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Medscape Conference Coverage, based on selected sessions at the:
American Heart Association Scientific Sessions 2003
November 9 - 12, 2003, Orlando, Florida

This activity is not sanctioned by, nor a part of, the American Heart Association.


Also On This Page:Late-Breaking Clinical TrialsSession CoverageConference News
Topic Overviews
Advances in Cardiovascular Disease Treatment CME
Physicians - up to 0.75 hour(s) of AMA PRA category 1 credit
•New Findings in Treatments for Post-MI, Atrial Fibrillation, and Heart Failure Patients
Ileana L. Piña, MD
•From Myocardial Infarction to Heart Failure -- Highlights From the 2003 AHA
Jonathan Howlett, MD, FRCPC
Acute Coronary Syndromes CME
Physicians - up to 0.5 hour(s) of AMA PRA category 1 credit
•What's "New" in Acute Coronary Syndromes?
Christopher P. Cannon, MD
•Atorvastatin: Clopidogrel Interactions, Clopidogrel Resistance, and Noncompliance in Atherothrombotic Clinical Trials
Victor Serebruany, MD, PhD
Sudden Cardiac Death and Atrial Fibrillation CME
Physicians - up to 0.5 hour(s) of AMA PRA category 1 credit
•Are We Any Closer to DEFINITE Answers for Prevention of Sudden Cardiac Death?
Anne B. Curtis, MD
•An Alternative to Oral Anticoagulation With Warfarin in Patients With Atrial Fibrillation at Risk for Stroke -- Commentary on the SPORTIF V Trial
Albert L. Waldo, MD
Drug-Eluting Stents CME
Physicians - up to 0.5 hour(s) of AMA PRA category 1 credit
•Registries and Real-World Practice of Drug-Eluting Stents
Marco Aurelio D. Costa, MD, PhD, and Pedro A. Lemos, MD
Angiogenesis CME
Physicians - up to 0.5 hour(s) of AMA PRA category 1 credit
•Angiogenesis: Is it Ready for Prime Time?
Stephen E. Epstein, MD
•The Ultimate Repair -- Cellular Regeneration
Jonathan Howlett, MD, FRCPC
Noninvasive Imaging CME
Physicians - up to 0.75 hour(s) of AMA PRA category 1 credit
•Noninvasive Cardiac Imaging -- A Review
John S. Gottdiener, MD
Expert Interviews
Cardiac Resynchronization Therapy (CRT) and Biventricular Pacing: Future Guidelines and Current Issues -- An Expert Interview With Mandeep R. Mehra, MD
Dr. Mehra addresses such issues as the proper terminology for cardiac resynchronization therapy, strengths and deficits of clinical trials, and the importance of stratifying candidates for therapy.
The Valsartan in Acute Myocardial Infarction Trial (VALIANT): An Expert Interview With Marc Pfeffer, MD, PhD, and John JV McMurray, MD
Dr. Pfeffer and Prof. McMurray discuss the implications of the VALIANT trial and the future role of angiotensin receptor blockade in an era of angiotensin-converting enzyme inhibitors.
Late-Breaking Clinical Trials
VALIANT: Valsartan In Acute Myocardial Infarction
The angiotensin receptor blocker valsartan has now been shown to be statistically equivalent to the ACE inhibitor captopril in reducing rates of death and cardiovascular events in a high-risk subset of post-MI patients.
SPORTIF V: Stroke Prevention Using Oral Thrombin Inhibitor in Atrial Fibrillation V
Ximelagatran has once again proven equivalent to warfarin for prevention of stroke and systemic embolic events in patients with AF -- but without warfarin's well-known safety and monitoring limitations.
REVERSAL: Reversing Atherosclerosis With Aggressive Lipid Lowering
More intensive lipid lowering than recommended by the current US National Cholesterol Education Program (NCEP) guidelines may be warranted as secondary prevention in patients with coronary heart disease.
ACTIV in CHF: Acute and Chronic Therapeutic Impact of a Vasopressin 2 Antagonist (Tolvaptan) in Congestive Heart Failure
Initial results with tolvaptan, a new oral vasopressin receptor antagonist, suggest that it may be as effective as, and safer than, diuretics in CHF patients.
DEFINITE: Defibrillators in Non-ischemic Cardiomyopathy Treatment Evaluation
Compared with standard medical therapy alone, the use of an ICD in patients with non-ischemic dilated cardiomyopathy is associated with a 34% relative risk reduction (RRR) in all-cause mortality and a 67% RRR in arrhythmic death.
PAD: The Public Access Defibrillation Trial
Survival rates for out-of-hospital cardiac arrest in public locations are nearly doubled when laypersons trained in CPR are also trained in the use of AEDs. Investigators express disappointment at low survival rates in residential units.
