American College of Cardiology, March 29-31, 2009Last Updated: April 02, 2009.
The American College of Cardiology's 58th Annual Scientific Session took place March 29 to 31 in Orlando, Fla., attracted 14,800 professionals from around the world and presented 5,300 abstracts. Highlights included studies suggesting benefits from high doses of statins before percutaneous coronary intervention (PCI), the use of bare-metal stents in older patients, and an implantable device that helps prevent stroke in patients with atrial fibrillation.
In two studies, Italian researchers gave 80 milligrams of atorvastatin to either statin-naive or statin-taking patients within 24 hours of percutaneous coronary intervention. In the first study, Carlo Birguori, M.D., of Clinica Mediterranea in Naples, and colleagues found that a high dose of atorvastatin in statin-naive patients compared to no atorvastatin was associated with significantly lower rates of periprocedural myocardial infarction (9.5 percent versus 15.8 percent) and troponin elevation greater than three times the upper limit of normal (26.6 percent versus 39.1 percent).
In the second study, Germano Di Sciascio, M.D., of the University of Rome, and colleagues randomly assigned 352 statin-taking patients to receive either a high dose of atorvastatin or placebo and found that atorvastatin was associated with a 48 percent lower risk of major adverse cardiac events at 30 days.
"Even in the background of chronic statin therapy, there is still a clinical advantage of giving a further dose of atorvastatin prior to percutaneous coronary intervention," Di Sciascio said in a statement. "The findings have the potential to change current clinical practice, in that pre-loading with atorvastatin may now be indicated in all patients undergoing PCI, both those who are statin-naive, and those already taking statins chronically."
Another study, which was published online March 28 in the Journal of the American College of Cardiology, compared outcomes in 217,675 Medicare patients who received drug-eluting stents and 45,025 Medicare patients who received bare-metal stents. Led by Pamela S. Douglas, M.D., of Duke University in Durham, N.C., the researchers found that drug-eluting stents were associated with significantly lower adjusted rates of death (13.5 percent versus 16.5 percent) and myocardial infarction (7.5 percent versus 8.9 percent) without an associated increase in bleeding or stroke after 30 months.
"Drug-eluting stents seem to be safe and effective in community practice in the elderly population," Douglas and colleagues conclude. "Longer follow-up studies will need to be conducted to further support these results and to confirm the possible effects of antiplatelet agents."
"One of the most important late-breaking trials evaluated the Watchman device and showed that it helped prevent stroke in patients with atrial fibrillation," said meeting program chair Aaron Kugelmass, M.D., of the Henry Ford Pierce Clinic in Detroit. "Although the results were not completely definitive, they were very promising."
During the Embolic Protection in Patients With Atrial Fibrillation (PROTECT AF) trial, researchers randomly assigned 707 patients to receive either the Watchman device -- which is used to occlude the left atrial appendage where most blood clots occur during atrial fibrillation -- or standard warfarin therapy. They found that the Watchman group had a 32 percent lower risk of stroke and cardiovascular death, and fewer complications, than the warfarin group.
"Patients with atrial fibrillation have a sixfold increased risk of stroke and therefore require long-term anticoagulation therapy," lead researcher David R. Holmes, Jr., M.D., of the Mayo Graduate School of Medicine in Rochester, said in a statement. "The placement of this device results in excellent long-term outcomes -- effective ischemic stroke prevention with the elimination of hemorrhagic strokes and major bleeding often associated with the use of warfarin. The take-home message is that although there are complications associated with implantation of the device, patients can avoid the need for chronic warfarin therapy, with all its attendant risks."
"Another important finding was that fish oil did not change outcomes in heart attack patients who received optimal medical care," Kugelmass said. Previous studies had suggested that fish oil supplements are beneficial.
During the study, Jochen Senges, M.D., of the University of Heidelberg, Germany, and colleagues randomly assigned more than 3,800 heart attack survivors to receive either a highly purified omega-3 fatty acid supplement or placebo. More than 90 percent of the patients received beta-blockers, a statin and aspirin, and nearly 90 percent received ACE inhibitors and clopidogrel. After a year, the researchers found no significant group differences in the rates of death, myocardial infarction, non-lethal stroke, or sudden cardiac death (4.1 percent, 3.9 percent, 1.7 percent, and 1.5 percent, respectively).
"Although omega-3 fatty acids are considered effective for improving prognosis after acute myocardial infarction, no randomized, double-blind trial has tested their effect on top of current, strictly guideline-based treatment," Senges said in a statement. "In our study, we saw no beneficial effect. In patients who are already taking optimal medical therapy, cardiac event rates become very low and omega-3 does not further improve them. It would be incorrect to say that omega-3 fatty acids are not effective, but we could not find any additional benefits after optimizing medical therapy."
"Other important research came out of the JUPITER trial showing that rosuvastatin reduces the risk of thromboembolism -- which had not been previously demonstrated -- and cardiovascular risk in patients with low levels of low-density lipoprotein cholesterol and high levels of C-reactive protein," Kugelmass said. "That fit into one of the meeting's main themes, which was the prevention of atherosclerotic disease."
