AHA 2009 - Cardiology Conference Coverage

Heartwire

News

Full medical coverage means equivalent AMI care for poorest citizens in France

1 COMMENT - Nov 27, 2009 18:00 EST

Patients under age 60 in the lowest-income bracket in France can sign up for a full, no-user-fee medical coverage plan and, under this plan, receive identical care to AMI patients treated under the general health plan. But there are other socioeconomic factors that likely reduce survival and medication adherence over time, researchers say.

Arrhythmia/EP

From the dead: Gene tests of sudden cardiac death victims would aid diagnosis of relatives

Nov 27, 2009 14:00 EST

Researchers at a genomics clinic say that the assessment of the relatives of sudden cardiac death victims would be easier and cheaper if genetic testing, so-called molecular autopsy, could be performed on the deceased.

Imaging

AMI patients get 30% of annual maximum recommended radiation dose in one hospital admission

Nov 26, 2009 11:00 EST

Researchers say physicians and patients should think about radiation risks in a new way: not on a dose-per-test basis, but on the total dose per "episode of care."

Heart failure

Seattle Heart Failure Model shows promise as predictor of who needs an LVAD

Nov 25, 2009 16:45 EST

Data from the clinical trials of the HeartWare LVAD suggest the Seattle Heart Failure Model is a better predictor of mortality risk in prospective VAD recipients than heart-failure symptoms alone.

Lipid/Metabolic

JUPITER: Primary-prevention statin therapy in women cuts cardiovascular risk in half

20 COMMENTS - Nov 25, 2009 16:00 EST

The primary-prevention study showed that women with normal LDL cholesterol but elevated CRP levels treated with statins reduced their risk of cardiovascular events 46% compared with placebo-treated individuals.

Prevention

Study of different ethnic groups shows method of fish preparation affects cardiac benefits

4 COMMENTS - Nov 25, 2009 12:45 EST

A new study reveals a unique snapshot of the dietary habits of different ethnic groups and shows that eating fish per se is not necessarily beneficial, but that the method of cooking it is key.

Lipid/Metabolic

Vitamin D: A potential role in cardiovascular disease prevention

61 COMMENTS - Nov 24, 2009 14:30 EST

A new observational study shows an association between vitamin-D deficiency and cardiovascular disease and death. But definitive data are needed from randomized trials to confirm a beneficial role of this vitamin in CVD prevention, say researchers.

Lipid/Metabolic

Heart disease evident in mummies 3500 years old

Nov 23, 2009 17:15 EST

Contrary to views that heart disease is the result of modern humans' poor lifestyle, new research shows that even ancient Egyptians might have needed a stent or two.

Prevention

Obesity effects on glucose, blood pressure are offsetting gains in smoking status, cholesterol

1 COMMENT - Nov 23, 2009 15:30 EST

Despite improvements in lowering cholesterol and smoking status over the past 20 years, overall risk-factor profiles in American adults today are identical to those of men and women in the US two decades ago—likely due to rising obesity rates, a new study shows.

Medscape Medical News

Stroke incidence related to PCI steady over 15 years

2 COMMENTS - Nov 20, 2009 13:00 EST

Mayo Clinic researchers report that their stroke rate related to PCI has stayed steady for the last 15 years, something they interpret as good news, given that substantially older, sicker patients with more complex anatomy are now undergoing PCI.

Medscape Medical News

ALLHAT investigators report 10-year follow-up and stand by diuretics as first step antihypertensive treatment

17 COMMENTS - Nov 19, 2009 14:00 EST

New 10-year mortality and morbidity data confirm the original trial conclusions, they say, that while amlodipine and lisinopril are not superior to chlorthalidone on any outcome, chlorthalidone is superior to these agents on one or more secondary end points. Full agreement with this conclusion in the community, though, is still hard to come by.

