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Nov 29

Medsacpe Top Ten Practice Changing News in Cardiology in the Year 2011

1. The results of the EMPHASIS-HF trial: showed that aldosterone antagonist eplerenone produced large reductions in both the risk for death and the risk for hospitalization compared with placebo in patients with systolic heart failure and mild symptoms.

2. New Data Show COURAGE Findings Are Not Being Implemented: In 2007, the landmark COURAGE study found that in patients with stable coronary artery disease, optimal medical therapy was just as good at preventing future events as receiving a stent on top of optimal medical therapy. New data in 2011 from ACC National Cardiovascular Data Registry showed that, at least among patients ultimately treated with PCI, there was little change in prescribing practice from pre- to post-COURAGE.

3. FDA Approves Rivaroxaban for Stroke Prevention in Atrial Fibrillation: Following dabigatran, rivaroxaban is the second drug approved in AF. [ROCKET-AF]. Apixaban is approved in Europe. The ARISTOTLE trial suggests that apixaban is noninferior to warfarin in AF.

4. AIM-HIGH: Results Raise Controversy Over Early Discontinuation: The AIM-HIGH trial randomized patients with established CAD, low HDL and high TG to extended-release niacin (1.5-2 gm per day) or placebo. All patients also received simvastatin plus ezetimibe if needed to maintain LDL < 80 mg/dL, On April 25, 2011 the trial was stopped after a mean follow-up of three years on the ground that niacin was showing no additional benefits over placebo and there was also a small, unexplained increase in ischemic stroke in the niacin group. The final results in NEJM suggest that the signal of increased ischemic stroke with niacin could have been the play of chance.

5. The NICE Hypertension Guidelines: 1st time new guidelines recommend ambulatory blood-pressure monitoring as a “key priority” in diagnosing suspected hypertension, particularly if a clinic blood pressure reading is 140/90 mm Hg or higher.

6. PARTNER Cohort A: TAVI is non inferior to surgery in selected high-risk operable patients.

7. DOSE: trial concluded that aggressive decongestion is a critical part of achieving good outcomes in acute heart failure. It may seem to come at the cost of transient worsening renal function, but that doesn’t seem to be a major problem, as long as it’s monitored carefully.

8. STICH: CABG was associated with an early risk of death as a result of the surgical intervention, but this disadvantage for surgery disappeared 2 years after the procedure.

9. STICH: Viability Testing Didn’t Affect Treatment Outcomes: A randomized comparison of CABG vs medical therapy in patients with EF < 35% and CAD amenable to CABG showed that substantial viable myocardium evident at baseline imaging studies had no independent bearing on all-cause mortality over 5 years.

10. SYNTAX: The trial randomized patients with LMCA/ TVD to either CABG or PCI with Taxus DES. At 3 years major adverse cardiac and cerebrovascular event remained statistically lower in the CABG-treated patients. PCI experts no more use Taxus stents (use everolimus-eluting stents).

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