ACC 2010 - Cardiology Conference Coverage

Heartwire

Heart failure

Just do it: No increased risk of ICD shocks with exercise training in HF, study shows

Mar 31, 2010 12:00 EDT

The finding should help alleviate concerns that might be keeping some heart-failure patients with implantable defibrillators from reaping the benefits of exercise therapy, according to researchers.

Arrhythmia/EP

Omega-3 PUFAs may help preserve sinus rhythm after AF cardioversion

13 COMMENTS - Mar 26, 2010 17:30 EDT

The addition of omega-3 fatty acids at 1 g/day to standard antiarrhythmics cut the risk of recurrence after cardioversion of atrial fibrillation in a randomized trial.

Prevention

More heat for aspirin in new primary-prevention meta-analysis: "Creativity" needed to determine who will benefit

7 COMMENTS - Mar 25, 2010 15:00 EDT

This latest meta-analysis adds in the JPAD, POPADAD, and AAA trials to the 2009 Aspirin Treatment Trialists' Collaboration and reached very similar conclusions: aspirin's benefits in primary prevention are modest and substantially offset by its risks.

Arrhythmia/EP

Higher complication rates in women undergoing AF catheter ablation

Mar 25, 2010 11:45 EDT

The results showed that the complication rate was 2.7-fold higher in women, which was driven by increased vascular complications.

Interventional/Surgery

Not yet closed? PFO-migraine link probed in two new studies

Mar 23, 2010 13:15 EDT

Two new studies, including an oral presentation at the recent ACC meeting, are offering new hints that in appropriately selected patients, closing a patent foramen ovale can lead to migraine improvement or even cure.

Interventional/Surgery

Women with MI less likely to get cath procedures

Mar 23, 2010 10:00 EDT

Women's adjusted MI mortality rate would be in line with men's if they received comparable treatment, a French study suggests.

Imaging

Long-term marathon running linked with increased coronary calcification

15 COMMENTS - Mar 22, 2010 09:45 EDT

Researchers have shown that long-term marathon runners, those who have completed at least 25 marathons over the past 25 years, have increased coronary calcium and calcified plaque volume. Another study linked marathon running with increased aortic stiffness.

Hypertension

ACE inhibitor/ARBs still used in pregnancy despite teratogenicity

3 COMMENTS - Mar 19, 2010 14:15 EDT

New research from the UK has found that doctors are still prescribing ACE inhibitors and angiotensin-receptor blockers in women of child-bearing age, despite evidence that they are teratogenic. Reasons include a lack of awareness of the issue among GPs and obstetricians and ambiguity in hypertension guidelines, says the researcher.

Interventional/Surgery

JETSTENT: Improved reperfusion and short-term clinical end points with thrombectomy

Mar 18, 2010 17:15 EDT

The results lead researchers to conclude that thrombectomy should be routine in PCI for patients with an increased thrombus burden. Others aren't sure the data are sufficient to justify its routine use, however.

Prevention

Death, CVD risk declines in people who "normalize" vitamin-D levels

6 COMMENTS - Mar 18, 2010 17:00 EDT

In a group of nearly 1000 subjects told they had low vitamin D at baseline, those who managed to up their levels over follow-up were significantly less likely to die or to suffer a combination of cardiovascular end points.

Hypertension

Mar 18, 2010 16:00 EDT

A new BP-lowering drug that acts in a similar way to omapatrilat—an agent that never quite made it to the market—has shown promise in a preliminary trial. Crucially, this dual inhibiting agent, named LCZ696, blocks angiotensin II rather than angiotensin-converting enzyme; there was no indication of angioedema in the study.

Heart failure

How to diurese in acute HF: Dosing strategies get an evidence base

3 COMMENTS - Mar 17, 2010 11:00 EDT

Is it safe to start patients with acute decompensated heart failure on loop diuretics at higher-than-standard doses? And is it more effective to administer them in a continuous infusion or intermittent boluses? Until the DOSE trial asked those questions, IV diuretic strategies in ADHF had never or rarely been put to a randomized, controlled test.

