The European Society of Cardiology (ESC) 2012 Congress took place in Munich, Germany from August 25 through August 29, 2012. Key trials presented at the sessions include: WOEST, ALTITUDE, FAME II, TRILOGY ACS, ACCESS EU,PURE, GARY. IABP SHOCK II, PARAMOUNT and DeFACTO
TCT 2012 research highlights: A slideshow presentationtheheart.org
TCT 2012 took place in Miami, FL, on October 22-26. Key trials and presentations at the sessions included: PFO Closure, RESPECT, PC Trial, FAME II, ADVANCE, TAVR, TRILOGY-ACS, Live cases, DESSOLVE I and II, SES PARTNER B, MASTER, Career Achievement Award, ADAPT-DES, STEMI-RADIAL and POST
ACC 2011 research highlights: A slideshow presentation theheart.org
http://www.theheart.org/editorial-program/1210493.do
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.
AHA 2010 research highlights: A slideshow presentation theheart.org
http://www.theheart.org/editorial-program/1156073.do
The American Heart Association (AHA) 2010 Scientific Sessions took place in Chicago. Key trials presented at the sessions include: ADVANCE,RAFT,QRS EMPHASIS-HF,ASCEND HF,ROCKET AF,CLOSURE I,GRAVITAS,P-OM3,BASKET-PROVE,DEFINE,SYMPLICITY HTN,ASCOT CRP and ACT.
TCT 2012 research highlights: A slideshow presentationtheheart.org
TCT 2012 took place in Miami, FL, on October 22-26. Key trials and presentations at the sessions included: PFO Closure, RESPECT, PC Trial, FAME II, ADVANCE, TAVR, TRILOGY-ACS, Live cases, DESSOLVE I and II, SES PARTNER B, MASTER, Career Achievement Award, ADAPT-DES, STEMI-RADIAL and POST
ACC 2011 research highlights: A slideshow presentation theheart.org
http://www.theheart.org/editorial-program/1210493.do
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.
AHA 2010 research highlights: A slideshow presentation theheart.org
http://www.theheart.org/editorial-program/1156073.do
The American Heart Association (AHA) 2010 Scientific Sessions took place in Chicago. Key trials presented at the sessions include: ADVANCE,RAFT,QRS EMPHASIS-HF,ASCEND HF,ROCKET AF,CLOSURE I,GRAVITAS,P-OM3,BASKET-PROVE,DEFINE,SYMPLICITY HTN,ASCOT CRP and ACT.
The American Heart Association (AHA) 2012 Scientific Sessions took place in Los Angeles, CA on November 3-7, 2012. Key trials presented at the sessions include: FREEDOM, TACT, UMPIRE, PHS II, OPERA and FORWARD, ASPIRE, TRILOGY ACS/ARCTIC, MADIT-RIT, RELAX-AHF, POSEIDON / SCIPIO, PCSK9 studies, PCSK9, dal-OUTCOMES andLoDoCo.
Coronary artery bypass grafting with adjunctive
endarterectomy: A mandatory procedure in complex
revascularizations. current results and postoperative
considerations
Presentación "Manejo de la antiagregación ajustada a las pruebas de reactividad plaquetaria. Experiencia, Resultados y futuro de un programa nacional" del Dr. Daniel Aradi durante la Mesa Redonda de Antiagregación de la XXV Reunión Anual de la Sección de Hemodinámica y Cardiología Intervencionista (SHCI) de 2014 en Córdoba.
The American Heart Association (AHA) 2012 Scientific Sessions took place in Los Angeles, CA on November 3-7, 2012. Key trials presented at the sessions include: FREEDOM, TACT, UMPIRE, PHS II, OPERA and FORWARD, ASPIRE, TRILOGY ACS/ARCTIC, MADIT-RIT, RELAX-AHF, POSEIDON / SCIPIO, PCSK9 studies, PCSK9, dal-OUTCOMES andLoDoCo.
