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Medscape Conference Coverage, based on selected sessions at the:
American Heart Association 2004 Annual Scientific Sessions
November 7 - 10, 2004, New Orleans, Louisiana

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


Also On This Page:International PerspectiveLate-Breaking Clinical Trials
Session CoverageConference News
Topic Overviews
Highlights From American Heart Association Scientific Sessions 2004 CME
Physicians - up to 1.25 hour(s) of AMA PRA category 1 credit
•New Insights Into Implantable Cardioverter Defibrillators and Cardiac Resynchronization Therapy: Who Benefits?
Anne B. Curtis, MD
•SCD-HeFT and DEFINITE Substudies: Establishing a Formative Role for ICD Therapy in the Primary Prevention of Sudden Death
Alan H. Kadish, MD
•Cardiac Imaging to Determine Candidates for Resynchronization Therapy
John S. Gottdiener, MD
•Atherosclerosis Imaging: The Role of Intravascular Ultrasound
Gary S. Mintz, MD
Expert Interview
Implications of the SCD-HeFT Cost-effectiveness Analysis: An Expert Interview With Richard Luceri, MD
Can the overall results of SCD-HeFT and its cost-effectiveness analysis be applied to the real world? Dr. Luceri shares his impressions of these results and where the future of ICD therapy is headed.
Comparison of Amlodipine vs Enalapril to Limit Occurrences of Thrombosis (CAMELOT): An Expert Interview With Steven E Nissen, MD
CAMELOT is yet another trial supporting calcium antagonists and suggesting that RAS inhibition may not have benefits beyond blood pressure lowering - as discussed here.
International Perspective
Developed in collaboration with our international partners.
Canada Canada
The Prevention of Events with Angiotensin-Converting Enzyme Inhibition (PEACE): A Canadian Thought-Leader Perspective From Wayne Warnica, MD
Linda Brookes, MSc
Late-Breaking Clinical Trials
A-HeFT: African-American Heart Failure Trial
Fixed-dose combination of isosorbide dinitrate plus hydralazine: Is it one of the most fortuitous combinations in cardiovascular medicine for the treatment of African Americans with heart failure?
Cost-effectiveness of ICD Therapy in the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)
ICDs cost more, but save more lives. According to a cost-effectiveness study of SCD-HeFT, the resultant cost per life-year saved is within a reasonable range.
RIO-NA: Rimonabant In Obesity -- North America
The previous 1-year metabolic control results with the new class of cannabinoid receptor blockers, rimonabant, have now been extended to 2 years, with qualifications.
PEACE: Prevention of Events with Angiotensin-Converting Enzyme Inhibition
Just when you thought it was safe to add ACE inhibitors to the water... but several thought leaders add different explanations.
Pioglitazone vs Rosiglitazone in Patients with Type 2 Diabetes and Dyslipidemia
Does comparing pioglitazone to rosiglitazone amount to comparing Coke to Pepsi (as Dr. Califf suggests) -- or are the significant differences important?
ARBITER 2: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 2
For the hypercholesterolemic patient, it isn't just the LDL cholesterol, and it isn't just a statin -- other targets and other agents should be considered.
GEMINI: Glycemic Effects in Diabetes Mellitus: Carvedilol-Metoprolol Comparison in Hypertensives
Head-to-head comparisons of 2 of the most prescribed beta blockers continue to show differential results -- although the common results may be the more important.
ISAR-SWEET: Intracoronary Stenting and Antithrombotic Regimen -- Is Abciximab a Superior Way to Eliminate Elevated Thrombotic Risk in Diabetics?
Does the GP IIb/IIIa antagonist abciximab provide protective effects in diabetic patients undergoing elective PCI after pretreatment with 600 mg of clopidogrel?
CREATE: Clinical Trial of Metabolic Modulation in Acute Myocardial Infarction Treatment Evaluation
This large, simple, international trial was run by and for the developing world and has demonstrated an important addition to the treatment of acute MI.
CREATE-ECLA: Clinical Trial of Metabolic Modulation in Acute Myocardial Infarction Treatment Evaluation -- Estudios Cardiologicos Latinoamerica
It's an old hypothesis that metabolic support of the infarcted myocardium should be therapeutic - and this trial stops just short of providing a final answer.