Interventional/Surgery

Long-term, but small, PASSION and DEDICATION studies raise concern about DES in STEMI

2 COMMENTS - Mar 16, 2010 18:15 EDT

There was an increased risk of cardiac death observed in the DEDICATION trial with the drug-eluting stents and a trend toward an increase in stent thrombosis in PASSION, but experts still caution the studies are small and should not be overinterpreted.

Interventional/Surgery

PLATO CABG analysis confuses cardiologists

7 COMMENTS - Mar 16, 2010 17:15 EDT

Cardiologists here at the ACC meeting were confused by a new analysis of PLATO, this time in ACS patients who subsequently underwent CABG surgery. Those in the ticagrelor group were 50% less likely to die, despite the fact that there was no difference in bleeding or MIs between these patients and those who got clopidogrel. The investigator admitted he didn't have the answers, and further analyses "are ongoing."

Interventional/Surgery

Patency for radial-artery no better than saphenous-vein grafts at one year

Mar 16, 2010 16:15 EDT

The study results may surprise some surgeons, who have tended to think that the radial artery might perform more like the LIMA, which has demonstrated superiority to the saphenous vein for CABG procedures. But 12 months is not enough.

Thrombosis

Warfarin genotyping reduces hospitalizations

2 COMMENTS - Mar 16, 2010 16:00 EDT

Although there was a suggestion that some of the effect could have simply been due to more attention being paid to the patients, most agree that any intervention that helps warfarin control is worthwhile.

Interventional/Surgery

Finally final? New STICH analysis finds no subset that benefits from ventricular reconstruction

2 COMMENTS - Mar 16, 2010 14:45 EDT

STICH investigators examine whether baseline end-diastolic volume index and total volume reduction mark which CABG patients benefit from surgical ventricular reduction.

Interventional/Surgery

Platinum-chrome DES performs heroically in PERSEUS

2 COMMENTS - Mar 16, 2010 12:00 EDT

Taxus Element paclitaxel-eluting stent performs especially well in small vessels in PERSEUS trial.

Interventional/Surgery

Is triple antiplatelet therapy after PCI the way forward?

2 COMMENTS - Mar 16, 2010 11:00 EDT

Adding cilostazol to clopidogrel and aspirin did not significantly reduce event rates, but it did improve posttreatment platelet reactivity in the CILON-T trial, and the study was underpowered for hard clinical events.

Hypertension

Is BP variability a stronger determinant of CV outcomes than mean pressure?

2 COMMENTS - Mar 16, 2010 09:45 EDT

A host of new analyses published in the Lancet journals, some of which were also reported at the ACC meeting, suggest that variability in blood pressure is a much stronger determinant of both stroke and coronary disease outcome than average blood pressure. And calcium-channel blockers have the strongest effect of all antihypertensives on reducing BP variability, say the researchers.

Interventional/Surgery

Cardiologists voice concern on FDA clopidogrel warning

4 COMMENTS - Mar 16, 2010 09:00 EDT

Several experts have questioned why the FDA has issued a warning about poor metabolizers of clopidogrel when there are no firm data about what to do for these patients.

Interventional/Surgery

Polymer-free, dual-drug DES shows little late catch-up in ISAR-TEST-2

Mar 15, 2010 18:45 EDT

Two-year ISAR-TEST-2 results show that the safety and efficacy of dual-drug DES are maintained out to two years.

Arrhythmia/EP

STOP-AF and CABANA: Trials show effectiveness of ablation over drugs in AF

Mar 15, 2010 15:45 EDT

UPDATED WITH CORRECTION // In STOP-AF, patients with paroxysmal AF treated with a novel cryoablation technology were significantly more likely to be free of arrhythmia at one year compared with antiarrhythmic drug therapy. In addition, feasibility results of the CABANA pilot study were also presented.

Arrhythmia/EP

New factor Xa inhibitor betrixaban safe in phase 2 AF trial

Mar 15, 2010 14:45 EDT

A novel oral factor Xa inhibitor, betrixaban, was safe and well tolerated when compared with warfarin in a phase 2 trial in patients with AF. Along with other new anticoagulants, this could represent an advance on warfarin, but betrixaban first needs to be evaluated in a much larger phase 3 trial, said the lead researcher.

