Обзор американских кардиологических журналов за неделю (ссылки)

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Lower education level linked with higher rates of STEMI-related mortality
Mehta R. J Am Coll Cardiol. 2011;57:138-146.

Researchers have reported an inverse relationship between years of education and 1-year mortality in patients treated for STEMI.

In the study, data from 11,326 patients with STEMI who received fibrinolysis from the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-III) trial, which was conducted from Oct. 1995 to Jan. 1997, were analyzed. Researchers examined unadjusted in-hospital clinical outcomes and in-hospital, 30-day and 1-year mortality, as well as adjusted 1-year mortality.

They found an inverse association between 1-year mortality and years of education, culminating with a fivefold increase in the mortality rate seen in patients with less than 8 years vs. those with more than 16 years of education (17.5% vs. 3.5%; P<.0001). Although the strength of this relationship varied among different countries, years of education still remained an independent factor of mortality between day 8 and 1 year, with an HR of 0.96 per year of increase in education (95% CI, 0.94-0.98).

In addition, aside from in-hospital bleeding, most in-hospital adverse outcomes, including mortality and reinfarction, were also inversely related to education level.

“This study demonstrates that lower socioeconomic status, as ascertained by years of completed education, was associated with significantly poorer outcomes in subjects who received fibrinolysis after hospitalization for acute STEMI,” the researchers wrote. “Although fewer years of education were associated with adverse demographic, clinical and presenting features that have been shown to portend a poor prognosis in STEMI patients, years of education remained independently correlated with mortality, even after accounting for these high-risk characteristics.”

They said future studies should investigate the behavioral, social, biological and physiological mechanisms that underlie the link between socioeconomic status and CVD outcomes.
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High rate of CHD-related deaths in Sweden occurred out-of-hospital
Dudas K. Circulation. 2011;123:46-52. S

Three in four coronary heart disease-related deaths in Swedish patients who experienced a first major coronary event happened outside the hospital setting, according to study data.

“Case fatality associated with a first coronary event is often underestimated when only those who survive to reach a hospital are considered,” the researchers wrote. “Few studies have examined long-term trends in case fatality associated with a major coronary event that occurs out of the hospital.”

This lack of data led Kerstin Dudas, PhD, and colleagues to conduct a study of all case participants (n=384,597; age 35-84 years) with a first major coronary event in Sweden between 1991 and 2006.

According to researchers, 111,319 patients (28.9%) without previous hospitalization for acute MI died out-of-hospital with CHD as the primary cause of death, whereas 36,552 patients (9.5%) died within 28 days of first hospitalization for acute MI.

During the study period, out-of-hospital deaths as a proportion of all major coronary events declined (adjusted mean annual decrease, 2.2%), although the greatest reduction was reported in the hospitalized group (adjusted mean annual decrease, 5.8%). Conversely, in the out-of-hospital group, male sex and younger age (35-54 years) were associated with a 4% increased event risk each successive calendar year.

“The great majority of all fatal coronary events occur outside the hospital, and this proportion is increasing, particularly among younger individuals,” the researchers said, adding that primary prevention and persuading individuals to seek hospital treatment at the onset of a major coronary event symptom are increasingly important measures in reducing CHD-related fatality.

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Pioglitazone delayed atheroma progression in patients with diabetes
Nicholls S. J Am Coll Cardiol. 2011;57:153-159.

Patients with type 2 diabetes who were treated with pioglitazone had improvements in triglyceride/HDL ratio that were associated with delayed progression of atheroma, new findings suggested.

The study included 360 patients with type 2 diabetes and CAD who were treated with either 15 mg to 45 mg of pioglitazone (Actos, Takeda) with dose titration or 1 mg to 4 mg of glimepiride for 18 months. Researchers used serial IVUS to determine the relationship between changes in percent atheroma volume, total atheroma and biochemical parameters.
According to results, patients treated with pioglitazone had greater increases in HDL, as well as reductions in triglycerides, CRP and hemoglobin, when compared with glimepiride. For patients assigned pioglitazone, changes in percent atheroma correlated with triglycerides (P=.04), glycated hemoglobin (P=.03) and triglyceride/HDL-C ratio (P=.03), whereas for glimepiride use, changes in percent atheroma were associated with changes in LDL (P=.05), apolipoprotein B (P=.04) and apolipoprotein A-I (P=.01).

On multivariable analysis, pioglitazone’s effect on triglyceride/HDL was associated with changes in percent atheroma (P=.03) and total atheroma (P=.02) volume.

The study’s findings, the researchers wrote, “[support] the hypothesis that pioglitazone halted disease progression predominantly because of its properties beyond glycemic control. These findings are also consistent with clinical outcome data indicating the importance of atherogenic dyslipidemia as a target for therapeutic manipulation in patients with diabetes mellitus to achieve more effective prevention of CVD.”

Nicholls et al provides us with some important new information about the effects of pioglitatzone, a drug that is likely to be increasingly prescribed in patients with diabetes. That pioglitazone has the potential to confer CV benefits through secondary mechanisms on triglyceride, HDL and atheroma burden is a win: win for high risk patients who take the drug as part of their diabetes regimen. It may delay or prevent the need for additional triglyceride lowering or HDL raising therapies in some patients, which can minimize cost and pill burden.

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Relation of Obesity to Recurrence Rate and Burden of Atrial Fibrillation
Weerasooriya R, Guglin M, Maradia K, Chen R, Curtis AB.
Am J Cardiol 2011;Jan 3:[Epub ahead of print].
Study Question: Does obesity increase the risk for recurrent atrial fibrillation (AF)?

A Randomized Active-Controlled Study Comparing the Efficacy and Safety of Vernakalant to Amiodarone in Recent-Onset Atrial Fibrillation
Camm AJ, Capucci A, Hohnloser SH, et al., on behalf of the AVRO Investigators.
J Am Coll Cardiol 2011;57:313-321.
Study Question: Is vernakalant more effective than amiodarone for acute conversion of atrial fibrillation (AF)?

Comparative Validation of a Novel Risk Score for Predicting Bleeding Risk in Anticoagulated Patients With Atrial Fibrillation: The HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) Score
Lip GY, Frison L, Halperin JL, Lane DA.
J Am Coll Cardiol 2011;57:173-180.
Study Question: What are the predictors of bleeding events among patients with atrial fibrillation (AF)?

Long-Term Comparison of Drug-Eluting Stents and Coronary Artery Bypass Grafting for Multivessel Coronary Revascularization: 5-Year Outcomes From the Asan Medical Center-Multivessel Revascularization Registry
Park DW, Kim YH, Song HG, et al.
J Am Coll Cardiol 2011;57:128-137.
Study Question: What are the long-term (5-year) outcomes of a large cohort of patients who underwent drug-eluting stent (DES) or coronary artery bypass graft (CABG) surgery for multivessel revascularization?

Randomized, Controlled Trial of Individualized Heparin and Protamine Management in Infants Undergoing Cardiac Surgery With Cardiopulmonary Bypass
Gruenwald CE, Manlhiot C, Chan AK, et al.
J Am Coll Cardiol 2010;56:1794-1802.
Study Question: Are postoperative clinical outcomes improved in children less than 1 year of age undergoing cardiopulmonary bypass (CPB) with the use of individualized heparin management with Hemostasis Management System (HMS) Plus rather than traditional weight-based anticoagulation management using activated clotting time (ACT)?

