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American College of Cardiology, April 2-5, 2011

The American College of Cardiology 60th Annual Scientific Session and Expo

The American College of Cardiology's 60th Annual Scientific Session and Expo was held April 2 to 5 in New Orleans and attracted approximately 30,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in cardiology. The conference highlighted recent advances in the treatment, management, and prevention of cardiovascular diseases, with presentations also focusing on novel drugs and surgical approaches to improve the quality of care for patients with cardiovascular diseases.

In the five-year PLATINUM study, Gregg W. Stone, M.D., of the New York-Presbyterian Hospital/Columbia University Medical Center in New York City, and colleagues found that a novel platinum chromium stent was noninferior to the standard cobalt chromium stent. The investigators randomized 1,530 patients undergoing angioplasty in one or two of their coronary arteries between January 2009 and September 2009 to receive either the new platinum chromium stent or the standard cobalt chromium stent.

The researchers followed patients for a year after surgery, with the primary end point being a composite of target vessel-related cardiac death, target vessel-related heart attack, or ischemia-driven target lesion revascularization, Stone said. He noted that the primary end point occurred in a similar proportion of patients in both groups.

"Only 3 percent of patients had an event over one-year follow-up. In addition, few patients died and only 1.9 percent of patients underwent target lesion revascularization. Stent thrombosis occurred in only 0.4 percent of patients in each group," Stone said. "We concluded that the new platinum chromium everolimus-eluting stent was noninferior to the cobalt chromium everolimus-eluting stent. Whether the newer generation platinum chromium stent is easier to use was not evaluated in this trial, and will be determined in clinical practice. Overall, both stents provided good outcomes and are attractive options for patients undergoing percutaneous coronary intervention."

The study was funded by Boston Scientific; several authors disclosed financial relationships with Boston Scientific, Medtronic, Cordis, and Abbott Vascular. The cobalt chromium stent was manufactured by Abbott Vascular as XIENCE V and distributed by Boston Scientific as PROMUS, while the platinum chromium stent was manufactured as PROMUS Element by Boston Scientific.

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In the MAGELLAN trial, Alexander T. Cohen, M.D., of King's College Hospital in London, and colleagues found that rivaroxaban was noninferior to enoxaparin for short-term use (10 days) and superior to enoxaparin followed by placebo for long-term use (35 days) for the prevention of venous thromboembolism (VTE) in acutely ill hospitalized patients. The investigators randomized 8,101 patients from 52 countries to receive rivaroxaban for 35 days or enoxaparin for 10 days, with both groups also receiving either an oral or subcutaneous placebo. The primary efficacy end point was a composite of asymptomatic proximal deep venous thrombosis (DVT), symptomatic DVT, symptomatic non-fatal pulmonary embolism, and VTE-related death. The primary safety outcome was a composite of clinically relevant non-major bleeding and treatment-related major bleeding.

After a follow-up at 10 days, the investigators found that rivaroxaban was noninferior to enoxaparin with respect to the primary efficacy outcome, with 2.7 percent of patients in both groups experiencing the primary end point. In addition, the investigators found that rivaroxaban was superior to enoxaparin followed by placebo after a follow-up conducted at 35 days, with 4.4 percent of patients receiving rivaroxaban experiencing the primary efficacy outcome compared to 5.7 percent receiving enoxaparin. However, the investigators found that enoxaparin was associated with a significantly reduced rate of bleeding as compared with rivaroxaban at both 10 and 35 days.

"As observed in previous studies in this area, we found an ongoing risk of VTE past the initial period of hospitalization. We did not see a consistently positive benefit-risk balance with rivaroxaban use, and thus further analysis is required to identify which groups of patients in MAGELLAN may derive benefit from thromboprophylaxis with rivaroxaban," Cohen said in a statement.

The study was funded by Bayer HealthCare and Johnson & Johnson Pharmaceutical Research & Development LLC; several authors disclosed financial relationships with these companies and other pharmaceutical and medical device companies.