DIPOM: Diabetic Postoperative Mortality and Morbidity
The guidelines stipulate beta-blockers for perioperative care, and this small trial was the first of several well-meant efforts to elucidate those guidelines.
REACT: Rescue Angioplasty versus Conservative Therapy of Repeat Thrombolysis
Should rescue PCI be the treatment of choice for AMI patients who failed to show signs of reperfusion after thrombolytic therapy? Or should repeat lysis be administered?
CARP: Coronary Artery Revascularization Prophylaxis Trial
Does coronary artery revascularization prior to elective vascular surgery in stable coronary artery disease patients improve long-term survival?
SEEDS: Syncope Evaluation in the Emergency Department Study
Nothing beats a good physician work-up; read why.
SHIELD: Shock Inhibition Evaluation With Azimilide
While clinical trial data have unequivocally demonstrated the superiority of ICD therapy over drugs, do these same drugs have a role in decreasing the occurrence of ICD therapy?
ESCAPE: Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness
Does therapy guided by pulmonary artery catheter monitoring and clinical assessments improve morbidity and mortality compared with clinical assessment alone in patients with severe coronary disease?
Session Coverage
Do Selective COX-2 Inhibitors Increase Blood Pressure More or Less Than Nonselective NSAIDs?
The authors studied the associated increases in SBP and DBP, the relative risk of developing hypertension with coxibs vs NSAIDs, as well as differences between rofecoxib and celecoxib.
SHEP X: Influence of Long-term Diuretic-Based Hypertensive Therapy by Diabetic Status -- 14-Year Follow-up From SHEP
Does chlorthalidone-based treatment for hypertension help or hurt long-term outcomes in patients with diabetes?
ARIES: American Rosuvastatin Investigation of Efficacy and Safety
As is well known, on equivalent milligram doses, different statins have different effects -- as illustrated here in a minority population.
ADCLT: Alzheimer's Disease Cholesterol-Lowering Treatment Trial
Contrary to previous anecdotal observations, new work appears to provide the first demonstration that statins may ameliorate, not exacerbate, Alzheimer's disease and dementia.
Lipid Predictors of Risk Reduction in Lipid Intervention Trials
Is it "lipid altering" or "lipid lowering" that really matters? And is it time for a mind-altering approach to treating the hyperlipidemic patient?
Therapeutic Synergism of Statins With Angiotensin Receptor Blockers
Does the combination of a statin with an ARB have a synergistic/additive effect on blood pressure lowering in patients with combined hypertension and hyperlipidemia?
Do Statins Lower Blood Pressure?
Among the many pleiotropic effects of statins, data are beginning to appear supporting a possible antihypertensive effect.
Safety and Efficacy of Achieving Low LDL-C Levels in Patients Treated With Aggressive Statin Therapy
Can LDL-C be too low? Results of a posthoc analysis from PROVE-IT - TIMI 22 evaluating patients treated with intensive lipid-lowering therapy suggest not.
Intensive vs Moderate Lipid Lowering: Interrelationships of LDL-C, CRP, and Clinical Outcomes -- Prespecified Analysis of the PROVE-IT - TIMI 22 Trial
The results of this prespecified analysis may introduce an entirely different perspective on how we screen and treat our patients.
Baseline CRP in ACS Patients: Results From the CURE Inflammatory Marker Substudy
Investigators found that increasing CRP levels correspond to an increased risk of cardiovascular events independent of other contemporary risk stratification; however, it does not predict the effectiveness of clopidogrel.
PRINCESS: Prevention of Ischemic Events by Early Treatment of Cerivastatin
Does very early statin treatment (< 48 hours from symptom onset) reduce the rates of death, recurrent infarction, and recurrent ischemia in AMI patients compared with moderate treatment?
Early vs Delayed Statin Administration in ACS Patients
Despite study limitations, results support AHA/ACC guidelines to initiate early statin therapy in ACS patients.
Risk of Events: Predischarge CRP Levels in High-Risk ACS Patients Treated With Contemporary Therapy
Should CRP levels be measured at discharge in routine clinical practice to identify high-risk patients and determine intensity of required treatment?