Coronary artery bypass grafting with adjunctive
endarterectomy: A mandatory procedure in complex
revascularizations. current results and postoperative
considerations
Presentación "Manejo de la antiagregación ajustada a las pruebas de reactividad plaquetaria. Experiencia, Resultados y futuro de un programa nacional" del Dr. Daniel Aradi durante la Mesa Redonda de Antiagregación de la XXV Reunión Anual de la Sección de Hemodinámica y Cardiología Intervencionista (SHCI) de 2014 en Córdoba.
http://www.theheart.org/web_slides/1225341.do
The first randomized trial on Endovascular Valve Edge-to-Edge Repair (EVEREST) to compare outcomes with MitraClip vs surgery
Percutaneous Coronary Intervention [PCI] has been a revolutionary advance in cardiology, and many lives have been saved as a result of the widespread application of primary PCI. However, elective PCI has not yet been proven to save lives or reduce the risk of myocardial infarction. Despite this lack of
evidence, elective PCI has been misused and in some cases, abused for nonmedical reasons. The considerable cost of elective PCI can be reduced, and the resources could potentially be utilized for better public health outcomes. The following.article intends to highlight the lack of evidence supporting the use of elective PCI, which is a problem not only in North America and Europe but also throughout the world.
Better regulation of the elective PCI procedure could reduce health care expenditures and divert resources to cardiovascular disease prevention.
Invasive coronary physiology to select patients for coronary revascularisation has become established in contemporary guidelines for the management of stable coronary artery disease. Compared to revascularisation based on angiography alone, the use of coronary physiology has been shown to improve clinical outcomes and cost efficiency. However, recent data from randomised controlled trials have cast doubt upon
the value of ischaemia testing to select patients for revascularisation. Importantly, 20-40% of patients have
persistence or recurrence of angina after angiographically successful percutaneous coronary intervention
(PCI). This state-of-the-art review is focused on the transitioning role of invasive coronary physiology from
its use as a dichotomous test for ischaemia with fixed cut-points, towards its utility for real-time guidance of PCI to optimise physiological results. We summarise the contemporary evidence base for ischaemia testing
in stable coronary artery disease, examine emerging indices which allow advanced physiological guidance
of PCI, and discuss the rationale and evidence base for post-PCI physiological assessments to assess the success of revascularisation.
TCT 2010 research highlights: A slideshow presentation theheart.org
http://www.theheart.org/editorial-program/1128553.do
The 22nd annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium took place in Washington. Key trials presented at the meeting include: PARTNER, ZILVER PTX, ISAR-TEST 4,SORT-OUT 4, COMPARE,SPIRIT IV, HORIZONS-AMI, BIOFREEDOM, PROTECT-AF, CAP and Robotically assisted PCI
ONTARGET trial - Summary & Results with Ramipril Global Endpointtheheart.org
A study to test whether an ARB (which blocks the effects of angiotensin II without enhancing bradykinin) was similarly effective to an ACE inhibitor and whether the combination of an ACE inhibitor and an ARB may be superior
OASIS-6 trial - Summary & Results at ACCtheheart.org
http://www.theheart.org/web_slides/1136801.do
A randomized, placebo study using patients with STEMI exposed to fondaparinux or to usual care-placebo. The Sixth Organization to Assess Strategies in Acute Ischemic Syndromes.
http://www.theheart.org/web_slides/1136565.do
A prospective,randomized, open-label, blinded-end-point evaluation trial on incremental decrease in endpoints through aggressive lipid lowering (IDEAL) using patients with a history of acute MI
http://www.theheart.org/web_slides/1283911.do
A survey of 153,996 adults on prospective urban rural epidemiology (PURE) to examine the relationship of societal influences on human lifestyle behaviors, CV risk factors, and incidence of chronic non communicable diseases
http://www.theheart.org/web_slides/1146197.do
A randomized study,on action to control cardiovascular risk in diabetes and blood-pressure-lowering arm (ACCORD BP) in a nonblinded fashion, to intensive BP-lowering
http://www.theheart.org/web_slides/1186083.do
A randomized study on Acetylcysteine for Contrast-Induced Nephropathy Trial (ACT) with patients undergoing an angiographic procedure.