After five years, the JUPITER researchers found that rosuvastatin-treated subjects who achieved target low-density lipoprotein levels of less than 70 mg/L and high-sensitivity C-reactive protein (hsCRP) less than 2 mg/L had a 65 percent reduced cardiovascular risk while those who achieved either one or none of these goals only had 36 percent reduced risk.
"Our data strongly confirms that statins reduce vascular risk by lowering both inflammation and cholesterol, and we found that achieving low levels of both matters for heart health," lead author Paul Ridker, M.D., of Brigham and Women's Hospital in Boston, said in a statement. "Reducing cholesterol is clearly important, but a reduction in hsCRP with statin therapy appears equally important, and patients who lower both simply do better than those who lower only cholesterol or only hsCRP."
ACC: Pulmonary Hypertension Consensus Document Released
TUESDAY, March 31 (HealthDay News) -- Although recent advances have led to increased recognition of new therapies for pulmonary hypertension, this complex and rare disorder has been inadequately explored, according to an Expert Consensus Document published online March 30 in the Journal of the American College of Cardiology to coincide with the American College of Cardiology's 58th Annual Scientific Sessions held March 29 to 31 in Orlando, Fla.
ACC: Combo Treatment Beneficial in Atrial Fibrillation
TUESDAY, March 31 (HealthDay News) -- In atrial fibrillation patients for whom vitamin K-antagonist therapy such as warfarin is not indicated, adding clopidogrel to aspirin reduces the risk of major vascular events but increases the risk of major hemorrhage, according to a study published online March 31 in the New England Journal of Medicine to coincide with the American College of Cardiology's 58th Annual Scientific Sessions held March 29 to 31 in Orlando, Fla.
ACC: Polypill May Reduce Cardiovascular Risk
TUESDAY, March 31 (HealthDay News) -- A polypill -- a combination of three blood-pressure-lowering drugs at low doses, with a statin, aspirin and folic acid -- could significantly reduce cardiovascular events in otherwise healthy patients, according to an article published online March 30 in The Lancet to coincide with the American College of Cardiology's 58th Annual Scientific Session held March 29 to 31 in Orlando, Fla.
ACC: Early Eptifibatide Not Beneficial in Coronary Syndrome
MONDAY, March 30 (HealthDay News) -- In patients with acute coronary syndromes without ST-segment elevation, early use of eptifibatide does not lead to better outcomes compared to delayed use and may be associated with an increased risk of bleeding that necessitates transfusion, according to a study published online March 30 in the New England Journal of Medicine to coincide with the American College of Cardiology's 58th Annual Scientific Session held March 29 to 31 in Orlando, Fla.
ACC: Rosuvastatin Not Beneficial for Dialysis Patients
MONDAY, March 30 (HealthDay News) -- In hemodialysis patients, rosuvastatin lowers levels of low-density lipoprotein (LDL) cholesterol but has no effect in reducing mortality, according to research published online March 30 in the New England Journal of Medicine to coincide with the American College of Cardiology's 58th Annual Scientific Session held March 29 to 31 in Orlando, Fla.
ACC: Renal Sympathetic Nerve Ablation Beneficial
MONDAY, March 30 (HealthDay News) -- In patients with resistant hypertension, treatment with catheter-based renal sympathetic denervation leads to significant and sustained blood pressure reduction, according to study findings published online March 30 in The Lancet to coincide with American College of Cardiology's 58th Annual Scientific Session held March 29 to 31 in Orlando, Fla.
ACC: Relaxin Beneficial in Acute Heart Failure
MONDAY, March 30 (HealthDay News) -- In patients with acute heart failure, treatment with an intravenous infusion of relaxin -- a natural human peptide that affects multiple vascular control pathways -- may improve clinical outcomes, according to a report published online March 29 in the The Lancet to coincide with American College of Cardiology's 58th Annual Scientific Session held March 29 to 31 in Orlando, Fla.
ACC: Combo Surgery Not Beneficial in Heart Failure
MONDAY, March 30 (HealthDay News) -- In patients with heart failure caused by coronary artery disease, outcomes are not significantly different in those who undergo coronary-artery bypass grafting with surgical ventricular reconstruction than in those who undergo coronary-artery bypass grafting alone, according to the results of a study published online March 29 in the New England Journal of Medicine to coincide with the American College of Cardiology's 58th Annual Scientific Session held March 29 to 31 in Orlando, Fla.
ACC: Finger Sensor Test May Predict Cardiac Events
MONDAY, March 30 (HealthDay News) -- In patients with a low or moderate Framingham Risk Score, a 15-minute non-invasive finger sensor test may identify those who are at high risk of having a heart attack or stroke, according to research presented at the American College of Cardiology Annual Scientific Session held March 29 to 31 in Orlando, Fla.