Aortic Valve Reinterventions After Balloon Aortic Valvuloplasty for Congenital Aortic Stenosis: Intermediate and Late Follow-Up
Brown DW, Dipilato AE, Chong EC, Lock JE, McElhinney DB.
J Am Coll Cardiol 2010;56:1740-1749.
Study Question: What is the freedom from aortic valve reintervention, and what are the patient-related and procedural risk factors for reintervention following transcatheter balloon aortic valvuloplasty for congenital aortic stenosis (AS)?

A Randomized Trial of Internet and Telephone Treatment for Smoking Cessation
Graham AL, Cobb NK, Papandonatos GD, et al.
Arch Intern Med 2011;171:46-53.
Study Question: Does Internet and telephone treatment for smoking cessation increase quit rates?

An Online Community Improves Adherence in an Internet-Mediated Walking Program. Part 1: Results of a Randomized Controlled Trial
Richardson CR, Buis LR, Janney AW, et al.
J Med Internet Res 2010;12:e71.
Study Question: Does an online community improve adherence to an Internet-based walking program?

3-Year Follow-Up of Patients With Coronary Artery Spasm as Cause of Acute Coronary Syndrome: The CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) Study Follow-Up
Ong P, Athanasiadis A, Borgulya G, Voehringer M, Sechtem U.
J Am Coll Cardiol 2011;57:147-152.
Study Question: What is the long-term outcome of patients with acute coronary syndrome (ACS) who have no identifiable coronary artery disease on angiography, but have evidence of spasm in response to intracoronary acetylcholine?

Evaluation of the Efficacy and Safety of RLY5016, a Polymeric Potassium Binder, in a Double-Blind, Placebo-Controlled Study in Patients With Chronic Heart Failure (the PEARL-HF) Trial
Pitt B, Anker SD, Bushinsky DA, Kitzman DW, Zannad F, Hung IZ, on behalf of the PEARL-HF Investigators.
Eur Heart J 2011;Jan 5:[Epub ahead of print].
Study Question: What is the efficacy and safety of RLY5016 (a non-absorbed, orally administered, potassium [K+]-binding polymer) on serum K+ levels in patients with chronic heart failure (HF) receiving standard therapy and spironolactone?

Generalizability and Longitudinal Outcomes of a National Heart Failure Clinical Registry: Comparison of Acute Decompensated Heart Failure National Registry (ADHERE) and Non-ADHERE Medicare Beneficiaries
Kociol RD, Hammill BG, Fonarow GC, et al.
Am Heart J 2010;160:885-892.
Study Question: Can clinical registry data be generalized to the general population of interest?

Meta-Analysis of Randomized Trials of Glycoprotein IIb/IIIa Inhibitors in High-Risk Acute Coronary Syndromes Patients Undergoing Invasive Strategy
De Luca G, Navarese EP, Cassetti E, Verdoia M, Suryapranata H.
Am J Cardiol 2011;107:198-203.
Study Question: What is the comparative effectiveness of a strategy of upstream administration of glycoprotein (GP) IIb/IIIa inhibitors, aimed at cooling the culprit coronary plaque before angioplasty, to a strategy of downstream selective administration of such drugs?

Lowering the Triglyceride/High-Density Lipoprotein Cholesterol Ratio Is Associated With the Beneficial Impact of Pioglitazone on Progression of Coronary Atherosclerosis in Diabetic Patients: Insights From the PERISCOPE (Pioglitazone Effect on Regression of Intravascular Sonographic Coronary Obstruction Prospective Evaluation) Study
Nicholls SJ, Tuzcu EM, Wolski K, et al.
J Am Coll Cardiol 2011;57:153-159.
Study Question: What factors are associated with the favorable effect of pioglitazone on atheroma

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SPIRIT IV: Everolimus-eluting stent outperforms paclitaxel-eluting stent in patients without diabetes
Kereiakes D. J Am Coll Cardiol. 2010;56:2084-2089.

The latest results from the SPIRIT-IV trial have shown everolimus-eluting stents to produce superior clinical outcomes in patients without diabetes, despite both stents performing similarly in patients with diabetes.

“The SPIRIT IV trial confirms and extends the observation made in the SPIRIT III trial of a significant interaction between randomized stent type everolimus-eluting stent (Xience V, Abbott Vascular) vs. paclitaxel-eluting stent (Taxus Express, Boston Scientific) and the presence of diabetes on the primary composite safety-plus-efficacy clinical endpoint,” the researchers wrote.

The randomized, prospective, single blind study included 3,687 patients with up to three de novo native coronary artery lesions who received either an everolimus-eluting stent (n=2,458) or a paclitaxel-eluting stent (n=1,229). Clinical outcomes were analyzed in randomly assigned patients with (n=1,185) and without (n=2,498) diabetes.

One-year results indicated that among patients without diabetes, everolimus-eluting stent vs. paclitaxel-eluting stent reduced the primary endpoint of target lesion failure by 54% (3.1% vs. 6.7%; P<.0001) and major adverse CV events by 52% (3.2% vs. 6.7%; P<.0001). Use of everolimus-eluting stent also resulted in lower rates of the major secondary endpoints of ischemia-driven target vessel revascularization, as well as the composite occurrence of cardiac death or target vessel MI (P=.05).

However, among patients with diabetes, there were no statistically significant differences in outcomes at 1 year between randomly assigned stent types for both target lesion failure and major adverse CV events.

“These findings suggest the need for further studies to elucidate the mechanistic pathways underlying the poor prognosis of patients with diabetes mellitus, with a focus toward development of novel drugs and stents to improve outcomes in this high-risk patient cohort,” the researchers wrote.
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P-OM3: Prescription omega-3 no more effective than placebo for paroxysmal AF treatment
American Heart Association Scientific Sessions 2010

CHICAGO — Researchers of the P-OM3 trial have reported that prescription omega-3 was no more beneficial for patients with paroxysmal atrial fibrillation than placebo for the recurrence of symptomatic AF.

“The rationale for this study was that many of our patients do use fish oil products in various doses and preparations in the hope of preventing several CV endpoints,” researcher Peter Kowey, MD, with the Jefferson Medical College, Philadelphia, and a Cardiology Today Editorial Board member, said in a press conference. “There clearly has been equipoise in the area of AF with as many studies producing positive as those producing negative results.”

In the prospective, randomized, double-blind, placebo-controlled study, 663 patients (paroxysmal AF, (n=542; persistent AF, n=121) were assigned to either P-OM3 (Lovaza, GlaxoSmithKline) 4 g daily or placebo and treated for 24 weeks. Patients had no substantial structural heart disease and normal sinus rhythm at baseline and were recruited from 96 sites in the United States between November 2006 and July 2009. The primary outcome was the time to first recurrence of symptomatic AF (including flutter) in subjects with paroxysmal AF.