http://www.theheart.org/web_slides/1144191.do
A randomized to prasugrel or clopidogrel study on TRITON-TIMI 38 with patients who have moderate- to high-risk ACS.
http://www.theheart.org/web_slides/1425587.do
A randomized to placebo or ivabradine study on Systolic Heart Failure Treatment with the If Inhibitor Ivabradine (SHIFT) with patients on standard HF medications according to guidelines
http://www.theheart.org/web_slides/1146285.do
A prospective randomized trial on Embolic Protection in Patients with Atrial Fibrillation (PROTECT-AF) comparing closure of the LAA* (with the Watchman occluder) with long-term warfarin therapy
http://www.theheart.org/web_slides/1242353.do
An analysis based on an Italian registry of 308 patients with Brugada syndrome who underwent programmed electrical stimulation (PES) studies according to one consistent protocol (unlike earlier multicenter studies that were based on varying PES protocols)
http://www.theheart.org/web_slides/1242347.do
A trial on ALTITUDE to evaluate mortality after device implantation or after shock therapy in large numbers of patients with implanted devices
http://www.theheart.org/web_slides/1225253.do
A PRECOMBAT trial Premier of randomized comparison of bypass surgery vs angioplasty using sirolimus-eluting stent in patients with left main coronary artery disease
http://www.theheart.org/web_slides/1225165.do
A randomized study on Olmesartan and Calcium Antagonists Randomized (OSCAR) using high-dose of olmesartan or standard dose calcium-channel blocker (CCB) (amlodipine or azelnidipine) with patients with uncontrolled hypertension
http://www.theheart.org/web_slides/1225049.do
A randomized double-blind, double-dummy trial on MAGELLAN (VTE Prophylaxis in Medically Ill Patients) to show noninferiority of rivaroxaban to enoxaparin at 10 days and superiority at 35 days
http://www.theheart.org/web_slides/1135591.do
A randomized study on Cardiac Resynchronization - Heart Failure with NYHA class 3-4 HF despite standard drug therapy, an LVEF and QRS.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. ESC 2012 Research Highlights
he European Society of Cardiology (ESC) 2012 Congress
took place in Munich, Germany from August 25 through August
29, 2012.
Key trials presented at the sessions include:
WOEST: Drop aspirin in stent patients on oral anticoagulants
ALTITUDE: Details on why the trial was stopped, including the
role of ischemic stroke
FAME II: FFR-guided PCI reduces urgent reinterventions, but
does not change mortality, MI
TRILOGY ACS: No win for prasugrel in high-risk patients with
ACS who are medically managed without revascularization
ACCESS EU: Encouraging registry data on the MitraClip
PURE: Healthy lifestyle factors and diet linked with income
GARY: TAVI in-hospital death, stroke rates stay low even as
use climbs
IABP SHOCK II: No survival benefit of balloon pump in AMI
with shock
PARAMOUNT: Dual-action agent shows promise in preserved-
EF heart failure
DeFACTO: Results encouraging for "virtual" FFR despite
missing target
3. WOEST
Drop aspirin in stent patients on oral anticoagulants
Results: Patients on oral anticoagulant therapy undergoing stenting
should be treated with clopidogrel but not aspirin, according to
results reported at the ESC 2012. The study showed a large
reduction in overall TIMI bleeding in patients receiving dual therapy
with oral anticoagulants and clopidogrel compared with those
receiving triple therapy including aspirin. And efficacy did not seem to
be compromised. If anything, there appeared to be lower rates of
ischemic events and a significant reduction in all-cause mortality.
"This is a huge deal," said Dr David Holmes (Mayo Clinic,
Rochester, MN). "How to treat AF patients undergoing stenting is a
huge clinical problem. These results have incredibly important clinical
implications. They are going to change guidelines overnight."