Arrhythmia/EP

Faster CONNECTions: Remote monitoring reduces event-to-decision time

Mar 15, 2010 13:30 EDT

Remote monitoring of ICDs reduces the time from clinical events to a clinical decision by about three weeks, on average, results of the CONNECT study of Medtronic's CareLink ICD remote-monitoring system show.

Interventional/Surgery

SORT OUT III: Cypher bests Endeavor at 18 months

1 COMMENT - Mar 15, 2010 10:30 EDT

UPDATED // A head-to-head stent comparison has shown that patients treated with the zotarolimus-eluting stent had more major adverse cardiac events at 18 months than patients treated with the sirolimus-eluting stent.

Thrombosis

Optimal dual antiplatelet duration in REAL-LATE, ZEST-LATE: Too little, too soon

3 COMMENTS - Mar 15, 2010 10:30 EDT

UPDATED // Cardiologists of every stripe are eager for any new information on just how long their patients should be taking dual antiplatelet therapy after receiving a drug-eluting stent. But the REAL-LATE/ZEST-LATE analysis seems to provide more questions than answers. The question everyone now seems to be asking now is, so what?

Arrhythmia/EP

Safely switch from amiodarone to dronedarone in two days, suggests analysis

Mar 15, 2010 08:30 EDT

Most patients, at least, who are in sinus rhythm after cardioversion from atrial fibrillation and for whom a transition from the old drug to the new one is planned can switch in two days. The post hoc analysis points to two signals that waiting longer might be safer, according to researchers.

Acute Coronary Syndromes

"Lenient" as good as "strict" ventricular rate control in permanent AF: RACE-2 trial

Mar 15, 2010 08:00 EDT

UPDATED // The standard heart-rate target of <80 bpm doesn't lead to better clinical outcomes and is harder to achieve than a target of <110 bpm, a prospective randomized trial found.

Acute Coronary Syndromes

New meta-analysis: Routine invasive strategy betters selective care for non-ST-elevation ACS

Mar 14, 2010 18:45 EDT

A more aggressive routine invasive strategy is clearly better than a conservative selective invasive strategy for all patients with non-ST-elevation acute coronary syndromes, a new meta-analysis shows. And the highest-risk patients had the most to gain, indicating that risk stratification is crucial, says the lead researcher.

Hypertension

INVEST: Mortality hazard with lowest blood pressures in diabetics with CAD?

1 COMMENT - Mar 14, 2010 18:00 EDT

Diabetic patients whose systolic blood pressure was lowered to 130 to 140 mm Hg had a better outcome than those with systolic pressures over 140. But reductions below 130 did not appear to offer any additional benefit and had a higher mortality rate in this retrospective analysis.

Imaging

Abdominal CT exams may reveal patients at higher risk for cardiovascular disease

Mar 14, 2010 14:15 EDT

A small study of patients who have had both abdominal CT scans and coronary angiography found that abdominal aortic calcification is a predictor of obstructive coronary disease.

Prevention

Psoriasis "firmly established" as risk factor for CV disease

Mar 14, 2010 10:15 EDT

Psoriasis patients should be considered at increased cardiovascular risk and prioritized for earlier medical risk-factor intervention for heart disease, the authors of a new study say.

Lipid/Metabolic

No increased atherosclerotic-plaque burden in cops and firefighters

Mar 14, 2010 08:45 EDT

The atherosclerotic-plaque burden among cops and firefighters is no higher than in a cohort of age-matched controls, suggesting that something else, possibly increased emotional and physical stress, is causing the increased risk of on-the-job cardiac-related events.

Interventional/Surgery

Nanoparticle detonations may be able to burn vascular plaques

Mar 14, 2010 08:15 EDT

Biophotonic destruction of plaques with laser-activated nanoparticles shows promise in early clinical studies.

