American College of Cardiology 55th Annual Scientific Session

This year, the ACC introduced the Innovation in Intervention: i2 Summit 2006 -- the first meeting-within-a-meeting at the ACC specifically geared toward interventional cardiology. The Summit, which was cosponsored by the Society for Cardiovascular Angiography and Interventions (SCAI), provided a forum for experts to discuss the latest advances in this constantly evolving field. However, it was not only the i2 Summit that featured topics on interventional cardiology; research in this field was also a prominent focus during the main ACC Sessions. With our coverage of the ACC 2006 meeting and i2 Summit, Medscape Cardiology is inaugurating a special section -- Interventional Corner -- led by Luis Gruberg, MD, highlighting research and clinical advances in this all-important arena. Below are selected summaries with viewpoints from the late-breaking trial presentations on interventional cardiology held during both meetings.

• Imaging in Intervention: Emerging Technologies
  
  As described in this session, advances in imaging technology will enable us to understand the pathologic changes and therefore provide a wider range of therapeutic alternatives to our patients.

• ACUITY and ACUITY Timing: Heparin, GP IIb/IIIa inhibitors (Upstream vs Deferred Use), and Bivalirudin -- Managing Moderate- to High-Risk ACS Patients
  
  The results from ACUITY have widespread implications that are likely to change the way adjuvant anticoagulation is given to ACS patients who undergo PCI.
• OASIS-6: Sixth Organization to Assess Strategies in Acute Ischemic Syndromes -- Effects of Fondaparinux in STEMI Patients
  
  These are important results that may improve the outcomes of STEMI patients, especially those who do not undergo primary PCI as a reperfusion strategy.
• ExTRACT-TIMI 25: Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment
  
  The present study provides important data that may change current guidelines for the management of STEMI patients treated with thrombolytic therapy.
• ISAR-REACT 2: Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 2
  
  Should abciximab be added to the treatment regimen of high-risk ACS patients undergoing PCI after pretreatment with clopidogrel?

• STENT: Strategic Transcatheter Evaluation of New Therapies -- Paclitaxel- vs Sirolimus-Eluting Stents in Diabetic Patients
  
  These results will likely only fuel the ongoing debate about the superiority of one stent over the other.
• TAXUS-V ISR: Paclitaxel-Eluting Stents vs Vascular Brachytherapy for the Treatment of In-stent Restenosis Within Bare-Metal Stents
  
  Is it time to retire vascular brachytherapy as the gold-standard treatment for in-stent restenosis?
• PROGRESS-AMS: Coronary Stenting With Magnesium-Alloy Absorbable Metal Stent
  
  First-in-man trial results suggest a magnesium-alloy absorbable stent may overcome some of the limitations associated with conventional stenting.
• BASKET-LATE: Late Clinical Events Related to Late Stent Thrombosis After Stopping Clopidogrel: Drug-Eluting vs Bare-Metal Stenting
  
  The results of this small study and the conclusions reached by the authors are certainly a cause for concern.
• CAPTURE: Evaluation of Carotid Stenting in Community Practice
  
  Further analysis of these data will certainly help us understand the best therapeutic options for patients with symptomatic and asymptomatic carotid artery stenosis.

• ASTEROID: A Study To Evaluate the Effect of Rosuvastatin on Intravascular Ultrasound-Derived Coronary Atheroma Burden
  
  Using intravascular ultrasound to assess atherosclerotic vessel segments, high-dose statin therapy has been shown for possibly the first time to cause actual regression of atheroma volume -- although this result is short-term and does not prove clinical benefit.
• CHARISMA: Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance
  
  Dual antiplatelet therapy with aspirin + clopidogrel is beneficial for secondary prevention, but apparently not primary prevention, according to CHARISMA -- but read the societies' comments before modifying treatment regimens!
• MIST: Migraine Intervention with STARflex Technology Trial
  
  Does catheter-based closure of patent foramen ovale (PFO) cure migraine headaches?
• Heart Outcomes Prevention Evaluation (HOPE) 2 -- Homocysteine Lowering in Stable Chronic Vascular Disease
  
  Homocysteine continues to be regarded as a possible marker of cardiovascular disease risk -- and one of the follow-up studies from HOPE explores whether lowering serum homocysteine levels will have beneficial effects on that risk.
• TROPHY: Trial Of Preventing Hypertension
  
  JNC 7 redefined the JNC VI "high normal" BP category as "prehypertension" -- TROPHY asked what happens if prehypertensive BP levels are treated with drugs, and is this to be recommended?
• The Pediatric Randomized Carvedilol Trial in Children with Heart Failure
  
  Carvedilol has a proven track record in adult heart failure (HF) patients and a presumed one in children -- but this first clinical trial in pediatric HF suggests that perhaps that presumption is not evidence-based.
• PRIMO-CABG II: Pexelizumab for the Reduction of Infarction and Mortality in Coronary Artery Bypass Graft Surgery II
  
  The use of a specifically designed drug that can block the detrimental effects of complement activation seems logical. But...

• Waist Circumference a Stronger Independent Predictor of CVD
  
  [RFM News]
• Results of the APAF Trial
  
  [CRM News]
• Statin Pretreatment Reduces Post-Cardiac Surgery Arrhthmia Risk
  
  [CRM News]
• Heart Failure Model Accurately Predicts Patient Survival
  
  [Medscape Medical News]
• Darbepoetin Alfa May Treat Anemia in Heart Failure
  
  [Medscape Medical News]
• Drug-Eluting Stents Significantly Outperform Brachytherapy for In-Stent...
  
  [Medscape Medical News]
• Ezetimibe/Simvastatin Better Than a Statin Alone
  
  [Medscape Medical News]
• Early, Aggressive Statin Therapy in Acute Coronary Syndromes Improves...
  
  [Medscape Medical News]
• Discharge Use of Carvedilol Reduces Mortality
  
  [Medscape Medical News]
• Dual Blood Pressure, Lipid Control Could Help Millions
  
  [Medscape Medical News]
• Sirolimus-Eluting Stents May Outperform Paclitaxel-Eluting Stents
  
  [Medscape Medical News]
• Novel Renin Inhibitor Lowers Blood Pressure
  
  [Medscape Medical News]
• CRP Levels Increase After Statin Withdrawal
  
  [Medscape Medical News]
• Studies Conflict on Effect of Obesity on CHF Mortality
  
  [Medscape Medical News]
• Lower HDL Cholesterol Increases Risk of Cardiovascular Event
  
  [Medscape Medical News]
• Low-Tech Device Beats Out IV Diuretics for Heart Failure
  
  [Medscape Medical News]