See: WOEST: Drop aspirin in stent patients on oral anticoagulants
4. ALTITUDE
Increase in ischemic stroke played role in decision to stop trial
Results: New data from the trial with the direct renin inhibitor
aliskiren (Tekturna, Novartis) in diabetic patients were released at
the ESC 2012, shedding more light on why the trial was halted
prematurely. The trial, which was studying the effects of aliskiren on
top of ACE-inhibitor or angiotensin-receptor-blocker (ARB) therapy in
diabetic patients with renal disease (glomerular filtration rate <60
mL/min per 1.73 m2 or microalbuminuria), was stopped late last year
by the data and safety monitoring board. The reason given was no
apparent benefit and an increase in adverse events, including
nonfatal stroke, renal complications, hyperkalemia, and hypotension.
Dr Hans-Henrik Parving (University of Copenhagen, Denmark) said
an increase in ischemic stroke was "prominent" in the decision to stop
the trial. At the time the decision was made, the increase in stroke
was significant in the aliskiren group, but as more data have come in,
this finding is no longer statistically significant, although they still
show a strong signal.
"There was a 25% relative increase in stroke risk in the aliskiren group, which is a warning signal that there could be harm
here, but it could also be a chance finding," said Parving. He stressed that an increased risk of stroke is converse to what
would be expected with a drug that lowers blood pressure and has not been seen in any studies of the drug in
hypertension. "It is a very peculiar finding. It is certainly unique to have a blood-pressure–lowering medication that
increases stroke risk."
See: ALTITUDE: New data on why trial halted
5. FAME II
FFR-guided PCI reduces urgent reinterventions, but does
not change mortality, MI
Results: Stable patients who got a stent to treat a functionally
significant coronary lesion were less likely to need an urgent
reintervention than those treated with medical therapy alone.
However, all the other outcomes, including mortality, were the
same with either therapy, so the significance of the trial's
findings remains controversial. The trial was stopped last
winter—over the objections of some outside observers—after
an interim analysis clearly showed that patients randomized to
PCI were much less likely to need an urgent revascularization
than patients randomized to optimal medical therapy.
Although FAME II did not show any mortality or MI benefit for PCI among stable coronary disease patients, the difference
in the need for urgent revascularizations is an important benefit, insists lead investigator Dr Bernard De Bruyne (OLV
Clinic, Aalst, Belgium). All of the urgent revascularizations were performed in patients fulfilling the criteria for acute
coronary syndrome, either with acute MI, ECG evidence of ischemia, or clear unstable angina. De Bruyne also pointed out
that a landmark analysis showed that PCI patients were more likely to die or have an MI than the medical-therapy-only
patients within the first week after randomization, but this trend reversed after eight days, "suggesting that over time, we
might witness the emergence of a significant difference."
See: FAME II: FFR-guided PCI reduces urgent reinterventions, but not change mortality, MI
6. TRILOGY ACS
No win for prasugrel (over clopidogrel) in high-risk patients
with ACS who are medically managed without
revascularization
Results: In one of the few studies to focus on high-risk patients
with acute coronary syndrome (ACS) who are medically
managed without revascularization, the newer antiplatelet agent
prasugrel (Effient, Lilly/Daiichi-Sanyo) has failed to show a
reduction in major cardiovascular events compared with
clopidogrel.
"This trial does not suggest a priori that prasugrel should be
used for medically managed patients, because the results are
neutral," said senior author Dr Magnus Ohman (Duke Clinical
Research Institute). But, he says, there was a surprising twist.
The study was a median of 17 months in length, longer than
most previous trials in ACS, he noted, and "the most striking
thing is that there appears to be a time-dependent treatment
effect."
See: No win for prasugrel in TRILOGY ACS
7. ACCESS EU
Encouraging registry data on MitraClip
Results: Encouraging new results with the MitraClip (Abbott,
Abbott Park, IL) in patients with mitral regurgitation who are
unsuitable for surgery have been presented from the largest
registry yet with the product. The new data come from the
ACCESS-EU registry, which included 567 patients from four
European countries (Denmark, Switzerland, Italy, and
Germany). There was a high implant success rate (99.6%), low
rate of procedural events, and meaningful improvements in
NYHA class, MR grade, quality of life, and walking distance
reported in this elderly, symptomatic, high-risk population with
multiple comorbidities.