Top Story

Oral anticoagulants REDEEMed? Daily dabigatran "safe" with dual antiplatelets after MI

Nov 19, 2009 11:00 EST

A dose-finding study saw what were characterized as low bleeding rates associated with triple-drug antithrombotic therapy that included the oral anticoagulant dabigatran in patients with a recent ACS event and other cardiovascular risk factors.

News

EFFECT: Public reporting of hospital performance improves quality of care?

Nov 19, 2009 10:00 EST

Publicly released report cards based on hospital performance did not result in a measurably greater systemwide improvement in two composite AMI or CHF process-of-care indicators in a Canadian study. But they did appear to stimulate some important changes in delivery of care that could have led to some better outcomes.

Murmurs

Kenneth Baughman killed while jogging at AHA

45 COMMENTS - Nov 19, 2009 08:30 EST

UPDDATED // Dr Kenneth Baughman, a cardiologist at Brigham and Women's Hospital, died Monday morning in Orlando, FL, when he was struck by a car while out for a morning run.

Interventional/Surgery

BARI 2D cost-effectiveness analysis favors medication over PCI for less severe CVD in diabetic patients

1 COMMENT - Nov 18, 2009 15:45 EST

New data from the BARI 2D trial comparing medical therapy vs revascularization in diabetics shows higher up-front costs of revascularization are only partially offset by long-term savings.

Thrombosis

Ticagrelor effects unraveled in new phase 2 trials

Nov 18, 2009 15:00 EST

New and unique phase 2 data add to the growing body of evidence explaining the pharmacologic effects of the new antiplatelet agent ticagrelor.

Imaging

CT-STAT: CT angiography rules out CAD faster and cheaper than standard care

14 COMMENTS - Nov 18, 2009 13:45 EST

The use of coronary CT angiography in the emergency room can successfully triage at-risk chest-pain patients and can do so faster and less expensively than standard diagnostic testing.

Interventional/Surgery

Baseline function data from STICH no help in pinpointing patients who benefit from SVR

Nov 18, 2009 10:45 EST

Measures of left ventricular dysfunction or wall motion identified by different imaging modalities at baseline offer no clues as to whether a subset of patients treated with surgical ventricular reconstruction might benefit from the procedure.

Lipid/Metabolic

Niacin not beneficial in patients at goal with statins: NIA Plaque

19 COMMENTS - Nov 18, 2009 09:00 EST

The addition of niacin to statin therapy in secondary-prevention patients resulted in a significant improvement in lipids but failed to significantly alter atherosclerotic disease progression as measured by MRI. Researchers say it's a win for treating patients to target and suggest this trumps raising HDL.

Acute Coronary Syndromes

ACC/AHA focused update of guidelines for STEMI, PCI

10 COMMENTS - Nov 18, 2009 09:00 EST

The latest evidence for the treatment of STEMI and PCI has been incorporated into a fast-track update of US guidelines. But questions remain about the quality of some of the evidence informing the guidelines and about the composition of the writing committees.

Heart failure

JCHF: Are low doses of carvedilol effective in heart failure?

4 COMMENTS - Nov 18, 2009 09:00 EST

Doses of carvedilol as low as 2.5 mg daily may be effective in Japanese patients with heart failure, according to this study. But experts said the trial was far too small to draw any meaningful conclusions.

Medscape Medical News

RE-LY: Post hoc analysis confirms benefit of dabigatran relative to warfarin at all INR levels

2 COMMENTS - Nov 17, 2009 16:30 EST

A new analysis confirms that regardless of INR control achieved across participating centers, dabigatran remained noninferior at the lower dose and superior at the higher dose to warfarin for prevention of stroke and systemic embolism.

Lipid/Metabolic

Statins do not eliminate risk of low HDL-cholesterol levels

4 COMMENTS - Nov 17, 2009 14:45 EST

Researchers say a new study shows that statins don't alter the risks associated with low HDL-cholesterol levels and that raising HDL cholesterol 10 mg/dL could prevent an additional eight MIs per 1000 patient-years.

