ESC 2009 - Cardiology Conference Coverage

Heartwire

Heart failure

B-CONVINCED: Maintain beta blockers during acute heart-failure management

2 COMMENTS - Sep 14, 2009 10:30 EDT

Short-term outcomes are the same whether beta blockers are continued or withheld at hospitalization for acute decompensated heart failure, and there are good reasons to continue them, according to researchers.

Acute Coronary Syndromes

Nationwide smoking ban cuts incidence of acute coronary syndrome in nonsmokers

Sep 14, 2009 09:45 EDT

A smoking ban in public places throughout Iceland resulted in a 21% reduction in ACS among nonsmoking men.

Clinical cardiology

Ivabradine BEAUTIFUL in subset of patients with angina and heart rates >70 bpm

1 COMMENT - Sep 10, 2009 16:00 EDT

Ivabradine may reduce major cardiovascular events in patients with stable CAD and LV dysfunction who present with limiting angina, BEAUTIFUL investigators say in a post hoc analysis.

Arrhythmia/EP

Implantable ECG loop recorder differentiates between syncope and epilepsy

Sep 9, 2009 11:00 EDT

Is it syncope? Or is it epilepsy? When there's doubt, an implantable ECG loop recorder can help make the correct diagnosis.

Prevention

New ESC guidelines on infective endocarditis

7 COMMENTS - Sep 9, 2009 09:45 EDT

The ESC issues new recommendations on the prevention, diagnosis, and treatment of infective endocarditis—"an old but changing disease." The guidance with respect to antibiotic prophylaxis is similar to US advice, experts say.

Lipid/Metabolic

Elderly patients in JUPITER benefit from statin therapy

Sep 8, 2009 16:30 EDT

The analysis showed that adults >70 years of age had a smaller reduction in relative risk in cardiovascular events compared with those younger than 70 years old but larger absolute reductions, resulting in a lower number needed to treat, particularly for more serious adverse events, according to investigators.

Heart failure

ARB/ACE-inhibitor combo not recommended in CHF

1 COMMENT - Sep 8, 2009 15:45 EDT

An individual patient-data meta-analysis of the studies to date of angiotensin-receptor blockers and ACE inhibitors in heart failure might help identify those candidates who could benefit from this drug combo, say Swiss researchers. But in the meantime, it should be avoided.

Prevention

Experts question routine aspirin for patients with type 2 diabetes

3 COMMENTS - Sep 8, 2009 12:30 EDT

Not all patients with type 2 diabetes respond in the same way to aspirin, and its routine use in the primary prevention of cardiovascular events in this population needs careful evaluation in large randomized controlled trials, experts say.

Interventional/Surgery

Manual thrombectomy during PCI for STEMI improves survival: ATTEMPT

Sep 8, 2009 10:30 EDT

Thrombectomy with manual thrombus-aspirating catheters significantly improved one-year survival in STEMI patients undergoing PCI in a pooled analysis of 11 randomized trials.

Heart failure

European CRT Survey: Indications in real life often ahead of guidelines

Sep 4, 2009 17:30 EDT

In Europe, cardiac resynchronization therapy in clinical practice is applied to many patients for whom there is no supporting clinical-trial evidence, including those with atrial fib and patients older than 75.

Clinical cardiology

First ESC guidelines for noncardiac surgery support use of beta blockers

Sep 4, 2009 13:45 EDT

The first-ever European recommendations to help cardiologists manage patients undergoing noncardiac surgery have been issued; advice focuses on medical therapy, including beta blockers, and judicious use of testing based on patient risk, attendees at the ESC 2009 meeting heard.

Interventional/Surgery

Music therapy lowers blood pressure and reduces reinfarction rates in ACS

5 COMMENTS - Sep 4, 2009 11:15 EDT

A new study presented this week showed that music therapy reduced blood pressure, heart rate, and patient anxiety and had a significant effect on future events, including reinfarction and sudden death.

Clinical cardiology

What if regular exercise were as good as a stent for stable angina?

Sep 4, 2009 10:30 EDT

That question may never be answered, after the multicenter PET study fizzled due to a lack of enthusiasm by enrolling centers, which may have been loathe to give up revenues that PCI brings in. Never mind that exercise seemed better at improving event-free survival.

Prevention

Interventional cardiologists at risk of developing cataracts

2 COMMENTS - Sep 3, 2009 14:15 EDT

More effort must be made to encourage interventional cardiologists to use protective eyewear, conclude the authors of the largest-ever study looking at radiation-induced eye damage among medical professionals.