ORBIT: Out-of-Hospital Rectilinear Biphasic Investigational Trial
Results of the largest study ever conducted comparing monophasic defibrillation with biphasic defibrillation fails to show any difference in the safety or efficacy in the termination of VT/VF in patients suffering out-of-hospital cardiac arrest.
PAPABEAR: Prophylactic Amiodarone for the Prevention of Arrhythmias That Begin Early After Revascularization
In the PAPABEAR trial, prophylactic amiodarone significantly reduced the incidence of atrial fibrillation/atrial flutter following cardiac surgery compared with placebo. However, reduction in arrhythmia recurrence did not influence mortality or day of arrhythmia onset.
PREVEND IT: Prevention of Renal and Vascular Endstage Disease Intervention Trial
Fosinopril, but not pravastatin, significantly lowers urinary albumin excretion levels in patients without hypertension or hypercholesterolemia and shows favorable trend toward a reduced risk in cardiovascular events.
PRIMO-CABG: Pexelizumab for the Reduction of Infarction and Mortality in Coronary Artery Bypass Graft Surgery
Pexelizumab, an anti-C5 complement antibody, is associated with a trend toward the reduction of death and MI in patients treated with CABG-only and a significant reduction in death and MI by intention-to-treat analysis.
EXPEDITION: Sodium-Proton Exchange Inhibition to Prevent Coronary Events in Acute Cardiac Conditions Trial
Use of cariporide, a sodium-hydrogen inhibitor, significantly reduces the incidence of death/MI in patients undergoing CABG surgery, but is associated with a significant increase in the rate of mortality compared with placebo.
BRAVE: Bavarian Reperfusion Alternatives Evaluation -- Reteplase Plus Abciximab or Abciximab Alone Prior to PCI in AMI Patients
Is facilitated PCI using a combination of thrombolytic therapy and glycoprotein IIb/IIIa inhibitors a more effective pretreatment strategy than GP IIb/IIIa antagonists alone?
Intracoronary Autologous Bone Marrow Cell Transplantation Post Myocardial Infarction: A Randomized Controlled Trial
First randomized study of its kind finds intracoronary delivery of autologous bone marrow cells is safe and significantly improves left ventricular function in AMI patients at 6 months.
CREST: Cilostazol for Restenosis Trial
Cilostazol taken orally after successful stent implantation of de novo lesions significantly reduced the rate of restenosis -- a benefit that extended to diabetic and small vessel subgroups.
The DIABETES (Diabetes and Sirolimus Eluting Stent) Trial: One-Month Clinical Follow-up
Compared with a bare metal stent, the use of a sirolimus-eluting stent to prevent restenosis in diabetic patients with de novo coronary lesions can be used safely without any adverse events as demonstrated at 1-month follow-up.
Session Coverage
REPLACE II Substudies: Effects of Clopidogrel Pretreatment and Cost-Effectiveness Analysis
Two respective studies find that clopidogrel pretreatment does not influence the effectiveness of bivalirudin in patients undergoing PCI, and use of the direct antithrombin is significantly more cost-effective than the use of heparin and glycoprotein IIb/IIIa inhibitors.
Optimal Duration of Pretreatment With Clopidogrel Prior to PCI: Data From the CREDO Trial
CREDO substudy finds that when using a 300-mg loading dose of clopidogrel prior to PCI, clopidogrel pretreatment should be initiated at least 15 hours prior to planned intervention to maximize its protective antithrombotic effects.
Clinical Predictors of Major Atherothrombotic Events Following Elective PCI: A CREDO Substudy
Older age, recent MI, and renal insufficiency contribute to a significantly higher risk of death, MI, or stroke 1 year following elective PCI, even despite prolonged anticoagulation therapy.
EPHESUS: Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study -- Patients With a Baseline History of Hypertension
Retrospective analysis indicates that the selective aldosterone blocker eplerenone is especially beneficial in reducing mortality and morbidity in patients with a history of hypertension as well as AMI complicated by systolic LV dysfunction.
Prognostic Value of Aldosterone in the Valsartan Heart Failure Trial (Val-HeFT)
It's not the circulating aldosterone levels, but blockade of the receptors, that confers the benefit in CHF patients.
Influence of Renal Function on Cardiovascular Outcomes: A VALIANT Substudy
An analysis of 3-year outcomes in VALIANT reported that baseline renal impairment is common and should be considered a potent, independent, and easily identifiable risk factor for cardiovascular complications post AMI.
Conference News
Head-to-Head Comparison of Drug-Eluting Stents Shows Few Differences 11/14/03
[Medscape Medical News]
Both the sirolimus- and paclitaxel-eluting stents had similar rates of target vessel revascularization, major adverse coronary events, and subacute stent thrombosis; price might be the deciding factor in choosing one device over the other.
