- metal stents in SVGs with a large enough study population to provide information on clinical end points, explained study investigator Dr Julinda Mehilli (Technische Universität Munich, Germany). Although many interventionalists already use DES in SVGs, most drug-eluting-stent trials have excluded SVGs, and the only two previous randomized trials of comparing DES and bare-metal stents in SVGs were very small and produced conflicting mortality results, said Mehilli. See: ISAR CABG: Drug-eluting stents reduce repeat revascularization in saphenous vein grafts
  18. 18. EXCELLENT (Efficacy of Xience/Promus Versus Cypher in ReducingLate Loss After Stenting) Results: Patients with coronary artery disease were randomized to dual antiplatelet therapy for six months or dual antiplatelet therapy for one year. Regarding the primary end point of target vessel failure (TVF), a composite of cardiac death, MI, or target vessel revascularization at 12 months, investigators observed no statistically significant difference between those treated for six months and those treated with for one year, suggesting that some patients can stop clopidogrel after just six months following drug-eluting-stent implantation. "The take-home message from our study is that, at least in low- risk, nondiabetic patients treated with second-generation drug- eluting stents, we can safely discontinue clopidogrel at about six months, especially if the patient is at high risk for bleeding or is anticipating some surgery," said lead investigator Dr Hyeon- Cheol Gwon (Sungkyunkwan University School of Medicine, Seoul, Korea) during a morning press conference announcing the results. See: EXCELLENT results for stopping DAPT at six months, but others say bigger trials are needed
  19. 19. Opinions and review Cutting-edge dialogues with Drs Tim Gardner and Mat Williams Surgeons and interventionalists partner to ensure best care Heart failure and transplantation with Dr Ileana Piña STICH: Focusing on the "crossover" patients Private practice with Dr Seth Bilazarian Shaking up the DES arena with safer, more efficacious newcomers Radial didnt beat its rival PARTNER A: Evaluating "important but different hazards" Clotblog with Dr Samuel Goldhaber MAGELLAN trial passes "proof-of-principle" test Trials and PIs Rivaroxaban vs enoxaparin for the Prevention of VenousHeartfelt with Dr Melissa Walton-Shirley Thromboembolism in Acutely Ill Medical Patients with...MAGELLAN on VTE, EXCELLENT on antiplatelets and OSCAR on PROTECTION-AMI with Dr Michael Lincoffantihypertensives NAGOYA HEART Study with Dr MuroharaSTICH, EVEREST, RIVAL, and top interventional trials from ACC 2011 EXCELLENT with Dr Hyeon-Cheol GwonTAVI vs surgery: Mortality data and cost-effectiveness in PARTNER A PRECOMBAT with Dr Seung-Jung Parkand B Surgical Treatment for Ischemic Heart Failure Trial with Dr RobertDiscussing science, anecdote, and opinion: Up in arms after RIVAL? BonowACC Day 1: Dr Ralph Brindis and the doctrine of cardiovascular EVEREST II: Two-year outcomes with Dr Ted Feldman TAVI vs SAVR in PARTNER with Dr Craig Smithecumenism RIVAL with DrSanjit JollyThis week in cardiology from heartwire REMEDIAL II with Dr Carlo Briguori#84: TAVI matches surgery in PARTNER cohort A; PARTNER B cost- Surgical Treatment of Ischemic Heart Failure Trial with Dr Ericeffectiveness; MAGELLAN on rivaroxaban in... Velazquez#83: Hot topics at ACC 2011; noninvasive CV imaging for subclinical RAPS with Dr Stephen Fremesdisease; Elizabeth Taylor and... PARTNER (cohort B) with Dr Matthew Reynolds
  20. 20. For more information ACC Scientific Sessions ACC 2011 coverage on ACC 2011 on Medscape
  21. 21. Credits and disclosures Editor: Shelley Wood Managing Editor, heartwire Kelowna, BC Disclosure: Shelley Wood has disclosed no relevant financial relationships. Contributor: Steven Rourke Manager, Editorial Programming Montreal, QC Disclosure: Steven Rourke has disclosed no relevant financial relationships.Journalists:Lisa Nainggolan, Michael ORiordan, theheart.orgLondon, UK Toronto, ONDisclosure: Lisa Nainggolan has disclosed no relevant financial Disclosure: Michael ORiordan has disclosed no relevant financialrelationships. relationships.Sue Hughes, Steve Stiles, theheart.orgLondon, UK Fremont, CADisclosure: Sue Hughes has disclosed no relevant financial relationships. Disclosure: Steve Stiles has disclosed no relevant financialReed Miller, theheart.orgBethesda, MDDisclosure: Reed Miller has disclosed no relevant financial relationships.
  22. 22. More slideshows AHA 2010 research highlights: A slideshow presentation TCT 2010 research highlights: A slideshow presentation ESC 2010 research highlights: A slideshow presentation
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