Interventional/Surgery

POPE: No benefit of diclofenac on pericardial effusion

Nov 17, 2009 10:00 EST

Mean pericardial effusion grade postcardiac surgery was not reduced with 14 days of treatment with the NSAID.

Interventional/Surgery

CASCADE: No significant benefit of clopidogrel in reducing graft disease after CABG

9 COMMENTS - Nov 17, 2009 09:00 EST

Dual antiplatelet therapy did not significantly reduce vein graft intimal hyperplasia compared with aspirin alone over 12 months.

Heart failure

HEAAL: High-dose trumps low-dose ARB for heart failure in the ACE-inhibitor intolerant

1 COMMENT - Nov 17, 2009 08:15 EST

UPDATED WITH COMMENTARY // The randomized trial, which compared losartan dosages of 150 mg/day and 50 mg/day, "makes a strong case for the value of incremental inhibition of the renin-angiotensin system," its authors say.

Heart failure

HeartMate II continuous-flow VAD sets new benchmark in destination-therapy trial

Nov 17, 2009 08:00 EST

UPDATED WITH COMMENTARY // Thoratec's HeartMate II continuous-flow VAD keeps about half of patients alive and stroke- or reintervention-free after two years in pivotal destination therapy trial.

Heart failure

FAIR-HF: Symptom improvement, functional gains follow correction of iron deficiency in heart failure

6 COMMENTS - Nov 17, 2009 08:00 EST

UPDATED WITH COMMENTARY // The randomized, placebo-controlled study's intriguing wrinkle: the benefits after 24 weeks of treatment with an injectable form of iron were independent of whether the patients were anemic.

Brain/Kidney/Peripheral

Bypassing the blues: How simple collaborative care can help tackle depression after CABG surgery

Nov 16, 2009 18:45 EST

Depression after coronary artery bypass surgery is often overlooked by physicians but is associated with worse outcomes. A new US study illustrates a simple telephone-based approach to tackle this, with nurses encouraging patients to seek help from their primary-care doctors and providing ongoing feedback and review.

Interventional/Surgery

Postop anemia in high-CV-risk patients: No CV gains from fixed hemoglobin target in trial

Nov 16, 2009 17:45 EST

A randomized trial found no protection from in-hospital cardiovascular events with a strategy of blood transfusions to maintain hemoglobin above 10 g/dL, compared with a more conservative approach to transfusion therapy, in patients with CV disease or risk factors who underwent hip surgery.

Arrhythmia/EP

RECORD AF: Better success with rhythm control, but no difference in outcomes

Nov 16, 2009 17:00 EST

New registry data presented this week showed that cardiologists are more likely to select rhythm control over rate control for the treatment of atrial fibrillation, and this strategy is more likely to lead to successful treatment of AF than the rate-control-based approach. Both strategies are equivalent in terms of their effect on clinical outcomes.

Acute Coronary Syndromes

Cangrelor in CHAMPION: What went wrong?

2 COMMENTS - Nov 16, 2009 15:15 EST

Discussion is abounding on why cangrelor did not show benefit over clopidogrel despite the fact that it did inhibit platelet activity more effectively.

Clinical cardiology

Plasma renin activity associated with cardiovascular events and mortality in HOPE

1 COMMENT - Nov 16, 2009 14:45 EST

Patients with elevated baseline plasma renin activity levels had a twofold increased risk of total or cardiovascular mortality compared with those with low levels, and the strength of the association persisted after multiple adjustments, including the HOPE score, CRP, and BNP.

Arrhythmia/EP

REPLACE registry finds 15.3% six-month complication rate with pacer and ICD lead replacements

Nov 16, 2009 09:30 EST

The REPLACE registry finds "sobering" comprehensive risk rates with pacemaker and ICD upgrades.