At the final follow-up in January of this year, there were no significant differences between treatment groups for recurrence of symptomatic AF in the following strata: paroxysmal (HR=1.15; 95% CI, 0.90-1.46), persistent (HR=1.64; 95% CI, 0.92-2.92), and paroxysmal and persistent combined (HR=1.22; 95% CI, 0.98-1.52). The secondary endpoints, including time to first onset of symptomatic AF (excluding flutter; P=.21) and first recurrence of symptomatic or asymptomatic AF or flutter (P=.33), also supported the primary outcome.

“I don’t think there is any ambiguity about the results in this trial [when] looking at patients with paroxysmal AF that the use of high doses of omega-3 fatty acids did not appear to have a significant effect on recurrence of AF,” Kowey told Cardiology Today. “This doesn’t apply to other populations or other CV disease, but I think we’ve put this issue to rest in this particular population.”

Kowey reports having consulted on an ad hoc basis for GlaxoSmithKline.

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Angina common among women, not associated with atherosclerosis
Banks K. J Am Coll Cardiol Img. 20114:65-73.
Bairey Merz CN. J Am Coll Cardiol Img. 20114:74-77.

Data from a new study suggest that angina detected by CT is common among women, but is not associated with subclinical atherosclerosis.

“Angina in women is a morbid condition for which the determinants are poorly characterized,” Kamakki Banks, MD, and fellow investigators wrote. “More than 50% of women with angina may have normal or near-normal coronary arteries visualized at coronary angiography, a rate much higher than is observed among men. Coronary angiography, however, is an insensitive measure of atherosclerosis burden, and some have hypothesized that subclinical atherosclerosis may promote microvascular dysfunction and ischemia in women with angina in the absence of obstructive epicardial coronary disease.”

This hypothesis led the researchers to evaluate the relationship between angina and coronary artery calcium (CAC) in women via data compiled from the multi-ethnic Dallas Heart Study. The final study population included 1,480 women (49% African American) with a mean age of 45 years.

Overall, 6.9% of the population had angina, which was not associated with CAC (P=.20). For women without CAC, variables that included obesity and insulin resistance were associated with angina, whereas independent factors for angina included African-American ethnicity, waist circumference and premature family history of MI (P<.05 for all). Women with angina vs. without had higher levels of reduced aortic compliance (P=.007), soluble vascular cell adhesion molecule-1 (P=.01) and soluble intercellular adhesion molecule-1 (P=.02).

“Typical exertional angina affects one of every 14 women between the ages of 30 and 65 years in Dallas County. Interestingly, angina was not associated with subclinical atherosclerosis among women,” the investigators wrote. “Angina that occurs in the absence of subclinical atherosclerosis was not related to many traditional atherosclerotic risk factors; however, it was associated with measures of vascular stiffness and endothelial dysfunction, suggesting a distinct vascular etiology and alternate potential therapeutic targets for this entity compared with atherosclerosis.”

C. Noel Bairey Merz, MD,with the Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles, wrote in an accompanying editorial that current alternative strategies utilizing tools to detect vulnerable patients should be useful in diagnosis and may even be preferential in women.

“Novel imaging strategies aimed at pathophysiological pathways, including measures of nonendothelial, endothelial function, vascular and myocardial compliance, as well as myocardial perfusion and flow reserve are actively being investigated as useful risk markers and diagnostic strategies,” she said. “Noninvasive, nonionizing radiation strategies are needed for this purpose, as invasive study has documented the feasibility of identifying future risk by pathophysiological evaluation in women with no obstructive CAD.”

Disclosure: Dr. Bairey Merz has received grants, contract support and lecture honoraria and has acted as a consultant for many companies and institutions. She also reported owning stock in Medtronic and Johnson and Johnson.
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Sedentary time negatively associated with cardiometabolic, inflammatory biomarkers
Healy G. Eur Heart J. 2011;doi:10.1093/eurheartj/ehq451.

Taking many breaks from sedentary time, even just 1-minute breaks, appeared to result in lower levels of C-reactive protein and smaller waist circumferences, according to researchers from The University of Queensland in Australia.

They also found that prolonged periods of sedentary time, even in those who exercised regularly, were associated with larger waist circumferences, lower levels of HDL cholesterol, higher levels of CRP and higher triglycerides.

The cross-sectional study was conducted in participants of the National Health and Nutrition Examination Survey between 2003 and 2006. The sample included 4,757 adults who wore accelerometers and had sufficient data. Researchers measured waist circumference, BP, cholesterol levels and CRP levels. A sub-sample of 2,118 participants was available for fasting analyses for triglycerides, plasma glucose and insulin.

The participants wore the accelerometer for 14.6 hours per day, and the average time spent sedentary was 8.44 hours. Women were more sedentary, but they took more breaks and had a more favorable cardiometabolic profile than men.

“These population-based findings provide further evidence on the deleterious associations of sedentary time with cardiometabolic health in adults, and provide novel evidence on the relationship of sedentary time with the inflammatory biomarker C-reactive protein,” the researchers wrote. “In general, these associations were consistent across sex, age and race/ethnicity.”

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Drug-eluting stents comparable with CABG in patients with multivessel disease
Park D. J Am Coll Cardiol. 2011;57:128-137.

Five-year results from a large cohort of patients with multivessel disease indicated that those who were treated with a drug-eluting stent had similar rates of mortality and composite adverse outcomes with those who underwent CABG, but had a higher rate of revascularization.

Researchers from Seoul, Korea, included 3,042 patients with multivessel disease in the study, 1,547 of whom received a drug-eluting stent and 1,495 underwent CABG. They compared the adverse outcomes of both procedures, which included death, a composite outcome of death, MI or stroke, and repeat revascularization.

After a median follow-up of 5.6 years and adjustments for differences in baseline risk factors, researchers reported that 5-year risk for death (HR=1.00; 95% CI, 0.76-1.32) and the composite outcome risk (HR=0.97; 95% CI, 0.76-1.24) were similar between the drug-eluting stent group and the CABG group. However, revascularization rates were significantly higher in the drug-eluting stent group (HR=2.93; 95% CI, 2.20-3.90). These results were consistent in most high-risk clinical subgroups, including patients with diabetes, age older than 65 years and abnormal ventricular function.

As an area for future research, the investigators suggested a large randomized comparison with longer-term follow-up of 5 or 10 years, which they said will provide more confidence in the long-term safety, durability and efficacy of percutaneous coronary intervention with drug-eluting stents in reference to CABG.

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Alcohol Consumption and Risk of Atrial Fibrillation: A Meta-Analysis
Kodama S, Saito K, Tanaka S, et al.
J Am Coll Cardiol 2011;57:427-436.
Study Question: Does alcohol consumption increase the probability of developing atrial fibrillation (AF)?

Cost-Effectiveness of Dabigatran Compared With Warfarin for Stroke Prevention in Atrial Fibrillation
Freeman JV, Zhu RP, Owens DK, et al.
Ann Intern Med 2011;154:1-11.
Study Question: What is the quality-adjusted survival, costs, and cost-effectiveness of dabigatran compared with adjusted-dose warfarin for preventing ischemic stroke in patients 65 years or older with nonvalvular atrial fibrillation (AF)?