Hypertension

ACCORD BP: Intensive BP lowering futile in diabetics

9 COMMENTS - Mar 14, 2010 08:00 EDT

The ACCORD BP study shows that there is no benefit to be gained from intensively lowering systolic blood pressure to less than 120 mm Hg in type 2 diabetics; for now, a goal of <140 mm Hg seems reasonable in this population, say the authors.

Lipid/Metabolic

ACCORD: Fenofibrate no benefit to statin therapy in high-risk diabetic patients

19 COMMENTS - Mar 14, 2010 08:00 EDT

UPDATED // The findings do not support the use of combination fibrate-statin therapy to reduce cardiovascular risk in the majority of patients with type 2 diabetes who are at high risk for cardiovascular disease, according to the ACCORD investigators.

Lipid/Metabolic

NAVIGATOR off course to diabetes prevention with valsartan, nateglinide

7 COMMENTS - Mar 14, 2010 08:00 EDT

UPDATED // In a population with impaired glucose tolerance and CV disease or risk factors, the angiotensin receptor blocker had a slight effect and the short-acting insulin secretagogue had no favorable impact on progression to diabetes; neither drug prevented cardiovascular events.

Interventional/Surgery

EVEREST II: Mitral-clip device noninferior to surgical repair or replacement

5 COMMENTS - Mar 14, 2010 08:00 EDT

UPDATED // Much-anticipated results from EVEREST II show that the novel device—a percutaneous version of edge-to-edge mitral-valve repair—may be safer than traditional valve repair or replacement, with "noninferior" efficacy out to one year.

Interventional/Surgery

Women more likely to be referred for cath

Mar 13, 2010 17:00 EST

There appears to have been a paradigm shift in the way cardiologists refer to the cath lab, a new registry study suggests.

Clinical cardiology

Fitness more important than fatness for thrombotic risk in firefighters

Mar 13, 2010 16:45 EST

Despite looking fit and healthy, a third of firefighters examined in a new study were at high risk of a thrombotic event, and improving their fitness is more likely to reduce this risk than tackling excess body weight, say the researchers.

Discussion and opinions

Blogs

Heart failure and transplantation with Dr Ileana Piña

Optimal medical therapy holds its own in STICH

May 26, 2011 14:50 EDT

Topolog

Calling for individualized medicine from ACC 2010

Mar 26, 2010 10:55 EDT

5 comments

Private practice with Dr Seth Bilazarian

RACE-2, rate control, and a wrap from ACC: Is less better?

Mar 23, 2010 13:10 EDT

Topolog

NAVIGATING lessons: Design smaller trials with more biological plausibility

Mar 19, 2010 15:30 EDT

This week in cardiology from heartwire

#31: PLATO CABG analysis confuses, concern on FDA clopidogrel warning, intensive BP lowering futile...

Mar 19, 2010 13:50 EDT

Heartfelt with Dr Melissa Walton-Shirley

Warfarin genotyping, aliskiren on LV remodeling, gender and treatment, how to diurese in acute HF

Mar 17, 2010 11:10 EDT

Private practice with Dr Seth Bilazarian

Are cardiologists apathetic when it comes to advocacy?

Mar 16, 2010 23:15 EDT

4 comments

Heartfelt with Dr Melissa Walton-Shirley

The DOSE trial: The Carnac-the-Magnificent approach to diuretic dosing still works!

Mar 16, 2010 18:18 EDT

7 comments

Topolog

Should we loosen up on ventricular rate control?

Mar 16, 2010 11:20 EDT

1 comments

Heartfelt with Dr Melissa Walton-Shirley

Gamblers Anonymous: Help for those who make blanket statements on clopidogrel duration following DES

Mar 16, 2010 08:51 EDT

4 comments

Topolog

Mitral-clip in EVEREST II: A step forward

Mar 15, 2010 23:30 EDT

1 comments

Heartfelt with Dr Melissa Walton-Shirley

Atrial fibrillation, heart rate control, remote monitoring of ICDs, update on stents, betrixaban, antiplatelet therapies,...

Mar 15, 2010 19:55 EDT

1 comments

Heart failure and transplantation with Dr Ileana Piña

Addressing health diversities with CREDO

Mar 15, 2010 17:30 EDT

Heartfelt with Dr Melissa Walton-Shirley

EVEREST II mitral-valve clip: It's a good start but still a long way to the...

