Webs de Interes
AMERICAN HEART 2006 Guidewire DES minus the stent: Paclitaxel-coated balloon suppresses in-stent restenosis in small pilot study The strategy avoids some of the limitations of contemporary drug-eluting stent procedures and could have important interventional roles to play if its early potential is borne out in larger future trials. (Scheller B et al. N Engl J Med 2006; 355:2113-2124. American Heart Association 2006 Scientific Sessions.) [14 Nov] Guidewire Harm or benefit? Mixed messages from DES registries A new "real-world" registry suggests that drug-eluting stents may increase all-cause death and revascularizations out to three years, but other registry findings, over the shorter term, show reduced revascularizations and no safety concerns. What experts agree on is that large-scale trials are desperately needed to resolve conflicting information from registry analyses. (American Heart Association 2006 Scientific Sessions.) [14 Nov] Medscape Medical News Pioglitazone slows progression of carotid atherosclerosis vs glimepiride Results of a head-to-head comparison of two antidiabetes drugs have shown an advantage for pioglitazone over glimepiride in reducing progression of carotid intima-media thickness in patients with type 2 diabetes. (Mazzone T et al. JAMA; published online before print November 13, 2006; American Heart Association 2006 Scientific Sessions.) [13 Nov] MEDAL: Etoricoxib shows same thrombotic cardiovascular risk as diclofenac Both drugs were similar in effectiveness against arthritis symptoms, but diclofenac was associated with more upper-GI and hepatic events, whereas etoricoxib showed more heart failure and discontinuations due to edema and hypertension. Discussion is focusing on whether diclofenac was the appropriate comparator drug, as it is also believed to carry an increased cardiovascular risk. (Cannon CP et al. Lancet; published online before print November 13, 2006. American Heart Association 2006 Scientific Sessions.) [13 Nov] FAME: Pharmacy-care program improves medication adherence, as well as BP and LDL-cholesterol levels A new study has shown that a comprehensive-care program, one that involves pharmacists and focuses on patient education, dramatically improves drug adherence. It is also associated with improvements in blood pressure and LDL-cholesterol levels. (Lee JK et al. JAMA; published online before print November 13, 2006. American Heart Association 2006 Scientific Sessions.) [13 Nov] Cremation of the homocysteine hypothesis: Another folic-acid trial fails to impress Yet another study has shown no benefit of folic acid and B vitamins in the secondary prevention of cardiovascular events, leading researchers to conclude that there is no reason for anyone to take these supplements for the prevention of heart disease. The trial also showed that the fortification of food with folic acid in the US does not explain the negative findings. (American Heart Association 2006 Scientific Sessions.) [13 Nov] Noninvasive microvolt T-wave alternans test for selective targeting of primary-prevention ICDs gets more trial support The ECG-like test can help target the devices to patients most likely to need them, confirms a study that also supports a possible complementary but selective screening role for traditional electrophysiologic testing, according to some experts. (American Heart Association 2006 Scientific Sessions.) [16 Nov] Medscape Medical News Migraine linked to increased CVD risk in men A new report from the Physicians' Health Study suggests that, as in women, men with migraine face a higher risk for cardiovascular disease, particularly myocardial infarction, over time. (American Heart Association 2006 Scientific Sessions.) [16 Nov] Canadian study indicates BNP test for suspected heart failure is cost-effective A new Canadian study looking at the use of BNP testing in patients with shortness of breath presenting to the emergency department has found that the assay saved almost $1000 per patient, by helping doctors better decide who had and who did not have heart failure. Although BNP testing is widely used in the US and some other countries, Canada's publicly funded healthcare system has yet to embrace it, says the investigator. (American Heart Association 2006 Scientific Sessions.) [15 Nov] Heart failure Pilot study shows ablation is superior to biventricular pacing for treatment of AF in CHF patients Pulmonary vein isolation is superior to biventricular pacing for the treatment of atrial fibrillation in chronic heart failure patients, a new study shows. Although the procedure is technically demanding, one expert suggests that curative ablation could become the standard of care for the treatment of atrial fibrillation in this patient population. (American Heart Association 2006 Scientific Sessions) [15 Nov] No MAGIC cure for ischemic cardiomyopathy with autologous myoblasts, but LV remodeling effects "encouraging" Neither a high nor a low dose of myoblast cells injected during CABG improved local contractility or global function better than placebo injections; however, the high dose, consisting of 800 million myoblast cells, appeared to reverse LV remodeling. (American Heart Association 2006 Scientific Sessions.) [15 Nov] ACUITY statistics challenged Cardiologist Dr Sanjay Kaul has suggested that the definition of noninferiority used in