Dabigatran Versus Warfarin in Patients With Atrial Fibrillation: An Analysis of Patients Undergoing Cardioversion
Nagarakanti R, Ezekowitz MD, Oldgren J, et al.
Circulation 2011;123:131-136.
Study Question: Is anticoagulation with dabigatran adequate for stroke prevention in the setting of cardioversion of atrial fibrillation (AF)?


Long-Term Cardiovascular Mortality After Radiotherapy for Breast Cancer
Bouillon K, Haddy N, Delaloge S, et al.
J Am Coll Cardiol 2011;57:445-452.
Study Question: What is the effect of radiotherapy for breast cancer on long-term cardiovascular mortality?

Survival of Patients Undergoing Rescue Percutaneous Coronary Intervention: Development and Validation of a Predictive Tool
Burjonroppa SC, Varosy PD, Rao SV, et al.
JACC Cardiovasc Interv 2011;4:42-50.
Study Question: What are the incidence and predictors of mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing rescue percutaneous coronary intervention (PCI) after failed fibrinolytic therapy?
Calcium-Channel Blockers Do Not Alter the Clinical Efficacy of Clopidogrel After Myocardial Infarction: A Nationwide Cohort Study
Olesen JB, Gislason GH, Charlot MG, et al.
J Am Coll Cardiol 2011;57:409-417.
Study Question: Do calcium channel blockers (CCBs) reduce the clinical efficacy of clopidogrel?

Cholesterol Efflux Capacity, High-Density Lipoprotein Function, and Atherosclerosis
Khera AV, Cuchel M, de la Llera-Moya M, et al.
N Engl J Med 2011;364:127-135.
Study Question: Does cholesterol efflux capacity from macrophages predict atherosclerosis burden independently of high-density lipoprotein (HDL) levels?
Reperfusion by Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction Within 12 to 24 Hours of the Onset of Symptoms (from a Prospective National Observational Study [PL-ACS])
Gierlotka M, Gasior M, Wilczek K, et al.
Am J Cardiol 2011;Dec 30:[Epub ahead of print].
Study Question: Is there benefit of reperfusion by percutaneous coronary intervention (PCI) performed between 12-24 hours of symptom onset in patients presenting with ST-elevation myocardial infarction (STEMI)?

Effects of n-3 Polyunsaturated Fatty Acids on Left Ventricular Function and Functional Capacity in Patients With Dilated Cardiomyopathy
Nodari S, Triggiani M, Campia U, et al.
J Am Coll Cardiol 2011; Jan 5:[Epub ahead of print].
Study Question: Does n-3 polyunsaturated fatty acid (PUFA) therapy impact left ventricular (LV) function or functional capacity in mild chronic nonischemic heart failure (HF)?
Exercise Training in Heart Failure: Practical Guidance
Conraads VM, Beckers PJ.
Heart 2010;96:2025-2031.
Perspective: This review discusses the clinical application and research supporting the use of exercise training in heart failure (HF). The following are 10 points to remember.

Meta-Analysis: Statin Therapy Does Not Alter the Association Between Low Levels of High-Density Lipoprotein Cholesterol and Increased Cardiovascular Risk
Increased Cardiovascular Risk
Jafri H, Alsheikh-Ali AA, Karas RH.
Ann Intern Med 2010;153:800-808.
Study Question: Does treatment with statins alter the association of low levels of high-density lipoprotein cholesterol (HDL-C) and increased risk for cardiovascular events (CVEs)?

High-Sensitivity ST2 for Prediction of Adverse Outcomes in Chronic Heart Failure
Ky B, French F, McCloskey K, et al.
Circ Heart Fail 2010;Dec 22:[Epub ahead of print].
Study Question: The ST2 receptor is a member of the toll-like/interleukin-1 receptor family and may be involved in cardioprotective stress-response signaling. Soluble ST2 is predictive of adverse outcomes in acute heart failure (HF), but does ST2 predict chronic HF outcomes?

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Meta-analysis: Hydrochlorothiazide as first-line BP therapy less effective than other drug classes
Messerli F. J Am Coll Cardiol. 2011;57:590-600.

Hydrochlorothiazide as a first-line therapy was inferior to all other drug classes for the reduction of BP, results from a meta-analysis suggested.

Researchers selected 19 randomized studies enrolling 1,463 patients with hypertension for inclusion in the analysis. All studies assessed BP by 24-hour ambulatory monitoring, compared hydrochlorothiazide in a head-to-head fashion with other drug classes and had duration of at least 4 weeks. The primary outcome of interest was a reduction in systolic and diastolic BP from baseline to follow-up.

According to the results, hydrochlorothiazide in the typical dose of 12.5 mg to 25 mg was less effective at lowering systolic BP when compared with ACE inhibitors (by 4.5 mm Hg, P=.001), angiotensin receptor blockers (by 5.1 mm Hg, P=.003), beta-blockers (by 6.2 mm Hg, P<.00001) and calcium antagonists (by 4.5 mm Hg, P=.02). For diastolic BP, hydrochlorothiazide was also inferior when compared with ACE inhibitors (by 4 mm Hg, P<.0001), angiotensin receptor blockers (by 2.9 mm Hg, P=.002), beta-blockers (by 6.7 mm Hg, P<.00001) and calcium antagonists (by 4.2 mm Hg, P=.0001).

There was also no difference in systolic (P=.30) or diastolic (P=.15) 24-hour BP reduction between the 12.5-mg dose of hydrochlorothiazide and the 25-mg dose, but the difference in systolic BP became significant at 50 mg (P=.04) when compared with the 25-mg dose.

“Hydrochlorothiazide in its commonly used dose of 12.5 mg to 25 mg daily lowers BP significantly less well than do all other drug classes as measure in head-to-head studies by ambulatory BP monitoring,” the researchers concluded. “Because of such paltry antihypertensive efficacy and the lack of outcome data at these doses, physicians should refrain from prescribing hydrochlorothiazide as initial antihypertensive therapy.”

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Intervention program improved care practice implementation in Canadian ICUs
Curtis J. JAMA. 2011;doi:10.1001/jama.2011.8.
Scales D. JAMA. 2011;doi:10.1001/jama.2010.2000.

A multicenter quality-improvement program improved the adoption of care practices in a network of community ICUs in Canada, according to new data published online by the Journal of the American Medical Association.

“Community ICUs admit the majority of critically ill patients and have fewer resources for implementing quality improvement initiatives,” the researchers wrote. “Our videoconferencing network is one model for helping health care workers in geographically dispersed community hospitals to improve quality by accessing resources usually restricted to academic hospitals.”

The video conference-based intervention involved expert-led educational sessions, an audit and feedback, as well as the dissemination of algorithms to sequentially improve delivery of six practices. Admissions from 15 community hospital ICUs in Ontario, Canada, were analyzed, 9,269 during the trial period (November 2005-October 2006) and 7,141 during a decay monitoring period (December 2006-August 2007).

According to researchers, compared with controls, the adoption of care practices in the intervention ICUs was noticeably higher (OR=2.79; 95% CI, 1.00-7.74). Adherence to semi-recumbent positioning in the intervention ICUs significantly improved in the first month compared with the last month (49.8%-89.6% of eligible patient-days; OR=6.35; 95% CI, 1.85-21.79), whereas only nonsignificant improvements were reported in the control arm (80.1%-90.2% of eligible patient-days; OR=2.04; 95% CI, 0.82-5.07).

