ACC 2011 - Cardiology Conference Coverage

Heartwire

Interventional/Surgery

PROACT: Early results show high-risk patients do well with low warfarin and carbon valve

Apr 13, 2011 17:00 EDT

The On-X pyrolytic carbon aortic valve is safe with lower doses of warfarin than usually prescribed with mechanical valves, early results of PROACT show.

Interventional/Surgery

ATOLL at six months: Better survival with enoxaparin persists

Apr 13, 2011 12:15 EDT

In addition, a meta-analysis of four studies comparing enoxaparin with unfractionated heparin in PCI patients suggests significant benefits for the low-molecular-weight heparin.

Interventional/Surgery

DEDICA: Low-dose heparin looks good in PCI

Apr 13, 2011 11:30 EDT

A 50-IU/kg dose of heparin seems to be sufficient for use in PCI if aspirin and clopidogrel are on board, a new study suggests.

Interventional/Surgery

ARMYDA BIVALVE: Bivalirudin vs low-dose heparin in PCI

Apr 13, 2011 10:30 EDT

In contrast to many previous trials of bivalirudin, GP IIb/IIIa inhibitors were not routinely used in the heparin arm.

Hypertension

Pulse pressure predicts white-coat hypertension

3 COMMENTS - Apr 12, 2011 12:30 EDT

Measuring pulse pressure, the systolic blood pressure minus the diastolic, could be an easy way to identify patients with white-coat hypertension, according to new research.

Arrhythmia/EP

Lower risk of stroke/TIA among AF patients treated with ablation: Retrospective analysis

Apr 12, 2011 10:30 EDT

There was also a trend toward a lower risk of heart-failure-related events among ablation patients when compared with those undergoing medical therapy, but investigators caution that definitive results won't be known until the randomized trials are completed.

Imaging

New CT method gets calcium score and coronary anatomy in a single scan

1 COMMENT - Apr 11, 2011 16:45 EDT

Researchers have validated a novel method for noncontrast CT scanning that allows both calcium scoring and evaluation of coronary anatomy with a single scan.

Arrhythmia/EP

Dabigatran 150 mg twice daily effective in all types of AF; lower dose and cost issues questioned

8 COMMENTS - Apr 11, 2011 11:45 EDT

Treatment with the 150-mg twice daily dose of dabigatran is equally safe and effective in patients with permanent, persistent, and paroxysmal atrial fibrillation. The 110-mg dose, however, was less effective in patients with permanent atrial fibrillation, while another study pointed to the high costs of switching patients from warfarin to dabigatran.

Hypertension

Mixed results with Rheos system, but development continues

Apr 8, 2011 13:45 EDT

Mixed results from a so-called "pivotal" trial of a new pacemakerlike device for the treatment of highly resistant hypertension, the Rheos system, were reported.

Hypertension

1 COMMENT - Apr 7, 2011 16:45 EDT

Still, the ARB might have had an edge for a nonprespecified end point in the trial comparing valsartan- and amlodipine-based hypertension therapy in patients with primarily diabetes but also some with impaired glucose tolerance.

Acute Coronary Syndromes

PROTECTION-AMI: Delcasertib fails to reduce reperfusion injury

1 COMMENT - Apr 7, 2011 14:45 EDT

Previously shown in animal models to reduce infarct size as well as myocyte and endothelial cellular damage, the intravenous administration of delcasertib failed to reduce infarct size when tested in patients with ST-segment elevation MI undergoing PCI. As one expert said, yet "another one bites the dust" when it comes to compounds testing attempts to limit reperfusion injury.

Interventional/Surgery

RADAR: First significant clinical use of novel reversible anticoagulation system

1 COMMENT - Apr 6, 2011 16:30 EDT

The REG1 system is said to be "ideal" for use in PCI, where very high levels of anticoagulation are needed for a short period.

Heart failure

TARGET: Echo-guided CRT lead placement gets backing from speckle tracking

Apr 6, 2011 10:00 EDT

In a randomized trial, echo-guided LV lead placement for optimizing pacing effectiveness in CRT led to smaller chamber sizes and improved symptom status, among other benefits.