"In expert hands, MitraClip is feasible and has an acceptable procedural risk in patients with comorbidities, but the word
'expert' needs to be reiterated," said designated discussant of the study Dr Simon Ray (Academic Health Science Centre,
Manchester, UK). He stressed that the procedure should be done only to improve symptoms. "There is no evidence that it
improves mortality, and there is no point improving MR grade if there is no symptomatic improvement. And as 25% to 35%
of patients derive little or no symptomatic benefit, patient selection is a key issue."
See: ACCESS EU: Encouraging registry data on MitraClip
8. PURE
Healthy lifestyle factors and diet linked with income
Results: In this newest analysis, energy from total fat, saturated fats,
and protein increased almost linearly with increasing incomes.
Carbohydrate intake, on the other hand, made up approximately 65%
of energy from diets in poor nations, with the percentage declining in
wealthier nations. The consumption of fruits and vegetables
increased among nations with a higher gross domestic product (GDP)
and wealth index, but this was offset by an increase in the amount of
energy obtained from total and saturated fats, as well as from protein.
In terms of physical activity, the researchers observed that the
amount of recreational physical activity increased with increasing
GDP and wealth, but this increase was offset by a reduction in the
amount of obligatory physical activity, such as activity required for
physical labor. Overall, the net result was a reduction of
approximately 2000 METS/minute/week, or 2.7 hours of brisk walking
every day, among countries with higher incomes.
Dr Salim Yusuf (McMaster University, Hamilton, ON), the lead researcher of the PURE study, said the study, which
describes an "epidemiological transition," might help shift global food policies so that countries subsidize the production of
fruits and vegetables rather than meat and dairy. In addition, the study highlights an insufficient policy approach when it
comes to increasing physical-activity levels.
See: Healthy lifestyle factors and diet linked with income: PURE
9. GARY
TAVI in-hospital death, stroke rates stay low even as use climbs
Results: Data collected in 2011 for the German Aortic Valve Registry (GARY) suggest that several forms of
transcatheter aortic-valve implantation (TAVI) were being used primarily in high-risk patients, just as the guidelines
recommend, researchers concluded at ESC 2012.
Although the in-hospital rate of cerebrovascular events was lowest for conventional surgery in absolute terms, it wasn't
significantly higher in the TAVI groups and stayed fairly low for those patients, "in the 3.5% range," said Dr Christian W
Hamm (Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany). Nor was the risk significant between the two main
categories of TAVI based on the catheter approach, transfemoral and transapical.
See: GARY: TAVI in-hospital death, stroke rates stay low even as use climbs
10. IABP SHOCK II
No survival benefit of balloon pump in AMI with shock
Results: Use of an intra-aortic balloon pump (IABP) offered no
mortality benefits at 30 days in the 600-patient IABP SHOCK II trial,
according the trial results presented in a hot-line session at ESC
2012. While use of the pump may make PCI safer by improving left
ventricular unloading, this did not translate into any survival benefit or
give a boost to any of the secondary end points in the study,
investigators observed.
"We were really surprised by the results," said Dr Holger Thiele
(University of Leipzig, Germany). "We thought we'd at least find
something positive in the secondary end points. Our assumption was
that the trial would be positive, but we have to live with the results.
That's why we need randomized trials."
See: IABP SHOCK II: No survival benefit of balloon pump in AMI with
shock
11. PARAMOUNT
Dual-action agent shows promise in preserved-EF heart
failure
Results: In a randomized comparison, in a phase 2 study of the
angiotensin-receptor/neprilysin inhibitor (ARNI) LCZ696
(Novartis) vs the angiotensin-receptor blocker (ARB) valsartan,
levels of a heart-failure severity biomarker dropped significantly
in patients with heart failure and preserved ejection fraction
(HF-PEF) who received the newer agent for 12 weeks,
compared with those who received the ARB. Systolic blood
pressure fell significantly more in patients receiving LCZ696.
And the drug was associated with significant improvements in
left atrial size and volume and in NYHA functional class at 36
weeks.