Further, the greatest improvements in delivery from first to last month in intervention ICUs occurred for semi-recumbent positioning to prevent ventilator-associated pneumonia (50% of patient-days in the first month vs. 90% in the last month) and precautions to prevent catheter-related bloodstream infection (10.6% vs. 70% of patients receiving central lines).

In an accompanying editorial, J. Randall Curtis, MD, MPH,of the University of Washington, Seattle, and Mitchell M. Levy, MD,with the Rhode Island Hospital, Providence, said the most interesting aspect of this study is that it was funded by an organization that funds delivery of health care, rather than by a research funding agency.

“To make significant steps toward improving the quality of health care and controlling the rate of increase in health care costs, this is an important model for the future,” they said. “The use of health care reimbursement to encourage and enforce quality is a reality of the US health care system today and in the future, but these quality measures must be selected and implemented based on rigorous science, and the implementation must be demonstrated to be effective without unintended consequences that lower quality in other ways or other areas of health care.”
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Statin therapy questionable for low-risk CVD patients
Taylor F. Cochrane Database Syst Rev. 2011;doi:10.1002/14651858.CD004816.pub4.

The administration of statins for the primary prevention of CVD in patients with no previous history of the disease has come under question by researchers.

Using data from 14 trials that included 34,272 patients, researchers compared outcomes in patients given statins with those given placebos or routine care; eight of the 14 trials involving 28,161 patients provided data on all-cause mortality deaths, and 11 of the 14 provided data on specific conditions (raised lipids, diabetes, hypertension, microalbuminuria). Duration of treatment was a 1-year minimum with a minimum 6-month follow up.

Researchers reported that all-cause mortality was reduced by statins (RR=0.83; 95% CI, 0.723-0.95), and that fatal and nonfatal CVD endpoints were also lower (RR=0.70; 95% CI, 0.61-0.79). Statins were also associated with reduced revascularization rates (RR=0.66, 95% CI, 0.53-0.83) and a reduction in both LDL and total cholesterol. Researchers wrote that they did not find a direct correlation between statin use and adverse events in low-risk CVD patients.

Most of the trials included in the study reported composite outcomes, and one-third reported selected outcomes. Two of the largest studies included in the report were halted, according to researchers, because “significant reductions in primary composite outcomes had been observed.” No adverse events were reported in eight of the studies.

The findings indicate shortcomings in published trials of statins for primary prevention, the researchers wrote.

“Selective reporting and inclusion of people with CVD in many of the trials included in previous reviews of [the role of statins] in primary prevention make the evidence impossible to disentangle without individual patient data,” they wrote.

In an accompanying editorial, Carl Heneghan, BM, BCH, director of the Centre for Evidence-Based Medicine, University of Oxford, wrote that, “To date, only one trial has been publicly funded, while the authors of nine trials reported having been sponsored either fully or partially by pharmaceutical companies. … Although various multiple prevention strategies exist, the most effective for primary prevention in adults at low risk currently remains unclear.”

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Iodine-123 mIBG imaging found beneficial in predicting AF, HF
Akutsu Y. J Am Coll Cardiol Img. 2011;4:78-86.
Crawford M. J Am Coll Cardiol Img. 2011;4:87-88.

Cardiac sympathetic nervous system abnormality measured by iodine-123 meta-iodobenzylguanidine imaging in patients with paroxysmal atrial fibrillation was associated with the occurrence of HF and permanent atrial fibrillation in a new study.

Researchers from Tokyo performed iodine-123 meta-iodobenzylguanidine (123I-mIBG) scintigraphy on 98 consecutive patients with idiopathic paroxysmal AF and preserved left ventricular ejection fraction of at least 50%. They determined sympathetic nervous system activity as the heart-to-mediastinum ratio.

During a median follow-up of 4 ± 3.6 years, 35 patients with paroxysmal AF transited to permanent AF. Overall, HF occurred in 16 patients, with 12 of the cases diagnosed in patients with permanent AF (34.3%) and four cases in patients without permanent AF (6.3%; trend P<.0001).

Independent predictors of transit to permanent AF included lower heart-to-mediastinum ratio (adjusted HR=3.44; 95% CI, 1.9-6.2) and lower LVEF (adjusted HR=1.04; 95% CI, 1.01-1.08). Furthermore, these factors, as well as a higher brain natriuretic peptide, were independent predictors of occurrence of HF with permanent AF (P≤.014 for all three).

“Our major finding is that [sympathetic nervous system] abnormality was an independently powerful factor for predicting not only the transit to permanent AF but also the occurrence of HF with permanent AF in patients with paroxysmal AF and preserved cardiac function,” the researchers concluded. “Our findings may have important implications for the management of patients with paroxysmal AF before the occurrence of remarkable structural remodeling of atria and subsequent cardiac dysfunction of the left ventricle caused by AF.”

Michael H. Crawford, MD, of the University of California San Francisco, commented in an accompanying editorial on the implications of these findings.

“The results … suggest that a low heart/mediastinum ratio in a paroxysmal AF patient should encourage prophylactic therapy, perhaps with at least beta-blockers to try to prevent the development of permanent AF,” Crawford said, adding, however, that a randomized trial is needed to establish such a strategy.
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FDA to streamline, clarify medical device review process

The FDA will enact a 25-point action plan this year to streamline the de novo review process for certain lower-risk medical devices, as well as clarify the premarket notification submission process, which critics had called “unpredictable” and not “robust enough,” according to an FDA press release.

These actions will produce “a smarter medical device program that supports innovation, keeps jobs here at home, and brings important, safe and effective technologies to patients quickly,” Jeffrey Shuren, MD, director of the FDA’s Center for Devices and Radiological Health (CDRH), said in the release.

According to the action plan, the FDA plans to clarify which device changes require a new premarket notification submission — called a 510(k) — and which changes are eligible for a Special 510(k). Other plans include clarifying when clinical data should be submitted in support of a 510(k), establishing a Center Science Council to ensure timely and consistent science-based decision-making and formalizing the Center’s process for assessing staffing shortages. The entire 25-point action plan is available here.

The plan is the product of two internal working groups created by the CDRH in response to complaints about the 510(k) review process by industry, consumers and health care professionals. The CDRH has also requested a review by the independent, nonprofit Institute of Medicine, the results of which are expected in April.

“We look forward to implementing these changes in support of our overall mission: improving the health of the American public,” Shuren said in an open letter to the public.

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The CONNECT (Clinical Evaluation of Remote Notification to Reduce Time to Clinical Decision) Trial: The Value of Wireless Remote Monitoring With Automatic Clinician Alerts
Crossley GH, Boyle A, Vitense H, Chang Y, Mead RH, on behalf of the CONNECT Investigators.
J Am Coll Cardiol 2011;Jan 19:[Epub ahead of print].
Study Question: What is the effect of wireless remote monitoring with automatic clinician alerts on time from a clinical event to a clinical decision in response to arrhythmias, cardiovascular (CV) disease progression, and device issues compared to patients receiving standard in-office care?