Interventional/Surgery

Hospital mortality from PCI is unrelated to procedural volume

2 COMMENTS - Sep 2, 2009 17:00 EDT

It makes no difference whether PCI—whether elective or urgent—is done in low- or high-volume centers. The hospital mortality is still the same, German researchers report.

Arrhythmia/EP

RE-LY subanalysis: Choose dabigatran in atrial fib even after successful warfarin therapy?

Sep 2, 2009 16:00 EDT

Patients in the trial who had a history of warfarin therapy and those who were naive to warfarin when they entered the trial benefited about equally from taking the new oral anticoagulant, researchers said.

Interventional/Surgery

Non-TIMI major bleeding just as important as TIMI major bleeding in predicting mortality in PCI patients

1 COMMENT - Sep 2, 2009 15:00 EDT

A new pooled analysis of REPLACE-2, ACUITY, and HORIZONS-AMI drums home the need for one universal definition of bleeding to be used in all trials, and efforts to make this happen are under way.

Heart failure

MAGGIC confirms lower mortality in preserved-EF heart failure

5 COMMENTS - Sep 2, 2009 13:30 EDT

Heart failure with preserved ejection fraction should be considered a different condition from heart failure with impaired ejection fraction, with the former having much lower mortality, a new individual patient-data meta-analysis has shown.

Arrhythmia/EP

Real-world registry study confirms MADIT 2 results

Sep 2, 2009 12:15 EDT

Survival at 36 months was the same as in MADIT 2, sicker patients had slightly more benefit, and implantation 11 months or more after the index MI was associated with superior survival. Trouble is, very few patients actually got a device.

Interventional/Surgery

SYNTAX year two: Significantly higher MI rate in PCI arm, no increase in CABG strokes after 12 months

2 COMMENTS - Sep 2, 2009 11:15 EDT

The overall results so far suggest that CABG, as expected, is pulling ahead. But more details on types of MI, as well as further follow-up, will be needed, experts say, before any hard conclusions are made about the best treatment for multivessel and left main disease.

Interventional/Surgery

FFR-guided PCI benefits confirmed at 18 months: The FAME study

2 COMMENTS - Sep 2, 2009 09:15 EDT

Confirming the results seen at one year, the 18-month data suggest that clinicians could reduce events and save money by stenting only hemodynamically significant lesions.

Heart failure

Rolofylline fails to PROTECT in acute heart failure

Sep 1, 2009 12:45 EDT

The adenosine antagonist was no more effective than placebo in the treatment of acute heart failure and was also associated with a higher incidence of stroke and seizure in the PROTECT trial.

Arrhythmia/EP

Irbesartan in atrial fibrillation: No overall benefit, but it may prevent later heart failure

Sep 1, 2009 11:30 EDT

The study missed its primary end point, but the ACTIVE investigators see a silver lining with irbesartan in AF patients treated with the drug, saying that the secondary reduction in heart-failure hospitalizations is "believable" and clinically useful. One expert, however, said that irbesartan adds little clinical benefit to these already well-treated patients.

Acute Coronary Syndromes

KYOTO HEART study not quite sufficient to extend the role of ARBs to first-line therapy

3 COMMENTS - Sep 1, 2009 10:30 EDT

Despite showing an impressive 45% reduction in stroke with valsartan add-on therapy compared with non-ARB add-on treatment in high-risk hypertensive patients in Japan, the findings of the KYOTO HEART study are not strong enough to support ARB use as first-line therapy in Western populations, say expert observers.

Acute Coronary Syndromes

TRITON-TIMI 38 reassures on PPI interaction with thienopyridines

Sep 1, 2009 05:20 EDT

Data from a second, much smaller study (PRINCIPLE-TIMI 44) show a modest reduction in platelet inhibition with both clopidogrel and prasugrel in patients taking a PPI, but the TRITON results suggest that this is not clinically relevant.

Heart failure

MADIT-CRT: Resynchronization therapy cuts heart-failure risk in patients with only mild disease

Sep 1, 2009 02:00 EDT

UPDATED WITH COMMENTARY // The trial, which randomized NYHA class 1-2 patients to receive defibrillators with or without cardiac resynchronization pacing, potentially broadens the population of heart-failure patients who might significantly benefit from the devices.