Interventional/Surgery

NCDR shows 11.6% of nonacute PCIs and 1.1% of acute PCIs are "inappropriate" based on AUC

17 COMMENTS - Apr 5, 2011 17:15 EDT

A study of half a million PCIs in the NCDR database finds that the majority are for indications classified as appropriate by the 2009 appropriateness guidelines, but that there is plenty of room for improvement.

Interventional/Surgery

EXCELLENT results for stopping DAPT at six months, but others say bigger trials are needed

Apr 5, 2011 17:00 EDT

The EXCELLENT study was not powered for hard clinical end points, such as death, MI, or stent thrombosis, but investigators report that one-year rates of target vessel failure were noninferior among patients treated with dual antiplatelet therapy for six months compared with those who received dual therapy for one year. Experts note that larger trials designed around hard end points are still needed.

Hypertension

OSCAR: Antihypertensive choice in elderly should be guided by underlying disease

Apr 5, 2011 16:00 EDT

Treating elderly hypertensive patients with a combination of an angiotensin-receptor blocker and a calcium antagonist seems to be similar to using a high (double) dose of an ARB alone, new data show. But doctors should pay close attention to patients' underlying disease when choosing antihypertensive therapy in this patient population, stressed the lead investigator.

Brain/Kidney/Peripheral

Hydration system may thwart contrast nephropathy: REMEDIAL 2 trial

Apr 5, 2011 09:45 EDT

A device that automatically titrates aggressive hydration according to urine output during procedures that use radiographic contrast agents may cut the risk of contrast-induced nephropathy in vulnerable patients, a small study suggests.

Thrombosis

MAGELLAN: Rivaroxaban prevents VTE in medical patients, but bleeding an issue

1 COMMENT - Apr 5, 2011 09:00 EDT

UPDATED // Although a net clinical benefit was not seen across the whole population, the lead investigator says he cannot rule out a benefit for some patients until subgroup analyses have been conducted.

Interventional/Surgery

Everolimus-eluting stent performs well in PLATINUM

1 COMMENT - Apr 4, 2011 19:30 EDT

A novel everolimus-eluting stent containing platinum as part of the structure has been shown to be noninferior to the widely used Xience V stent (also known as Promus) in a pivotal trial, PLATINUM. Experts said it is going to become increasingly difficult to differentiate these newer stents from one another, and that this will require registry data and use in high-risk patients.

Interventional/Surgery

Five-year data favor radial artery over saphenous vein grafts for CABG

Apr 4, 2011 18:15 EDT

The radial artery has outperformed the saphenous vein as a conduit for coronary artery bypass grafting in a five-year follow-up of patients with multivessel disease undergoing surgery in a randomized, multicenter Canadian study. These are the first long-term data to address this subject and challenge the notion that has previously existed: that this artery is not much better than a vein, said researchers.

Interventional/Surgery

ISAR CABG: Drug-eluting stents reduce repeat revascularization in saphenous vein grafts

Apr 4, 2011 17:30 EDT

The largest randomized trial of drug-eluting stents in the saphenous vein graft shows that DES reduce major adverse events by about one-third compared with bare-metal stents.

Interventional/Surgery

New Resolute zotarolimus stent data flesh out efficacy, safety

Apr 4, 2011 16:30 EDT

Two studies examining the performance of the Resolute zotarolimus-eluting stent suggest that the next-generation drug-eluting stent can deliver lasting freedom from restenosis, as well as low rates of MI, death, and stent thrombosis over time.

Interventional/Surgery

Radial RIVALs femoral access for invasive ACS treatment, but doesn't beat it

12 COMMENTS - Apr 4, 2011 11:45 EDT

UPDATED // Transradial access, however, did result in a 63% reduction in the risk of large vascular-access complications. Investigators conclude that, with both the femoral and radial approaches safe and effective in treating ACS patients invasively, the lower rate of local vascular complications might be a reason to use the radial route.