Outcomes for Endocarditis Surgery in North America: A Simplified Risk Scoring System
Gaca JG, Sheng S, Daneshmand MA, et al.
J Thorac Cardiovasc Surg 2011;141:98-106.
Study Question: Using the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database, can a simple risk scoring system be developed for patients who undergo surgery for infective endocarditis to identify areas for quality improvement?

Outcomes of Coronary Artery Bypass Grafting and Reduction Annuloplasty for Functional Ischemic Mitral Regurgitation: A Prospective Multicenter Study (Randomized Evaluation of a Surgical Treatment for Off-Pump Repair of the Mitral Valve)
Grossi EA, Woo YJ, Patel N, et al.
J Thorac Cardiovasc Surg 2011;141:91-97.
Study Question: What are the outcomes of reduction annuloplasty for ischemic mitral regurgitation (MR)?

The Impact of Adjusting for Reliability on Hospital Quality Rankings in Vascular Surgery
Osborne NH, Ko CY, Upchurch GR Jr, Dimick JB.
J Vasc Surg 2011;53:1-5.
Study Question: What effect would adjusting hospital mortality for statistical reliability have on hospital quality rankings in vascular surgery?

Secondary Prevention After Coronary Artery Bypass Graft Surgery: Findings of a National Randomized Controlled Trial and Sustained Society-Led Incorporation Into Practice
Williams JB, Delong ER, Peterson ED, et al., on Behalf of the Society of Thoracic Surgeons and the National Cardiac Database.
Circulation 2011;123:39-45.
Study Question: Can a low-intensity continuous quality improvement intervention be used to enhance secondary prevention adherence after coronary artery bypass graft surgery (CABG)?

A Multifaceted Intervention for Quality Improvement in a Network of Intensive Care Units: A Cluster Randomized Trial
Scales DC, Dainty K, Hales B, et al.
JAMA 2011;Jan 19:[Epub ahead of print].
Study Question: Can a multicenter quality improvement program increase delivery of evidence-based intensive care unit (ICU) practices?

Vitamin D, Parathyroid Hormone, and Cardiovascular Mortality in Older Adults: The Rancho Bernardo Study
Jassal SK, Chonchol M, von M?hlen D, Smits G, Barrett-Connor E.
Am J Med 2010;123:1114-1120.
Study Question: Is vitamin D and parathyroid hormone (PTH) associated with cardiovascular disease (CVD) mortality among older adults?
The Importance of Population-Wide Sodium Reduction as a Means to Prevent Cardiovascular Disease and Stroke: A Call to Action from the American Heart Association
Appel LJ, Frohlich ED, Hall JE, et al.
Circulation 2011;Jan 13:[Epub ahead of print].
Perspective: The following are 10 points to remember about sodium reduction.

Door-to-Balloon Times for Patients With ST-Segment Elevation Myocardial Infarction Requiring Interhospital Transfer for Primary Percutaneous Coronary Intervention: A Report From the National Cardiovascular Data Registry
Wang TY, Peterson ED, Ou FS, Nallamothu BK, Rumsfeld JS, Roe MT.
Am Heart J 2011;161:76-83.e1.
Study Question: What are the trends in door-to-balloon time in patients with ST-segment elevation myocardial infarction (STEMI) who require transfer to another hospital for primary percutaneous coronary intervention (PCI)?

Transradial Approach (Left vs Right) and Procedural Times During Percutaneous Coronary Procedures: TALENT Study
Sciahbasi A, Romagnoli E, Burzotta F, et al.
Am Heart J 2011;161:172-179.
Study Question: What is the safety and efficacy of the left radial approach (LRA) compared with right radial approach (RRA) for coronary procedures?

Randomized Comparison of Final Kissing Balloon Dilatation Versus No Final Kissing Balloon Dilatation in Patients With Coronary Bifurcation Lesions Treated With Main Vessel Stenting: The Nordic-Baltic Bifurcation Study III
Niemel? M, Kervinen K, Erglis A, et al., on behalf of the Nordic-Baltic PCI Study Group.
Circulation 2011;123:79-86.
Study Question: Should final kissing balloon angioplasty be performed in all patients who undergo bifurcation stenting using a strategy of only main vessel stenting?

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Aggrastat® high dose
bolus EU approval for (NSTE-ACS) PCI patients
re-informs the debate on
triple anti-platelet therapy

Aggrastat® high dose bolus EU approval
Triple anti-platelet therapy—which patients and why? Euro PCR, Paris, 17-20 May 2011
Iroko Cardio

Aggrastat® high dose bolus EU approval
High dose bolus (HDB) Aggrastat® for the treatment of acute coronary syndrome (NSTE-ACS) patients undergoing percutaneous coronary intervention (PCI) received EU regulatory approval in September 2010. National approvals have since followed in The Netherlands, UK, Germany, Finland, and Belgium and the process will be concluded in the Mutual Recognition Process (MRP) member states in 2011. Regulatory variations are in process for other global markets where Aggrastat® is available.

The PCI HDB dosing for Aggrastat® is 25?g/kg over 3 minutes followed by an infusion of 0.15?g/kg/min for 18-24 and up to 48 hoursi.

Triple anti-platelet therapy—which patients and why?
Triple anti-platelet therapy (aspirin, thienopyridine plus GPIIbIIIa receptor antagonist) may not be for everyone but, despite the availability of compelling clinical data and treatment guidelines, high risk patients often remain under-treated. The recent label change was the stimulus for a debate between Dr. A. van't Hof (Netherlands) and Dr. T. Cuisset (France), chaired by Dr. Valgimigli (Italy) hosted near Geneva by Iroko Cardio and joined online by cardiologists from Europe, Middle East, Asia, and Latin America.

Summarising the debate, Dr. Valgimigli concluded that "high risk patients undergoing PCI should be considered for aggressive anti-platelet therapy." Dr. Valgimigli went on to say that "despite the availability of newer agents and more potent oral options, l believe there is still room for GPIs in high risk ACS patients. In this respect, tirofiban offers doctors a potent, safe and cost-effective therapeutic option for their high risk ACS patients."

Euro PCR, Paris, 17-20 May 2011
Iroko Cardio will support a medical information lounge at Euro PCR and welcomes customers to a 'How should I treat' session chaired by Prof. Christian Hamm.

"While there's clear clinical trial evidence that triple anti-platelet therapy is beneficial for high risk PCI's, the underuse of this treatment regimen is unsatisfactory. Therefore, it is important to discuss the appropriate anti-thrombotic regime patient by patient in the context of combining new anti-thrombotic and anti-platelet drugs. At Euro PCR we will use a "how should I treat" session to translate study results to individual patient cases", said Prof. Hamm.

Iroko Cardio
Iroko Cardio is a privately held pharmaceutical company located in Geneva, Switzerland and Philadelphia, USA. It manufactures and markets Aggrastat® worldwide (with the exception of the USA) in collaboration with regional distribution partners. Iroko Cardio aims to contribute to the reduction of MACE.