Arrhythmia/EP

GISSI-HF trial finds marginal statin effect against new atrial fib

1 COMMENT - Aug 31, 2009 18:00 EDT

Rosuvastatin's effect was weak in a post hoc analysis of the randomized trial and reached significance only after much statistical adjustment, leaving researchers unenthused.

Interventional/Surgery

Primary angioplasty bests thrombolysis in very elderly AMI patients: TRIANA

Aug 31, 2009 17:15 EDT

Very elderly patients with acute MI fare better when treated with primary angioplasty than with thrombolytic therapy, Spanish researchers say.

Interventional/Surgery

PCI "preferred" strategy in left main disease, despite lack of randomized trials: GRACE registry

Aug 31, 2009 13:30 EDT

PCI is associated with an early in-hospital mortality risk in left main disease, primarily because higher-risk patients undergo PCI rather than being referred for surgery, but both CABG and PCI improve survival compared with conservative medical therapy from hospital discharge to six months.

Acute Coronary Syndromes

GP IIb/IIIa inhibitor of no benefit in AMI patients with cardiogenic shock

Aug 31, 2009 12:00 EDT

Seriously ill patients with acute MI complicated by cardiogenic shock did not benefit from the routine use of abciximab during primary PCI, results of the PRAGUE-7 study show.

Acute Coronary Syndromes

NORDISTEMI: Transfer for PCI beneficial in patients given lysis in remote areas

1 COMMENT - Aug 31, 2009 11:00 EDT

Results suggest that early PCI after fibrinolysis is worth it even when very long transfers are involved.

Interventional/Surgery

ISAR-TEST-4: Bioerodable polymer, rapamycin-coated stent equal to Cypher/Xience at 12 months

Aug 31, 2009 09:45 EDT

Bioerodable polymers may offer a solution to the stent-thrombosis problem that plagues permanent-polymer drug-eluting stents, particularly if efficacy is equivalent. More follow-up is needed, experts say.

Prevention

Use of low-dose aspirin in primary prevention of cardiovascular events not recommended

7 COMMENTS - Aug 30, 2009 16:00 EDT

The routine use of aspirin for the prevention of vascular events in the general population deemed at risk because of an abnormal ABI is not warranted, as the danger of bleeding outweighs any potential benefit.

Interventional/Surgery

Embers still smoldering from the 2006 ESC firestorm, as experts mull DES safety and efficacy

1 COMMENT - Aug 30, 2009 13:00 EDT

Experts reviewing meta-analyses, registry studies, and randomized trial data that have emerged since the galvanizing presentations of the 2006 World Congress of Cardiology 2006 say they are, on the whole, reassured. But at least one presenter says the body of knowledge to date still offers a clear warning against stent-thrombosis risk with the more "potent" drug-eluting stents.

Acute Coronary Syndromes

CURRENT OASIS-7: Benefit to doubling clopidogrel dose in ACS patients undergoing PCI

9 COMMENTS - Aug 30, 2009 11:45 EDT

UPDATED WITH COMMENTARY // Doubling the loading and maintenance doses of clopidogrel in acute coronary syndrome patients who underwent planned PCI significantly reduces stent thrombosis and cardiovascular events, largely driven by reductions in MI, without a significant increase in major bleeding, report researchers.

Brain/Kidney/Peripheral

RE-LY: Oral antithrombin dabigatran outshines warfarin in atrial fib

17 COMMENTS - Aug 30, 2009 02:00 EDT

UPDATED WITH COMMENTARY // Dabigatran safely and significantly cut the risk of stroke or peripheral embolic events compared with warfarin over two years in the huge randomized trial. Is the end of warfarin in sight for most patients with atrial fibrillation, at least those with other risk factors for stroke? Many observers think so.

Acute Coronary Syndromes

SEPIA-ACS1 TIMI 42: Mixed results for otamixaban in ACS

Aug 30, 2009 02:00 EDT

UPDATED // Intermediate doses of the new factor Xa inhibitor showed trends toward reduced event rates with a similar rate of bleeding compared with heparin/eptifibatide in this phase 2 study.

Acute Coronary Syndromes

PLATO shows benefits of ticagrelor over clopidogrel

8 COMMENTS - Aug 30, 2009 02:00 EDT

UPDATED WITH COMMENTARY // A new nonthienopyridine antiplatelet agent, ticagrelor, has trumped clopidogrel in a phase 3 pivotal trial comparing the two agents and appears not to have the bleeding risks associated with prasugrel. But ticagrelor, which has the advantage of being reversible, has some unique side effects that could prove problematic.