Mar 15, 2010 11:30 EDT

4 comments

Heart failure and transplantation with Dr Ileana Piña

Hospital-to-Home National Quality Improvement Initiative

Mar 15, 2010 08:55 EDT

Heartfelt with Dr Melissa Walton-Shirley

ACCORD on lipids, BP in diabetics, Mitral-clip may rival surgery, CV risk in prediabetics, psoriasis...

Mar 14, 2010 22:25 EDT

Heartfelt with Dr Melissa Walton-Shirley

Surprise, surprise! Time to INVEST in the gospel ACCORDing to ACCORD

Mar 14, 2010 22:14 EDT

1 comments

Private practice with Dr Seth Bilazarian

ACCORD BP, INVEST, and blood pressure management in diabetics

Mar 14, 2010 18:45 EDT

Private practice with Dr Seth Bilazarian

ACCORD lipid arm: Should we be using fibrates?

Mar 14, 2010 11:55 EDT

10 comments

This week in cardiology from heartwire

#30: What's going to be hot at ACC 2010? CAC warranty period, coffee and...

Mar 12, 2010 23:05 EST

Late-Breaking Clinical Trials I
Sunday, Mar 14, 2010, 8:00 AM - 9:20 AM
Murphy Ballroom

Click to download as PDF

8:00 AM–8:12 AM		3010-6: Effects of combination lipid therapy on cardiovascular events in type 2 diabetes mellitus: The ACCORD lipid study Henry Ginsberg, Columbia University College of Physicians & Surgeons, New York, NY
8:17 AM–8:29 AM		3010-8: Effects of intensive blood pressure control on cardiovascular events in type 2 diabetes mellitus: The Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure trial William C Cushman, Veterans Affairs Medical Center, Memphis, TN
8:34 AM–8:46 AM		3010-10: Rethinking lower BP goals for diabetics with documented coronary artery disease: Findings from the International Verapamil SR-Trandolapril Study (INVEST) Rhonda M Cooper-Dehoff, University of Florida, Gainesville
8:51 AM–9:03 AM		3010-12: The Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial Robert M Califf, Duke Clinical Research Institute, Durham, NC
9:08 AM–9:20 AM		3010-14: Primary safety and efficacy end points of the EVEREST II randomized clinical trial Ted Feldman, Evanston Hospital, IL

Late-Breaking Clinical Trials II
Monday, Mar 15, 2010, 8:00 AM - 9:20 AM
Murphy Ballroom

8:00 AM–8:12 AM		3015-6: Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: First results of the North American Arctic Front STOP-AF clinical trial Douglas L Packer, Mayo Clinic, Rochester, MN
8:17 AM–8:29 AM		3015-8: Rate-control efficacy in permanent atrial fibrillation: A comparison between lenient vs strict rate control in patients with and without heart failure. The RACE II study Isabelle C Van Gelder, University Medical Center Groningen, the Netherlands
8:34 AM–8:46 AM		3015-10: The impact of remote monitoring with automatic clinician notifications on the clinical care of ICD and CRT-D patients George H Crossley III, St Thomas Research Institute, Nashville, TN
8:51 AM–9:03 AM		3015-12: A randomized clinical trial of three doses of a long-acting oral direct factor Xa inhibitor (betrixaban) in patients with atrial fibrillation Michael D Ezekowitz, Lankenau Institute for Medical Research, Wynnewood, PA
9:08 AM–9:20 AM		3015-14: Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation: First results of the CABANA pilot study Douglas L Packer, Mayo Clinic, Rochester, MN

Late-Breaking Clinical Trials III
Monday, Mar 15, 2010, 10:30 AM - 11:52 AM
Murphy Ballroom