Aggrastat® is a registered trade mark of Iroko Cardio LLC, Philadelphia USA. For Aggrastat® prescribing information and further information on Iroko Cardio, visit: [Ссылки доступны только зарегистрированным пользователям ]

Iroko Cardio does not recommend the use of Aggrastat® in any manner other than as described in local prescribing information. Further information is available from the Iroko Cardio Medical Information Center: [Ссылки доступны только зарегистрированным пользователям ], +41 22 907 7970

About Aggrastat®
Aggrastat® is indicated for the prevention of early myocardial infarction in patients presenting with unstable angina or non-Q-wave myocardial infarction with the last episode of chest pain occurring within 12 hours and with ECG changes and/or elevated cardiac enzymes. Patients most likely to benefit from Aggrastat® treatment are those at high risk of developing myocardial infarction within the first 3-4 days after onset of acute angina symptoms including for instance those that are likely to undergo an early PTCA.

Patients managed with early invasive strategy (4-48 hrs. after diagnosis)

Initial intravenous infusion rate: 0.4 ?g /kg/min for 30 minutes. Maintenance infusion rate: 0.1 ?g /kg/min

Dosage information for patients undergoing PCI

Patients undergoing PCI demonstrated clinical efficacy with treatment with Aggrastat® utilizing an initial bolus of 25 ?g/kg given over a 3 minute period, followed by a continuous infusion at a rate of 0.15 ?g/kg/min for 18-24, and up to 48 hours.

In patients with severe kidney failure (creatinine clearance <30mL/min), the dosage of Aggrastat® should be reduced by 50%.

Aggrastat® should be administered with unfractionated heparin and oral antiplatelet therapy unless contra-indicated.

Contraindications

Hypersensitivity to active substance or excipient; previous thrombocytopenia with GPIIb/IIIa receptor antagonist; stroke within previous 30 days; history of haemorrhagic stroke; history of intracranial disease; clinically relevant bleeding (within the previous 30 days); malignant hypertension; trauma or major surgical intervention within the past six weeks; thrombocytopenia (platelet count <100,000/mm3), disorders of platelet function; clotting disturbances; severe liver failure.

Warnings and Precautions

Monitor patients for bleeding during treatment. In cases of haemorrhage, consider discontinuing Aggrastat®. In cases of severe uncontrollable bleeding discontinue Aggrastat® immediately.

For all other SPCs please refer to local prescribing information.

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Newly published guidelines suggest expanded use for carotid artery stenting
Brott T. J Am Coll Cardiol. 2011;doi:10.1016/j.jacc.2010.11.005.

The 2011 Guideline on the Management of Patients with Extracranial Carotid and Vertebral Artery Disease was recently published, highlighting the safety and efficacy of carotid artery stenting for patients requiring revascularization.

The guidelines, a joint collaboration between 14 organizations, including the American College of Cardiology Foundation, the American Heart Association and the Society for Cardiac Angiography and Interventions, were based upon a comprehensive review of literature relevant to carotid and vertebral artery interventions up until May 2010. They detail several indications for revascularization and make recommendations on the appropriate treatment regarding carotid artery stenting (CAS), carotid endarterectomy (CEA) and drug therapy, as well as appropriate diagnostic modalities.

Specifically, for selecting patients for carotid revascularization, the guidelines state that CAS may be considered in patients with asymptomatic carotid stenosis with a minimum of 60% detected by angiography or 70% detected by validated Doppler ultrasound. This recommendation follows less than a week after the FDA advisory panel vote that recommended expansion of the availability of CAS in patients at standard risk for surgical complications due to findings of the CREST trial.

The guidelines state that it is reasonable to perform CAS over CEA in patients with neck anatomy unfavorable for surgery and those with transient ischemic attack or stroke without contraindications to early revascularization, whereas CEA is advisable in older patients, as well as asymptomatic patients with more than 70% stenosis if the risk of stroke, MI and death is low.

However, members of the writing committee and task force said there are still many opportunities for future research because the CREST trial, although answering important questions, raised others.

“The most pressing question is how either technique of revascularization compares with intensive contemporary medical therapy, particularly among asymptomatic patients,” they said. “A direct comparative trial should include a sufficiently broad range of patients to permit meaningful analysis of subgroups based on age, sex, ethnicity and risk status.”
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Super Bowl loss linked with increased mortality rates in local men and women
Kloner R. Clin Cardiol. 2011;doi:10.1002/clc.20876.

Residents of Los Angeles County had significantly increased total and cardiac-related death rates after the Super Bowl loss of the Los Angeles Rams in 1980. However, when the Los Angeles Raiders won the Super Bowl in 1984, women and residents aged 65 years or older had reduced rates of mortality.

“It is known that stressors such as intense sporting events may increase cardiac event rates in fans, but there has been little data available on the demographics of these fans,” the researchers wrote. “Based on our linear regression analysis, our study suggested that Los Angeles’ 1980 Super Bowl loss increased total and cardiac deaths in both men and women and triggered more deaths in older patients compared with younger patients. Conversely, the 1984 Super Bowl win showed a trend for reduction of death rates, slightly better in older than younger patients and in women more than men.”

To generate this conclusion, investigators obtained death-certificate data for Los Angeles County from 1980 to 1988 that covered Jan. 15 to the end of February for each year and then used non-Super Bowl days as the control. Mortality data included in the analysis were deaths from all-cause, as well as deaths related to circulatory system diseases, ischemic heart disease, acute MI, HF and congestive HF.

According to study results, after the 1980 Super Bowl loss, researchers reported significant spikes in all-cause mortality (P<.0001), all cardiac deaths (P=.0001) and ischemic heart disease (P=.007) in residents, whereas changes in acute MI and HF/chronic HF did not reach statistical significance.

Four years later, after a Super Bowl victory, reductions were found in deaths due to all-causes (P=.003) and circulatory system diseases (P=.03) in women. Although no reductions were reported in men with the exception of a minimal and nonsignificant reduction in all-cause mortality, residents at least 65 years of age had lower rates of all-cause mortality (P=.03), as well as nonsignificant reductions in death due to circulatory system diseases and ischemic heart disease. – by Brian Ellis
This is an interesting article that focuses on the effect of emotional excitement, stress, despair and frustration on the risk of fatal cardiac events. The absolute changes in death following exciting/disappointing Super Bowls are relatively modest but statistically significant. Previously, emotional stress has been linked to acute stress cardiomyopathy. The lessons should be that football is a game and all fans need to remember that; large wagers/bets should not be levied, it appears.

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Disparity in outcomes reported for women, black stroke survivors
Roth D. Stroke. 2011; doi:10.1161/STROKEAHA.110.595322.

Among incident stroke survivors with family caregivers, women and blacks were at heightened risk for poor outcomes at 1 year after a first-time stroke event vs. men and white survivors, according to new data published in Stroke.

The study participants included 112 survivors of incident stroke from the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) project. The survivors were community-dwelling residents from 28 states who had family caregivers and incident stroke events between Nov. 15, 2004, and Sept. 10, 2009.

Study data revealed a significantly higher percentage of white stroke survivors living with their family caregiver than black survivors (76% vs. 43%; P=.0003). After controlling for age, education and whether the stroke survivors lived with their primary family caregivers, researchers reported that blacks had worse outcomes than whites, and women had worse outcomes than men (P<.05 for both race and gender effects).