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ACC: Novel Device Lowers Resistant Blood Pressure

WEDNESDAY, April 6 (HealthDay News) -- A new device, the Rheos System, can reduce blood pressure to target levels among patients with severe and uncontrolled hypertension through baroreflex activation, according to research presented at the American College of Cardiology's 60th Annual Scientific Session & Expo, held from April 2 to 5 in New Orleans.

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ACC: Valsartan and Amlodipine Provide Similar Effects

TUESDAY, April 5 (HealthDay News) -- An angiotensin II receptor blocker (ARB) appears to provide similar effects on cardiovascular outcomes as a calcium channel blocker (CCB) in patients with hypertension and glucose intolerance, while a combination of an ARB and a CCB seems to benefit elderly patients with hypertension and cardiovascular disease compared to a high-dose ARB alone, according to research presented at the American College of Cardiology's 60th Annual Scientific Session & Expo, held from April 2 to 5 in New Orleans.

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ACC: Mitral Regurgitation Approaches Evaluated

TUESDAY, April 5 (HealthDay News) -- Percutaneous repair that involves implantation of a mitral clip appears to be less effective at reducing mitral regurgitation than conventional surgery but seems to be associated with superior safety and similar improvements in other clinical outcomes, according to research published online April 4 in the New England Journal of Medicine to coincide with the American College of Cardiology's 60th Annual Scientific Session & Expo, held from April 2 to 5 in New Orleans.

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ACC: PCI Appears Noninferior to CABG for Stenosis

TUESDAY, April 5 (HealthDay News) -- For the treatment of left main coronary artery stenosis, percutaneous coronary intervention (PCI) with sirolimus-eluting stents appears to be equivalent to coronary artery bypass grafting (CABG) in terms of major adverse cardiac or cerebrovascular events, according to research published online April 4 in the New England Journal of Medicine to coincide with the American College of Cardiology's 60th Annual Scientific Session & Expo, held from April 2 to 5 in New Orleans.

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ACC: Radial and Femoral Access Equally Effective

TUESDAY, April 5 (HealthDay News) -- Radial and femoral access for coronary angiography in patients with acute coronary syndromes (ACS) are both safe and effective, though there is a lower rate of local vascular complications associated with the radial approach, according to research published online April 4 in The Lancet to coincide with the American College of Cardiology's 60th Annual Scientific Session & Expo, held from April 2 to 5 in New Orleans.

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ACC: No Survival Benefit With CABG in Heart Failure

MONDAY, April 4 (HealthDay News) -- In patients with coronary artery disease (CAD) and heart failure, there is not a significant difference between medical therapy alone or with coronary artery bypass grafting (CABG) with respect to the rate of death from any cause; and, in patients with CAD and left ventricular dysfunction, myocardial viability is unable to identify those with a differential survival benefit from CABG, according to research published online April 4 in the New England Journal of Medicine to coincide with the American College of Cardiology's 60th Annual Scientific Session & Expo, held from April 2 to 5 in New Orleans.

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ACC: Yoga Helpful for Atrial Fibrillation Patients

MONDAY, April 4 (HealthDay News) -- Practicing yoga may reduce episodes of irregular heartbeat and improve the symptoms of anxiety and depression associated with atrial fibrillation, while remaining physically active throughout a lifetime may prevent declines in heart mass, according to research presented at the American College of Cardiology's 60th Annual Scientific Session & Expo, held from April 2 to 5 in New Orleans.

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ACC: Safety and Efficacy of Two Drug-Eluting Stents Similar

MONDAY, April 4 (HealthDay News) -- After two years, a novel zotarolimus-eluting stent appears to be as effective as an everolimus-eluting stent for patients in routine clinical practice, according to research published online April 3 in The Lancet to coincide with the American College of Cardiology's 60th Annual Scientific Session & Expo, held from April 2 to 5 in New Orleans.

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