Outcomes Associated With Worsening Renal Function After Acute STEMI
Is the use of serum creatinine level testing a simple tool to predict the outcome of patients with cardiovascular disease?
Drug-Eluting Stents
Thrombosis Rates: Drug-Eluting vs Bare Metal Stents
In a meta-analysis that included over 5000 patients treated in 10 randomized drug-eluting stent trials, the rate of thrombosis in patients treated with drug-eluting stents vs bare metal stents was...
Stent Thrombosis Associated With Paclitaxel-Eluting Stent: A Meta-Analysis
Is the rate of stent thrombosis in patients treated with the paclitaxel-eluting stent higher (or lower) than rates reported in patients treated with bare metal stents?
Rapamycin vs Paclitaxel Drug-Eluting Stents in High-Risk Coronary Lesions
Early results demonstrate equal safety and efficacy between the 2 systems, but we may have a long way to go before making any definitive conclusions.
ENDEAVOR I: 1-Year Clinical, Angiographic, and IVUS Follow-up Assessing the Endeavor ABT-578-Eluting Stent
One-year results demonstrate the safety and efficacy of the Endeavor ABT-eluting stent in simple coronary artery lesions with low rates of binary restenosis and no incidence of late thrombosis.
Conference News
Bone Marrow Cell Transfer Improves LVEF After MI 11/15/04
[Medscape Medical News]
The 18-month results of BOOST show on magnetic resonance imaging that left ventricular ejection fraction remains better than that in control subjects.
Impedance Threshold Device May Improve Survival in Out-of-Hospital Cardiac Arrest 11/12/04
[Medscape Medical News]
When used with cardiopulmonary resuscitation, the device increases the blood supply to the heart and brain.
Recognition of Agonal Breathing May Result in Fewer Missed Cardiac Arrests 11/12/04
[Medscape Medical News]
In this 1-year study, 911 dispatchers were trained to help bystanders, and the results suggest that agonal breathing may be a marker for resuscitation success.
Alpha-Linolenic Acid Intake Inversely Associated With Cardiac Events 11/11/04
[Medscape Medical News]
In the Nurses' Health Study, diets rich in alpha-linolenic acid were associated with reduced risk of sudden cardiac death and fatal coronary heart disease.
Valdecoxib Meta-Analysis Suggests Increased Cardiovascular Risk 11/11/04
[Medscape Medical News]
Early cardiovascular signal seen in surgery patients.
Subclinical Atherosclerosis Present in Nearly All Young Adults With Diabetes and Metabolic Syndrome 11/11/04
[Medscape Medical News]
Fully 88% of young adults with metabolic syndrome and diabetes mellitus have signs of carotid atherosclerosis on ultrasound, study found.
LDL Particle Number, Not Size, a Significant Predictor of CVD Risk 11/11/04
[Medscape Medical News]
Particle measurement may optimize management in patients at high risk of cardiovascular disease.
Incidence of Metabolic Syndrome Low When Weight Is Stable 11/9/04
[Medscape Medical News]
Weight gain, not actual weight, is the most important risk factor for developing metabolic syndrome.
Disease Management Effective But Costly for CHF 11/9/04
[Medscape Medical News]
Disease management programs improved survival in patients with congestive heart failure, but the researchers found that the program did not reduce costs.
History of Premature CHD in Sister Warrants Aggressive Screening 11/8/04
[Medscape Medical News]
In women with a sibling history of premature coronary heart disease, especially if that sibling is a sister, risk is increased and noninvasive screening for subclinical atherosclerosis is needed.
Both Uphill, Downhill Exercise Help Lipid and Glucose Metabolism 11/8/04
[Medscape Medical News]
A randomized, crossover study in health, sedentary, nondiabetic adults found that hiking downhill is especially beneficial for improving glucose clearance.
Novel "Heart Sock" Demonstrates Efficacy for Off-Loading Heart in Patients With Dilated Cardiomyopathy 11/8/04
[Medscape Medical News]
In a pivotal trial, the device was associated with significant reduction in need for additional cardiac procedures, such as transplantation or left ventricular assist device implantation.

 
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