“Our results show that previously found race and gender differences in long-term stroke outcome are apparent, even when studied in a prospective population-based sample, and even when a family caregiver is available to all participants,” the researchers wrote. “Future research should more closely examine the mechanisms behind these differences, including more detailed assessments of the involvement of family caregivers and other cultural and demographic factors that may affect service utilization and recovery from stroke.”
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Two-year data promising for drug-eluting stent
Dake M. Presented at: 2011 International Symposium on Endovascular Therapy; Jan. 16-20; Miami Beach.

Patients treated with a drug-eluting stent had improved patency rate at 2 years, as well as patient safety, when compared with percutaneous transluminal angioplasty, according to data from a prospective, randomized trial.

The study, which was recently presented at the International Symposium on Endovascular Therapy, included 479 patients who were treated with either a paclitaxel-coated drug-eluting stent (Zilver PTX, Cook Medical; n=241) or percutaneous transluminal angioplasty (n=238). Among the risk factors patients presented with included hypertension (drug-eluting stent, 89% vs. percutaneous transluminal angioplasty, 82%), high cholesterol (drug-eluting stent, 76% vs. percutaneous transluminal angioplasty, 70%) and diabetes (drug-eluting stent, 49% vs. percutaneous transluminal angioplasty, 42%).

At 2 years, event-free survival was 86.6% in the drug-eluting stent group vs. 77.6% in the percutaneous transluminal angioplasty arm (P<.01). Primary patency was significantly improved in the drug-eluting stent arm (74.8% vs. 51.8%; P<.01), as was provisional patency (81.2% vs. 62.7%; P<.01). Researchers also reported that the drug-eluting stent reduced 24-month restenosis rates by 50% (37.3% vs. 18.8%).

“This 24-month data is important because it shows not only sustained effect of the drug-eluting platform, but an actual widening of the reductions between the drug-eluting stent and the bare metal stent,” Michael D. Dake, MD, with the department of cardiothoracic surgery at Stanford University School of Medicine and researcher on the study, told Cardiology Today.

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Regional Variation in the Use of Implantable Cardioverter-Defibrillators for Primary Prevention: Results From the National Cardiovascular Data Registry
Matlock DD, Peterson PN, Heidenreich PA, et al.
Circ Cardiovasc Qual Outcomes 2011;4:114-121.
Study Question: Is there geographic variability in the use of implantable cardioverter-defibrillators (ICDs)?

Ventricular Tachyarrhythmias After Cardiac Arrest in Public Versus at Home
Weisfeldt ML, Everson-Stewart S, Sitlani C, et al.
N Engl J Med 2011;364:313-321.
Study Question: Is the initial rhythm recorded during resuscitation influenced by the site at which out-of-hospital cardiac arrest (OHCA) occurs?

Safety of Percutaneous Left Atrial Appendage Closure: Results From the Watchman Left Atrial Appendage System for Embolic Protection in Patients With AF (PROTECT AF) Clinical Trial and the Continued Access Registry
Reddy VY, Holmes D, Doshi SK, Neuzil P, Kar S.
Circulation 2011;123:417-424.
Study Question: What is the influence of experience on the safety of percutaneous left atrial appendage closure?

Survival Comparison of the Ross Procedure and Mechanical Valve Replacement With Optimal Self-Management Anticoagulation Therapy: Propensity-Matched Cohort Study
Mokhles MM, K?rtke H, Stierle U, et al.
Circulation 2011;123:31-38.
Study Question: Is there a survival difference among young patients after a Ross procedure (auto-graft aortic valve replacement [AVR]) compared to mechanical AVR with optimal self-management of anticoagulation therapy?

Clinical Referral Patterns for Carotid Artery Stenting Versus Carotid Endarterectomy: Results From the Carotid Artery Revascularization and Endarterectomy Registry
Carotid Artery Revascularization and Endarterectomy Registry
Longmore RB, Yeh RW, Kennedy KF, et al.
Circ Cardiovasc Interv 2011;Jan 11:[Epub ahead of print].
Study Question: What are the clinical profiles of patients referred for carotid artery stenting (CAS) versus carotid endarterectomy (CEA) in a large national database?

Favorable Changes in Cardiac Geometry and Function Following Gastric Bypass Surgery: 2-Year Follow-Up in the Utah Obesity Study
Owan T, Avelar E, Morley K, et al.
J Am Coll Cardiol 2011;57:732-739.
Study Question: Does gastric bypass surgery (GBS) impact cardiac remodeling and function?

2011 ASA/ACCF/AHA/AANN/AANS/ACR/CNS/SAIP/SCAI/SIR/ SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease
Brott TG, Halperin JL, Abbara S, et al.
J Am Coll Cardiol 2011;Jan 31:[Epub ahead of print].
Perspective: The following are 10 points to remember about the guideline on management of patients with extracranial carotid and vertebral artery disease.
Aliskiren and the Calcium Channel Blocker Amlodipine Combination as an Initial Treatment Strategy for Hypertension Control (ACCELERATE): A Randomised, Parallel-Group Trial
Brown MJ, McInnes GT, Papst CC, Zhang J, Macdonald TM.
Lancet 2011;377:312-320.
Study Question: What is the comparative efficacy of a combination of aliskiren and amlodipine to each monotherapy in early control of blood pressure and risk of adverse events?

C-Reactive Protein Concentration and the Vascular Benefits of Statin Therapy: An Analysis of 20 536 Patients in the Heart Protection Study
Heart Protection Study Collaborative Group.
Lancet 2011;Jan 28:[Epub ahead of print].
Study Question: What are the effects of statin therapy in relation to baseline concentrations of C-reactive protein (CRP) and low-density lipoprotein (LDL) cholesterol?

Clinical Guidelines and Performance Measures: Responsible Guidance and Accountability
Masoudi FA, Peterson ED, Anderson JL, Bonow RO, Jacobs AK.
J Am Coll Cardiol 2010;56:2081-2083.
Perspective: The following are 10 points to remember about clinical guidelines and performance measures.

Clinical Follow-Up 3 Years After Everolimus- and Paclitaxel-Eluting Stents: A Pooled Analysis From the SPIRIT II (A Clinical Evaluation of the XIENCE V Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions) and SPIRIT III (A Clinical Evaluation of the Investigational Device XIENCE V Everolimus Eluting Coronary Stent System [EECSS] in the Treatment of Subjects With De Novo Native Coronary Artery Lesions) Randomized Trials
Caixeta A, Lansky AJ, Serruys PW, et al.
JACC Cardiovasc Interv 2010;3:1220-1228.
Study Question: What are the long-term 3-year clinical outcomes of everolimus-eluting stents (EES) versus paclitaxel-eluting stents (PES)?

With the "Universal Definition," Measurement of Creatine Kinase-Myocardial Band Rather Than Troponin Allows More Accurate Diagnosis of Periprocedural Necrosis and Infarction After Coronary Intervention
Lim CC, van Gaal WJ, Testa L, et al.
J Am Coll Cardiol 2011;57:653-661.
Study Question: What is the best biomarker for defining post-percutaneous coronary intervention (PCI) myocardial infarction (MI)?