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Research Propels Advances in Clinical Cardiology

3 studies highlight new drug therapies, heart valve 'clips' and better nuclear imaging

TUESDAY, March 27, 2007 (HealthDay News) -- Advances in diagnosis, medical therapy and coronary intervention in patients with cardiovascular problems were highlighted in three studies expected to be presented today at the American College of Cardiology's Innovation in Intervention; i2 Summit, in New Orleans.

One study found that the anti-clotting agent bivalirudin -- a synthetic version of an anti-clotting compound found in the saliva of leeches -- provides similar long-term survival for patients with acute coronary syndrome, but reduces serious bleeding, compared to existing treatments.

Acute coronary syndrome includes a number of symptoms, including unstable chest pain and a type of heart attack called non-ST elevation myocardial infarction. This study of almost 14,000 patients in 17 countries compared treatment with bivalirudin alone; bivalirudin plus drugs called glycoprotein IIb/IIIa inhibitors (GPI); and heparin plus GPI.

In addition to drug therapy, about 60 percent of the patients received a drug-eluting stent, and 37 percent received a bare metal stent.

At one year, death rates were 4.4 percent for patients treated with heparin plus GPI; 4.2 percent for those treated with bivalirudin plus GPI; and 3.8 percent for those treated with bivalirudin alone.

The study also found that bivalirudin alone significantly reduced major bleeding at 30 days.

The findings suggest that bivalirudin may become an increasingly common choice for treatment of people with acute coronary syndrome, which includes heart attack, the study authors said.

The second study found that a catheter-mounted device called the MitraClip may offer patients with a heart valve condition called moderate-to-severe mitral regurgitation a long-lasting alternative to open-chest surgery.

MitraClip acts like a clothespin to clip together the flaps of leaky heart valves, the researchers explained.

The one-year results from the study of 55 patients confirm earlier findings that most patients who receive the MitraClip experience only mild leakage after the device is installed.

"We earlier established that we could reduce mitral regurgitation with the MitraClip, and now we've established the durability of the result," Dr. Ted Feldman, director of the cardiac catheterization laboratory for Evanston Northwestern Healthcare in Illinois, said in a prepared statement.

"A large number of patients have had a good enough result that they've been able to delay or completely avoid surgery," Feldman said.

The third study concluded that an investigational drug called regadenoson appears to be better tolerated and better able to deliver high quality nuclear scan images of the heart than the widely-used adenosine.

The study found that regadenoson could be safely combined with mild exercise, which improves image quality.

"In nuclear cardiology, images are everything. Exercise improves blood flow to the heart instead of the gut, resulting in better images," Dr. Gregory Thomas, a clinical associate professor of medicine at the University of California, Irvine, and director of nuclear cardiology at Mission Internal Medical Group in Mission Viejo, said in a prepared statement.

The study compared the use of adenosine in patients who were lying on their backs during the scan and patients who received regadenoson and did mild exercise.

More information

The U.S. National Heart, Lung, and Blood Institute has more about heart and vascular diseases.

SOURCE: American College of Cardiology, news release, March 27, 2007
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