Use of Rhythm Control Strategy in Patients With AF and CHF Not Superior to Rate Control 11/14/03
[Medscape CRM News]
Managing AF patients with a rhythm control strategy provides no survival advantage over rate control in patients with CHF. Warfarin still underutilized; investigators call for more randomized trials.
Racial Gap in Achievement of Hypertension Goals Grows 11/14/03
[Medscape Medical News]
Adherence to treatment regimens may play a major role.
ACE Inhibitor Use Shows Benefit in Microalbuminuria Without Clinical Signs of Vascular Disease 11/14/03
[Medscape Medical News]
Study suggests microalbuminuria is an early marker of vascular events; primary prevention of cardiovascular events may only require simple test.
CURE, CREDO Trials Demonstrate Clopidogrel Cost-Effective for ACS 11/14/03
[Medscape Medical News]
Life-years gained through the use of the drug in acute coronary syndrome patients, with or without PCI, would cost less than $50,000 over a lifetime.
Social Isolation May Lead to Poor Health Behaviors 11/13/03
[Medscape Medical News]
Study also finds that C-reactive protein, IL-6, and fibrinogen levels may be indicators of social isolation.
Amiodarone Prophylaxis Reduces Postoperative AF After CABG, Valve Repair 11/13/03
[Medscape Medical News]
Significant benefit was seen in all groups, irrespective of beta-blocker use.
Statin Reverses Carotid Atherogenesis, Exercise Improves Vascular Function in Children 11/13/03
[Medscape Medical News]
Two independent studies demonstrate the importance of early preventive intervention in children at risk of heart disease.
High-Dose Atorvastatin Stops Progression of Atherosclerosis 11/13/03
[Medscape Medical News]
Atorvastatin 80 mg daily stopped plaque progression in patients with symptomatic coronary artery disease as measured by intravascular ultrasound.
Blood Test May Predict Rebound Weight Gain 11/12/03
[Medscape Medical News]
Plasma levels of norepinephrine, insulin, and leptin can help to predict which patients will regain weight.
Out-of-Hospital Defibrillation by Trained Lay Volunteers Doubles Survival 11/12/03
[Medscape Medical News]
Results of the Public Access Defibrillation trial is seen as a bridge to home use of automatic external defibrillators.
Ximelagatran as Effective as Warfarin for Prevention of Stroke, Embolic Events 11/12/03
[Medscape Medical News]
In this high-risk group of patients with nonvalvular atrial fibrillation, significantly fewer bleeding events were seen inximelagatran arm.
Intracoronary Bone Marrow Transplant Shows Benefit Post-MI 11/12/03
[Medscape Medical News]
Findings suggest intracoronary autologous bone marrow cell transfer after myocardial infarction can regenerate the heart and improve ventricular function.
Mediterranean Diet Lowers C-reactive Protein Levels 11/11/03
[Medscape Medical News]
Diet's beneficial effect is independent of any other lifestyle factors.
Metabolife 356 Associated With Increased Cardiac Risk 11/11/03
[Medscape Medical News]
Significant increases in QTc interval with even a low dose of the supplement suggests increased risk of ventricular arrhythmia.
Tolvaptan Reduces Fluid Volume in Congestive Heart Failure 11/11/03
[Medscape Medical News]
The drug does not disturb electrolytes and, at the lowest dose, it achieves significant weight loss compared with placebo.
Get With the Guidelines Program Improves Quality of Care for CAD Patients 11/11/03
[Medscape Medical News]
A national initiative of the American Heart Association to improve guidelines adherence in patients hospitalized with CAD significantly improved the quality of care for patients hospitalized with CAD within 1 year of the program's implementation.
Four Popular Diets Equally Effective for Weight Loss 11/10/03
[Medscape Medical News]
The Atkins, Weight Watchers, and Zone diets also demonstrated significant improvements in cardiovascular risk factors, but the Ornish diet did not.
VALIANT Results Suggest ARBs as Effective as ACE Inhibitors Post-MI 11/10/03
[Medscape Medical News]
Combining valsartan and captopril does not increase benefit, but does increase adverse effects.
Study Documents Large Variation in Heart Failure Care 11/10/03
[Medscape Medical News]
Nearly one third of patients hospitalized for acutely decompensated heart failure who are candidates for treatment with angiotensin-converting enzyme inhibitors are discharged without a prescription.
Multifactor Program Reduces CVD Risk Factors Among the Medically Underserved 11/10/03
[Medscape Medical News]
But structured intervention fails to reach women, a second study shows.

 
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