"LCZ696 was effective for the primary [natriuretic-peptide] end point in every single one of the subgroups tested," said
lead investigator, Dr Scott D Solomon (Brigham and Women's Hospital, Boston, MA). The subgroup analysis broke
patients out by age, normal vs elevated systolic blood pressure, low vs preserved left ventricular ejection fraction, with vs
without atrial fibrillation or poor renal function, and with vs without a prior HF admission. "But there was one subgroup in
which [LCZ696] was more effective." There was a significant interaction in patients with diabetes, added Solomon. "It
appeared to be even more efficacious in that subgroup, even though it was effective in every subgroup."
See: PARAMOUNT phase 2 study: Dual-action agent shows promise in preserved-EF heart failure
12. New European STEMI guidelines emphasize
care coordination
Summary: Authors of the new European Society of Cardiology (ESC)
guidelines for the management of patients with acute ST-elevation MI
(STEMI) hope their recommendations spur efforts to improve the speed
and efficiency of STEMI care in Europe.
The new guidelines are "much more demanding [than the 2008 guidelines]
in terms of delays," said Dr Gabriel Steg, chair of the task force that wrote
the new recommendations. The new standard for time from medical
contact to ECG is 10 minutes, and "the fact that you use primary PCI
should not lead to complacency about the delays. You should target 60
minutes." Two hours is the limit of acceptable delay for a patient
transferred from a non-PCI center to a PCI center, but the target should be
90 minutes, Steg said. If PCI within two hours of presentation appears to
be impossible, then fibrinolysis should be administered within 30 minutes.
See: New European STEMI guidelines emphasize care coordination
13. DeFACTO
Results encouraging for "virtual" FFR despite missing target
Results: Noninvasive fractional flow reserve calculated from
computed tomography angiography (FFRCT) did not achieve the
prespecified target for diagnostic accuracy in the Determination of
Fractional Flow Reserve by Anatomic Computed Tomographic
Angiography (DeFACTO) trial. Nevertheless, investigators are
optimistic that FFRCT can become an important tool for efficiently
identifying high-grade stenoses and determining the hemodynamic
significance of lesions.
In an editorial on the study, Dr Manesh Patel (Duke University,
Durham, NC) writes that FFRCT "represents a novel and important
innovation, with the possibility not only to diagnose but also to help
direct invasive treatment." Because FFRCT demonstrated only
"modest" specificity in DeFACTO, "at first glance, readers of the study
may consider FFRCT technology to be limited based on the results
presented," Patel acknowledges. "However, this would be a naive
conclusion, likely based on the published diagnostic performance of
noninvasive tests compared only with invasive angiography."
See: DeFACTO results encouraging for "virtual" FFR despite missing
target
14. For more information
Complete ESC 2012 coverage on
theheart.org
ESC Congress 2012
European Society of Cardiology
15. Credits and disclosures
Editor: Journalists:
Shelley Wood Sue Hughes, theheart.org
Managing Editor, heartwire London, UK
theheart.org Disclosure: Sue Hughes has disclosed no
Kelowna, BC relevant financial relationships.
Disclosure: Shelley Wood has disclosed
no relevant financial relationships. Reed Miller, theheart.org
State College, PA
Contributors:
Disclosure: Reed Miller has disclosed no
Steven Rourke
relevant financial relationships.
Editorial Director
theheart.org
Montreal, QC
Lisa Nainggolan, theheart.org
Disclosure: Steven Rourke has London, UK
disclosed no relevant financial Disclosure: Lisa Nainggolan has disclosed
relationships. no relevant financial relationships.
Maria Turner Michael O'Riordan, theheart.org
Montreal, QC Toronto, ON
Disclosure: Maria Turner has disclosed Disclosure: Michael O'Riordan has
no relevant financial relationships. disclosed no relevant financial
relationships.
Steve Stiles, theheart.org
Fremont, CA
Disclosure: Steve Stiles has disclosed no
relevant financial relationships.
16. More slideshows
EuroPCR 2012 research highlights
HRS 2012 research highlights
ACC 2012 research highlights
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