the latest bivalirudin trial was not strict enough and that the drug would not have met the criteria he considers more appropriate. (American Heart Association 2006 Scientific Sessions.) [15 Nov] Heart failure Death is an option: The benefit of ICDs is "not as big as we think" Patients and doctors grossly overestimate the benefits of implantable cardiac defibrillators, new studies show. Physicians must have candid discussions with their patients to quantify the true benefits of these devices, to explain that most people will still die from heart failure in the long run, and to raise the issue of advance directives, the researchers say. (American Heart Association 2006 Scientific Sessions.) [14 Nov] APEX AMI: Adjuvant anti-inflammatory antibody a bust at PCI for acute MI The trial's "important" negative outcomes signal the end of an era for attempts to limit myocardial damage by suppressing inflammatory responses to infarction, according to some experts. (American Heart Association 2006 Scientific Sessions.) [14 Nov] Guidewire PCI no better than optimal medical therapy in persistent total occlusions three to 28 days post-MI: OAT and TOSCA-2 Late angioplasty for occluded infarct-related arteries is no better than medical management in reducing rates of death, reinfarction, or heart failure and may even increase reinfarction rates, despite the presence of patent arteries and less LV enlargement. The findings are a reproof to clinicians who prematurely decided, long before the results were in, that PCI would be superior. (Hochman JS et al. N Engl J Med; published online before print November 14, 2006. Dzavik V et al. Circulation; published online before print November 14, 2006. American Heart Association 2006 Scientific Sessions.) [14 Nov] Heart failure SALT 1 and 2: Tolvaptan shows promise in hyponatremia Results of two trials of an oral vasopressin V2-receptor antagonist show that treatment effectively increased serum sodium concentrations in patients with euvolemic or hypervolemic hyponatremia. (Schrier RW et al. N Engl J Med 2006; 355:2099-2112; American Heart Association 2006 Scientific Sessions.) [14 Nov] Atrial natriuretic peptide reduces infarct size and increases ejection fraction in STEMI patients The new J-WIND study, a Japanese study conducted in 65 hospitals, showed that it might be possible to reduce infarct size and increase ejection fraction with carperitide, a novel human atrial natriuretic peptide. One expert cautions, however, that despite the positive outcomes, preclinical work in animals and early human studies have yet to see reductions in infarct size translated into clinical benefit. (American Heart Association 2006 Scientific Sessions.) [14 Nov] Guidewire ACC/AHA launch D2B initiative; new study highlights key ingredients for closing the gaps As previously reported by heartwire, the D2B initiative is a Guidelines Applied in Practice program that aims to increase the percentage of AMI patients who receive primary angioplasty within 90 minutes of hospital presentation to 75%; currently, only 35% of patients are treated within the recommended 90-minute window. (American Heart Association 2006 Scientific Sessions.) [13 Nov] Magnetic cells could improve endothelialization of stents and reduce in-stent restenosis A novel idea that may offer a solution to the problem of subacute thrombosis seen with drug-eluting stents involves magnetically targeting endothelial cells to the stent. Antirestenosis genes could also be introduced, giving a possible dual benefit to this strategy, which has shown proof of concept in animal studies. (American Heart Association 2006 Scientific Sessions.) [13 Nov] Heart failure Selective TZD use won't exacerbate HF symptoms in diabetics with heart failure, says analysis Many diabetics with established heart failure can apparently take thiazolidinediones safely, as long as they are carefully followed for signs of HF exacerbation, according to investigators. (American Heart Association 2006 Scientific Sessions.) [12 Nov] Heart failure Should all heart-failure patients receiving a device also get a defibrillator? The debate continues Drs William Abraham and Angelo Auricchio squared off today as they debated whether all implantable devices in left ventricular dysfunction patients should have defibrillation capability. Abraham argued that defibrillation is necessary to prevent sudden death, while Auricchio suggests that the cost is too high and the benefit too little in older patients. (American Heart Association 2006 Scientific Sessions.) [12 Nov] Postmortem device retrieval: patients unaware of options Most patients have no idea what happens to their implantable cardiac device after they die, a new survey reveals. But the majority would be prepared to write a "device living will" stipulating what should happen, researchers found. However, they might face a conflict in deciding what to do. (American Heart Association 2006 Scientific Sessions.) [12 Nov] Presence of calcium leads to improved use of statins, aspirin in asymptomatic men Researchers say their study is the first to show that a calcium score, above and beyond presence of traditional risk factors, influences physician management decisions. One can "reasonably infer" that patient outcomes would also improve. (American Heart Association 2006 Scientific Sessions.) [12 Nov]
AMERICAN HEART 2006