Acute Coronary Syndromes

Good news continues for ticagrelor in PLATO STEMI subanalysis

1 COMMENT - Nov 15, 2009 19:30 EST

Ticagrelor, an investigational antiplatelet agent, may become a new standard of care for the management of patients with STEMI heading for primary PCI, said the lead investigator of the STEMI subset of the PLATO trial. Reporting the new findings here today, he said they were consistent with the overall PLATO results.

Lipid/Metabolic

ARBITER 6-HALTS: HDL raising with niacin superior to ezetimibe

81 COMMENTS - Nov 15, 2009 18:00 EST

Extended-release niacin is superior to ezetimibe in its effect on carotid intima-media thickness. While experts say the trial tells clinicians little about ezetimibe, it is a big win for niacin given the substantial regression of atherosclerosis observed at eight and 14 months.

Arrhythmia/EP

PACE: BiV pacing protects against RV pacing's adverse ventricular effects in randomized trial

Nov 15, 2009 16:30 EST

In patients with conventional indications for pacing and normal systolic function, preservation of synchrony with biventricular pacing prevented the adverse remodeling effects of right-ventricular-only pacing. But some question the trial's methods.

Thrombosis

Nov 15, 2009 14:15 EST

None of the eight platelet assays studied were able to predict bleeding, but four of the eight, based on ADP-induced platelet aggregation, produced results that correlated with adverse CV outcomes. By contrast, four tests that use shear-stress-induced adhesion-based methods were not predictive.

Interventional/Surgery

PEPCAD-3: Paclitaxel-coated-balloon/stent system misses mark in de novo coronary lesions

Nov 15, 2009 10:30 EST

Inflation of the paclitaxel-delivering balloon followed by a bare-metal stent failed a randomized noninferiority test against the Cypher sirolimus-eluting stent in previously untreated coronary lesions.

Interventional/Surgery

FRANCE: Transcatheter-valve registry permits "observation" of CoreValve, Sapien differences

Nov 15, 2009 09:45 EST

Results from one of the first registries to evaluate contemporary use of both the Edwards Sapien transcatheter valve and the CoreValve bioprosthesis show that complication rates are low and similar, following a short training period, and that mortality, at least out to six months, is "acceptable" for both types of devices.

Prevention

Canadian confusion: Primary-care docs lack knowledge of CVD risk factors, prevention

8 COMMENTS - Nov 15, 2009 09:00 EST

Family doctors and general practitioners in Canada are confused about cardiovascular risk assessment in primary prevention, a new survey reveals.

Interventional/Surgery

Two-year EXPIRA results suggest mechanical aspiration with primary PCI may reduce mortality

Nov 15, 2009 09:00 EST

Two-year follow-up results from the EXPIRA study show mechanical thrombectomy during primary PCI improves myocardial perfusion and may reduce mortality.

Interventional/Surgery

Experienced operators can switch easily and rapidly to radial-access PCI: RAPTOR

11 COMMENTS - Nov 15, 2009 08:30 EST

Experienced interventional cardiologists can rapidly shift their practice from the femoral-artery to the radial-access approach, with no increase in procedure time and radiation exposure for PCI. Also, the transradial approach leads to a more economic use of hospital resources, say researchers.

Acute Coronary Syndromes

CHAMPION: Negative trials but some positive angles for cangrelor?

2 COMMENTS - Nov 15, 2009 08:00 EST

Although neither CHAMPION-PCI nor CHAMPION-PLATFORM showed significant reductions in the primary end point with this new IV antiplatelet agent, some positive effects were seen, suggesting that the drug may yet have a future.

News

What's going to be hot at AHA 2009?

2 COMMENTS - Nov 11, 2009 09:00 EST

Anticipation is building for full trial results from ARBITER 6-HALTS, plus a better understanding of what went wrong with cangrelor in the CHAMPION trials. Also in the lineup are updates from PLATO, RE-LY, ALLHAT, BARI 2D, STICH, CASCADE, POPULAR, HEARTMATE II, and many more. Indeed, this year's "late-breaking" sessions include more than 30 trials over five days.