Interventional/Surgery

PRECOMBAT: PCI noninferior to CABG for left main disease, but questions linger

1 COMMENT - Apr 4, 2011 09:00 EDT

UPDATED // At one year, the primary end point, a composite of MACCE, occurred in 8.7% of patients assigned to PCI and 6.7% patients assigned to surgery, a cumulative event rate that reached statistical significance for noninferiority. Despite the positive data, researchers say the results are unlikely to be very helpful in clinical practice, because the study was underpowered as a result of unexpectedly low event rates.

Interventional/Surgery

Latest from EVEREST II: MitraClip less effective but safer than surgery

3 COMMENTS - Apr 4, 2011 09:00 EDT

UPDATED // Most commentators seem to agree that the clip will be used in those who are too high risk to undergo surgery: the older and sicker patients. But they are reserving judgment on the broader population until longer-term data become available.

Interventional/Surgery

Docs say STICH "hypothesis one" supports CABG in HF patients despite missing primary end point

3 COMMENTS - Apr 4, 2011 09:00 EDT

UPDATED // Coronary bypass fails to improve overall five-year survival compared with medical therapy alone in the 1212 heart-failure patients enrolled in the Surgical Treatment for Ischemic Heart Failure trial.

Interventional/Surgery

STICH substudy: Viability testing didn't affect treatment outcomes

Apr 4, 2011 09:00 EDT

UPDATED // The findings question the decades-old practice of revascularization guided by myocardial-viability studies, at least in patients like the ones the trial enrolled. But not everyone thinks the analysis is all that decisive.

Interventional/Surgery

PROTECT II investigator insists study shows benefits of Impella, despite early termination

Apr 3, 2011 20:30 EDT

The lead investigator of the PROTECT II trial, which was stopped early for futility, presented per-protocol analysis of the interim data, which he says proves that Abiomed's Impella circulatory support device provides much better hemodynamic support than an intraoperative balloon pump in high-risk PCI patients.

Heart failure

Primary-prevention ICD survival gains not tied to degree of EF reduction: Analysis

Apr 3, 2011 19:45 EDT

The devices cut mortality to a similar degree whether the left ventricular ejection fraction is on the high or low end of <35%, a meta-analysis suggests.

Acute Coronary Syndromes

Tripling of heart attack risk persisted four years after Katrina

Apr 3, 2011 19:00 EDT

Residents of New Orleans had a persistent threefold increased risk of heart attack four years after Hurricane Katrina. Chronic stress appears to have played a large role, and the findings indicate that closer attention must be paid to health in the wake of such catastrophes, say the researchers.

Interventional/Surgery

TAVI cost-effective treatment in surgery-ineligible patients: PARTNER cohort B cost analysis

Apr 3, 2011 17:30 EDT

TAVI cost approximately $80 000 more than standard medical therapy for inoperable aortic stenosis but was associated with increased survival, and this translated into a cost-effectiveness ratio of approximately $50 000, which researchers deemed acceptable.

Interventional/Surgery

PARTNER cohort A: Transcatheter valves noninferior to surgery

Apr 3, 2011 09:00 EDT

UPDATED // Called a "win-win" by most, the PARTNER cohort A trial showed deaths to be numerically lower in the TAVI group than the surgery group at both 30 days and one year, but not statistically different. Major strokes and vascular complications were higher in the TAVI-treated patients, both at 30 days and one year, while rates of major bleeding and new atrial fibrillation were higher in the surgery group.

Acute Coronary Syndromes

Got STEMI? Take the ambulance: Longer door-to-balloon times for ER self-referrals

5 COMMENTS - Apr 2, 2011 19:45 EDT

Patients who arrive by ambulance need and get more intensive care in the emergency department, but they still get to catheter-based treatment faster, probably because their ECGs are obtained before hospital arrival, researchers say.

Prevention

Regular exercise can help preserve/build heart mass

2 COMMENTS - Apr 2, 2011 19:30 EDT

Older individuals who had exercised throughout their lives had higher left ventricular mass and peak oxygen uptake than younger sedentary people in a new study.