10:30 AM–10:40 AM		3016-06: Randomized all-comer comparison of zotarolimus-eluting and sirolimuseluting coronary stents: 18-month follow-up in the SORT OUT III trial Michael Maeng, Aarhus University Hospital, Denmark
10:48 AM–10:58 AM		3016-08: Randomized trial of a polymer-free dual drug-eluting stent vs polymer-based Cypher and Endeavor drug-eluting stents: Two-year clinical and angiographic outcomes Robert A Byrne, Deutsches Herzzentrum, Munich, Germany
11:06 AM–11:16 AM		3016-10: First report of the PERSEUS randomized controlled trial comparison of a novel platinum-chromium, thin-strut TAXUS Element stent vs the TAXUS Express stent in de novo coronary stenoses Dean J Kereiakes, Christ Hospital Heart and Vascular Center/Lindner Center for Research and Education, Cincinnati, OH
11:24 AM–11:34 AM		3016-12: Randomized trial evaluating the efficacy of cilostazol on ischemic vascular complications after drug-eluting stent implantation for coronary heart disease: Influence of Cilostazol-Based Triple Antiplatelet Therapy on Ischemic Complication After Drug-Eluting Stent Implantation (CILON-T) study Hyo-Soo Kim, Seoul National University Hospital, South Korea
11:42 AM–11:52 AM		3016-14: Optimal duration of dual antiplatelet therapy after drug-eluting stent implantation: A randomized, multicenter trial Seung-Jung Park, Asan Medical Center, Seoul, South Korea

Late-Breaking Clinical Trials IV
Tuesday, Mar 16, 2010, 8:00 AM - 9:20 AM
Murphy Ballroom

8:00 AM–8:12 AM		3019-6: Effect of genotyping warfarin patients on outcomes: Results from the National Community-based Medco-Mayo Warfarin Effectiveness Study (MM-WES) Robert S Epstein, Medco Health Solution, Franklin Lakes, NJ
8:17 AM–8:29 AM		3019-8: The Diuretic Optimization Strategies Evaluation (DOSE) study: A randomized, double blind, placebo-controlled trial of diuretic strategies in acute decompensated heart failure Gary Michael Felker, Duke University School of Medicine, Durham, NC
8:34 AM–8:46 AM		3019-10: Effect of the direct renin inhibitor aliskiren on left ventricular remodeling following myocardial infarction with left ventricular dysfunction: ASPIRE Scott D Solomon, Brigham and Women’s Hospital, Boston, MA
8:51 AM–9:03 AM		3019-12: Effects of clinical characteristics and treatments on gender difference in outcomes after acute myocardial infarction: A propensity score-matched analysis François Schiele, University Hospital Jean Minjoz, Besançon, France
9:08 AM–9:20 AM		3019-14: Influence of reduction of left ventricular volume on outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction Robert E Michler, Duke Clinical Research Institute, Durham, NC

Late-Breaking Clinical Trials V
Tuesday, Mar 16, 2010, 10:30 AM - 11:51 AM
Murphy Ballroom

10:30 AM–10:40 AM		3020-06: Randomized comparison of Angiojet rheolytic thrombectomy before direct infarct artery stenting to direct stenting alone in patients with acute myocardial infarction: the Jetstent trial David Antoniucci, Careggi Hospital, Florence, Italy
10:48 AM–10:58 AM		3020-08: Long-term outcome after drug-eluting vs bare-metal stent implantation in patients with ST-elevation myocardial infarction. Three-year follow-up of the DEDICATION trial Peter Clemmensen, Copenhagen University Hospital, Denmark
10:58 AM–11:08 AM		3020-09: Five-year follow-up after primary percutaneous coronary intervention with a paclitaxel-eluting stent vs a bare-metal stent in acute ST-segment elevation myocardial infarction. A follow-up study of the PASSION trial Maarten Vink, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
11:23 AM–11:33 AM		3020-11: Ticagrelor vs clopidogrel in patients with acute coronary syndromes undergoing coronary artery bypass surgery: Results from the PLATO trial Claes Held, Uppsala Clinical Research Center, Sweden
11:41 AM–11:51 AM		3020-13: A randomized trial of radial artery grafts vs saphenous vein grafts in coronary artery bypass surgery: VA Cooperative Study Steven Goldman, Southern Arizona VA Health Care System, Tucson