Studies highlight advances in diagnosis, medical therapy

And coronary intervention

Three studies being presented today at the American College of Cardiology’s Innovation in Intervention: i2 Summit 2007 in New Orleans, La., highlight the breadth of research propelling advances in clinical cardiology. Innovation in Intervention: i2 Summit is an annual meeting for practicing cardiovascular interventionalists sponsored by the American College of Cardiology in partnership with the Society for Cardiovascular Angiography and Interventions.

One study explores the best medical and interventional treatment for patients with acute coronary syndromes, the second demonstrates the long-lasting promise of non-surgical approaches to the repair of heart valves, and the third highlights a new drug-exercise combination that, when used in nuclear scanning of the heart, not only improves image quality but also wins the approval of patients by reducing side effects.

A Prospective, Randomized Trial of Bivalirudin in Acute Coronary Syndromes: Final One-Year Results from the ACUITY Trial (Presentation Number 2414-5)

Use a synthetic version of an anticlotting compound found in the saliva of the medicinal leech results in similar long-term survival but reduces serious bleeding when compared to more complicated existing medical therapy for patients with acute coronary syndromes. The one-year results of the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial suggest that bivalirudin may become an increasingly common therapeutic choice.

"Given these outcomes, I would expect a further shift toward bivalirudin, based on the reduction in bleeding as well as a reduction in costs and the simplicity of the regimen," said Dr. Gregg Stone, a professor of medicine at Columbia University Medical Center and chairman of The Cardiovascular Research Foundation, New York City.

Acute coronary syndrome is an umbrella diagnosis that encompasses both unstable chest pain and a type of heart attack known as non-ST elevation myocardial infarction (NSTEMI). Today, drug therapy typically consists of aspirin, clopidogrel, heparin, and glycoprotein IIb/IIIa inhibitors (GPI), each of which interferes at a specific point in the complex events that result in a blood clot in the coronary artery. Patients also typically have angiography within a few days to determine whether further invasive treatment with either angioplasty or bypass surgery is needed to restore full blood flow to the heart.

The ACUITY trial recruited 13,819 patients with moderate-to-high-risk acute coronary syndromes from 450 medical centers in 17 countries, randomly assigning them to one of three treatments: heparin (conventional, unfractionated heparin or a low-molecular-weight alternative, enoxaparin) plus GPI; bivalirudin plus GPI; or bivalirudin alone. A total of 7,789 patients had a catheter procedure in addition to medical therapy, with approximately 60 percent receiving a drug-eluting stent and 37 percent, a bare metal stent.