News

Sea change in US cardiology will see emergence of the "physician executive"

1 COMMENT - Apr 2, 2011 18:45 EDT

Cardiology in America is undergoing a transformation, with more and more practices integrating with hospitals. To step up to the challenge of this new order, more and more cardiologists will need to train in management skills, starting early in their careers, say experts in the field.

Lipid/Metabolic

Antidepressant use linked with increased atherosclerosis measured by carotid IMT

3 COMMENTS - Apr 2, 2011 17:45 EDT

In a study of twins, the one taking any class of antidepressant had a 5% increase in carotid IMT compared with the twin not taking the medication. In lay terms, say investigators, the brother taking the antidepressant had carotid IMT measurements that would age him about four years compared with his untreated brother.

Arrhythmia/EP

Yoga found to reduce AF episodes

Apr 2, 2011 17:45 EDT

Taking a 45-minute yoga class three times a week was associated with a halving of episodes of atrial fibrillation in a new small study.

Interventional/Surgery

There is no "I" in cath-lab quality improvement

Apr 2, 2011 16:45 EDT

Although there are now a wealth of data on the performance of cath labs, in many centers not all of the critical staff are not fully included in the process of improving outcomes and patient care.

Features

Betty Crocker, Coke, and CardioSmart at ACC 2011: If CV prevention gets a boost, does it matter who pays?

12 COMMENTS - Apr 2, 2011 13:30 EDT

There's no subterfuge here—the ACC announced its new corporate partners back in 2010 and insists it has solid disclosure and protection policies in place. But as the second annual ACC CardioSmart Health Fair throws open its doors to some of America's highest-risk citizens, some are asking whether the hundreds of thousands of dollars donated by a fast-food restaurant and soda company, among others, lead to more harm than good.

News

What's going to be hot at ACC 2011

Mar 29, 2011 09:45 EDT

Depending on how a host of big trials turn out, "less is more" may end up being the major lesson from this year's ACC meeting/i2 Summit, which is dominated by tiny devices and less invasive approaches. The line-up of late-breaking trials is also downsized this year: 17 trials spread over four sessions, although the overall number of oral abstracts is up 10%.

Discussion and opinions

Blogs

The Bob Harrington Show

#37: Reversible anticoagulation in RADAR with Dr Thomas Povsic

Jun 02, 2011 08:35 EDT

This week in cardiology from heartwire

#85: RADAR: Novel anticoagulation system; Dabigatran 150mg twice daily; the Rheos system; Lost in transition:...

Apr 15, 2011 15:50 EDT

Cutting-edge dialogues with Drs Tim Gardner and Mat Williams

Surgeons and interventionalists partner to ensure best care

Apr 11, 2011 11:00 EDT

1 comments

Heart failure and transplantation with Dr Ileana Piña

STICH: Focusing on the "crossover" patients

Apr 08, 2011 12:30 EDT

This week in cardiology from heartwire

#84: TAVI matches surgery in PARTNER cohort A; PARTNER B cost-effectiveness; MAGELLAN on rivaroxaban in...

Apr 08, 2011 11:25 EDT

Private practice with Dr Seth Bilazarian

Shaking up the DES arena with safer, more efficacious newcomers

Apr 06, 2011 13:15 EDT

Clotblog with Dr Samuel Goldhaber

MAGELLAN trial passes "proof-of-principle" test

Apr 06, 2011 09:35 EDT

Heartfelt with Dr Melissa Walton-Shirley

MAGELLAN on VTE, EXCELLENT on antiplatelets, and OSCAR on antihypertensives

Apr 05, 2011 18:50 EDT

Trials and PIs

Rivaroxaban vs enoxaparin for the Prevention of Venous Thromboembolism in Acutely Ill Medical Patients with...

Apr 05, 2011 13:43 EDT

Trials and PIs

PROTECTION-AMI with Dr Michael Lincoff

Apr 05, 2011 13:42 EDT

Trials and PIs

NAGOYA HEART Study with Dr Toyoaki Murohara

Apr 05, 2011 13:41 EDT

Trials and PIs

EXCELLENT with Dr Hyeon-Cheol Gwon

Apr 05, 2011 13:39 EDT

Heartfelt with Dr Melissa Walton-Shirley

Discussing science, anecdote, and opinion: Up in arms after RIVAL?

