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Reviparin in acute myocardial infarction improves mortality
and reduces re-infarction
6/11/04 - 10/11/04, New Orleans, LA
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Scientific Sessions, the largest cardiovascular meeting
in the world, is being held in New Orleans Nov. 610.
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HAMILTON, ONTARIO (Nov. 8, 2004)--A major Canadian-led
global study has found that an inexpensive anti-blood-clotting
drug significantly reduces death and repeat heart attacks
without increasing the risk of stroke.
The study is of significance to patients in all countries,
including developing countries where access to high-tech
treatments for cardiovascular problems may be limited.
The CREATE randomized trial (Clinical trial
of Reviparin and mEtabolic modulation in Acute
myocardial infarction Treatment Evaluation) is a
clinical trial of low molecular weight heparin (LMWH a blood
thinner) and glucose-insulin-potassium (GIK) infusion in
patients presenting at emergency wards with suspected acute
myocardial infarction (persistent ST elevation or new left
bundle branch block) across China and India. It was initiated and coordinated in
Canada and enrolled more than 15,500 people in China, India and
Pakistan. Heart attack patients were given Reviparin, a low
molecular weight heparin, or a placebo, twice daily for seven
days.
The four-year study showed that the risk of deaths, heart
attacks and strokes were reduced by about one-sixth. This means
that treating 1,000 patients for a week would prevent about 15
to 20 individuals from dying or suffering a new heart attack.
The study also showed that the benefits were greater, the
earlier the treatment was used after the onset of symptoms. In
those who were treated within two hours of symptom onset, the
death rate was lowered by about 30 per cent.
The study was presented today at the Scientific Sessions of
the American Heart Association conference in New Orleans by
co-investigators Dr. Salim Yusuf and Dr. Shamir Mehta of the
Population Health Research Institute at Hamilton Health Sciences
and McMaster University. Dr. Yusuf is a professor of medicine at
the Michael G. DeGroote School of Medicine at McMaster
University, director of the Population Health Research Institute
and holds an endowed chair of the Heart and Stroke Foundation of
Ontario. Dr. Mehta is an associate professor of medicine at the
Michael G. DeGroote School of Medicine, member of the Population
Health Research Institute and a clinician scientist with the
Canadian Institutes of Health Research.
Although the effectiveness of antithrombolytic therapy with
LMWH has been well established in treating unstable angina (and
non-Q wave MI), its efficacy in patients with suspected AMI has
not been established. There have been no randomized controlled
trials (RCTs) with adequate power to determine if LMWH will
improve mortality or re-infarction. A moderate reduction in
vascular events with use of LMWH treatment in AMI would have a
major impact on AMI prognosis globally.
"Reviparin is a simple and relatively inexpensive anti-thrombotic
therapy, which can be used in both developed and developing
countries to reduce mortality for acute myocardial infarction,"
said Dr. Yusuf. "It is more affordable than newer anti-thrombotics,
simple to use and of benefit in addition to the broad range of
therapies of proven and established value. It is the only
treatment for a heart attack that has been convincingly
demonstrated to reduce mortality in a single study over the last
decade."
Dr. Mehta said: "The reduction in mortality with Reviparin is
truly remarkable since no other drug in this class has shown
similar benefits and the fact the drug was tested on top of
already proven therapies."
About 15.5 million people die worldwide from cardiovascular
deaths each year and about half of these are due to acute
myocardial infarction, with the majority occurring in low and
middle-income countries, Dr. Yusuf noted.
"Low cost therapies are obviously more invaluable than
expensive ones," he said. "This therapy could be used not only
in wealthy countries, but also in small medical centres in low
and middle income countries. It has the potential to benefit
more than a million individuals annually."
In a companion study, also presented today at the American
Heart Association meeting, Drs. Mehta and Yusuf evaluated the
role of high dose glucose-insulin-potassium (GIK) solution in
20,000 patients. The solution is thought to preserve heart
muscle and prevent it from dying during the acute stages of a
heart attack.
The study results show that GIK had a neutral effect, but the
authors wonder whether a solution that had a lower glucose
concentration may be of benefit.
"It is important to conduct large studies of promising agents
to determine whether or not they are of value," said Dr. Mehta.
"While demonstrating that something is of benefit is wonderful,
reliably excluding agents are not helpful is equally important
as it will avoid their unnecessary use and associated costs.
This is particularly important for therapies such as GIK that
may never otherwise be studied because they are of no commercial
value but have the promise to help many thousands of lives."
Dr. John Kelton, dean of the Michael G. DeGroote School of
Medicine and dean and vice-president, Faculty of Health
Sciences, McMaster University, said: "This important study
represents one of the first in many years that is bringing in a
new drug that will produce a significant reduction in deaths
from heart attack. Perhaps more importantly, I see a future
treatment given by ambulance attendants where a person suspected
of having a heart attack is given an aspirin and an injection of
this heparin-like drug. The lives saved in Canada and around the
world would be dramatic."
Mr. Murray Martin, President and CEO of Hamilton Health
Sciences of Hamilton, said: "Part of our mission as an academic
teaching hospital is to advance health care through education
and research. We commend Dr. Yusuf and Dr. Mehta for their
leadership and commitment to investigating best practices and
finding better ways to help people around the world deal with
important health issues."
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Sources
American Heart Association - scientific sessions - 6/11/04 - 10/11/04, New Orleans, LA Legal Disclaimer
The materials presented here were prepared by independent authors
under the editorial supervision of The Doctors Lounge, and do not represent a
publication of the American Heart Association. These
materials and the related activity are not sanctioned by the American
Heart Association or the commercial supporter of the
conference, and do not constitute an official part of that conference.
The material presented here does not reflect the views of The Doctors
Lounge or
the companies providing unrestricted educational grants. These materials
may discuss uses and dosages for therapeutic products that have not been
approved by the United States Food and Drug Administration. A qualified
health care professional should be consulted before using any
therapeutic product discussed. All readers or continuing education
participants should verify all information and data before treating
patients or employing any therapies described in this educational
activity.
Copyright © 2004 The Doctors Lounge.
| Article reviewed by: |
Dr. Tamer Fouad, M.D.
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