Apr 05, 2011 01:14 EDT

5 comments

Heartfelt with Dr Melissa Walton-Shirley

STICH, EVEREST, RIVAL, and top interventional trials from ACC 2011

Apr 04, 2011 23:00 EDT

Trials and PIs

PRECOMBAT with Dr Seung-Jung Park

Apr 04, 2011 17:00 EDT

Trials and PIs

Surgical Treatment for Ischemic Heart Failure Trial with Dr Robert Bonow

Apr 04, 2011 16:54 EDT

Trials and PIs

EVEREST II: Two-year outcomes with Dr Ted Feldman

Apr 04, 2011 16:48 EDT

1 comments

Trials and PIs

TAVI vs SAVR in PARTNER with Dr Craig Smith

Apr 04, 2011 16:42 EDT

Trials and PIs

RIVAL with Dr Sanjit Jolly

Apr 04, 2011 16:36 EDT

Private practice with Dr Seth Bilazarian

Radial didn't beat its rival

Apr 04, 2011 16:00 EDT

1 comments

Heartfelt with Dr Melissa Walton-Shirley

ACC Day 1: Dr Ralph Brindis and the doctrine of cardiovascular ecumenism

Apr 04, 2011 01:03 EDT

4 comments

Heartfelt with Dr Melissa Walton-Shirley

TAVI vs surgery: Mortality data and cost-effectiveness in PARTNER A and B

Apr 03, 2011 23:45 EDT

Trials and PIs

REMEDIAL II with Dr Carlo Briguori

Apr 03, 2011 23:45 EDT

Trials and PIs

Surgical Treatment of Ischemic Heart Failure Trial with Dr Eric Velazquez

Apr 03, 2011 23:35 EDT

Trials and PIs

RAPS with Dr Stephen Fremes

Apr 03, 2011 23:09 EDT

Trials and PIs

PARTNER (cohort B) with Dr Matthew Reynolds

Apr 03, 2011 19:46 EDT

Private practice with Dr Seth Bilazarian

PARTNER A: Evaluating "important but different hazards"

Apr 03, 2011 14:50 EDT

This week in cardiology from heartwire

#83: Hot topics at ACC 2011; noninvasive CV imaging for subclinical disease; Elizabeth Taylor and...

Apr 01, 2011 11:00 EDT

Late-Breaking Clinical Trials I
ACC/i2 Joint Session
Sunday, April 3, 2011, 8:00–10:05 am
Ernest N Morial Convention Center, Joint Main Tent: La Nouvelle

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		Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement in "High Risk" Patients with Aortic Stenosis: The Randomized PARTNER Trial Craig R Smith, Columbia University, New York, NY 9:15 AM–9:30 AM
		Panel discussion 9:30 AM–9:45 AM
		Lifetime Cost Effectiveness of Transcatheter Aortic Valve Implantation Compared with Standard Care among Inoperable Patients with Severe Aortic Stenosis: Results from the Randomized PARTNER Trial (Cohort B) Matthew R Reynolds, Beth Israel Deaconess Medical Center, Boston, MA 9:45 AM–9:57 AM
		Panel discussion 9:57 AM–10:05 AM

Late-Breaking Clinical Trials II
ACC/i2 Joint Session
Monday, April 4, 2011, 8:00–9:30 am
Ernest N Morial Convention Center, Joint Main Tent: La Nouvelle

		Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease (PRECOMBAT) trial Seung-Jung Park, Asan Medical Center, Seoul, South Korea 8:00 AM–8:17 AM
		EVEREST II Randomized Clinical Trial: Two Year Outcomes Ted Feldman, Evanston Northwestern Healthcare, Evanston, IL 8:17 AM–8:34 AM
		Medical Therapy with or without Coronary Artery Bypass Graft Surgery in Patients with Ischemic Cardiomyopathy: Results of the Surgical Treatment of Ischemic Heart Failure Trial Eric J Velazquez, Duke University, Durham, NC 8:34 AM–8:51 AM
		Influence of Myocardial Viability on Outcome of Patients with Coronary Artery Disease and Left Ventricular Dysfunction Undergoing Medical Therapy with and without Surgical Revascularization: Results of the Surgical Treatment for Ischemic Heart Failure Trial Robert O Bonow, Northwestern University Medical School, Chicago, IL 8:51 AM–9:08 AM
		Radial Artery and Saphenous Vein Patency More than Five Years Following Coronary Artery Bypass Surgery: Results from the Randomized Multicentre Radial Artery Patency Study (RAPS) Stephen E Fremes, Sunnybrook Health Sciences Centre, Toronto, ON 9:08 AM–9:25 AM

Late-Breaking Clinical Trials III: Interventional Cardiology
ACC/i2 Joint Session
Monday, April 4, 2011, 10:45 am–12:15 pm
Ernest N Morial Convention Center, Joint Main Tent: La Nouvelle

		Long-Term Outcomes after Use of Drug-Eluting Stents and Bare Metal Stents for the Treatment of Saphenous Vein Graft Lesions: Results of the Randomized ISAR-CABG Trial Julinda Mehilli, Deutsches Herzzentrum, Munich, Germany 10:45 AM–11:03 AM
		Rival Trial: A Randomized Comparison of Radial versus Femoral Access for Coronary Angiography or Intervention in Patients with Acute Coronary Syndromes Sanjit S Jolly, Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON 11:03 AM–11:21 AM
		One Year Clinical Outcomes from the Pivotal Multicenter RESOLUTE US Study Martin B Leon, Columbia University Medical Center, New York City, NY 11:21 AM–11:39 AM
		A Prospective, Randomized, Investigation of a Novel Platinum Chromium Everolimus-Eluting Coronary Stent: The PLATINUM Trial Gregg W Stone, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY 11:39 AM–11:57 AM
		Renal Insufficiency Following Contrast Media Administration Trial II (REMEDIAL II): Renalguard System In High-risk Patients For Contrast-induced Acute Kidney Injury Carlo Briguori, Clinica Mediterranea, Naples, Italy 11:57 AM–12:15 PM

Late-Breaking Clinical Trials IV
ACC/i2 Joint Session
Tuesday, April 5, 2011, 8:00–9:30 am
Ernest N Morial Convention Center, Joint Main Tent: La Nouvelle

		Rivaroxaban Compared with Enoxaparin for the Prevention of Venous Thromboembolism in Acutely Ill Medical Patients Alexander Cohen, Bayer HealthCare AG, Leverkusen, Germany 8:00 AM–8:17 AM
		The Comparison of High-dose Angiotensin II Receptor Blocker (ARB) Monotherapy versus Combination Therapy of ARB with Calcium Channel Blocker on Cardiovascular Events in Japanese Elderly High-Risk Hypertensive Patients: Olmesartan and Calcium Antagonists Randomized (OSCAR) Study Hisao Ogawa, Kumamoto University, Kumamoto, Japan 8:17 AM–8:34 AM
		Comparison between Valsartan and Amlodipine Regarding Cardiovascular Morbidity and Mortality in Hypertensive Patients with Glucose Intolerance (NAGOYA HEART Study) Toyoaki Murohara, Nagoya University School of Medicine, Nagoya, Japan 8:34 AM–8:51 AM
		Selective Inhibition of Delta Protein Kinase C to Reduce Infarct Size after Primary Percutaneous Intervention for Acute Myocardial Infarction: The PROTECTION-AMI Phase IIb Clinical Trial A Michael Lincoff, Cleveland Clinic, Cleveland, OH 8:51 AM–9:08 AM
		The Randomized Comparison of Six-Month versus 12-Month Duration of Dual Antiplatelet Therapy after Implantation of Drug Eluting Stent: From Comparison of Everolimus versus Sirolimus-Eluting Stents for Coronary Revascularization (EXCELLENT) Trial Hyeon-Cheol Gwon, Samsung Medical Center, Seoul, South Korea 9:08 AM–9:25 AM