Conference Coverage
Chelation Trial: Results Positive but Not Practice Changing
Major Finding: Post-MI patients who received chelation therapy had 39 fewer cardiovascular events than did those receiving placebo, a...
• Off-pump CABG: A Monday morning session combines three late-breaking trials comparing off-pump and on-pump coronary artery bypass grafting (CABG) that "probably will lead to a very spirited discussion," Dr. Davies said. One of them – the PRAGUE-6 (Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery in High-Risk Patients) trial – could be one of the most significant presentations at the meeting, he suggested. Elderly patients were the focus of the GOPCABE (German Off Pump Coronary Artery Bypass Grafting in Elderly Patients) study. In addition, 1-year results will be presented from the CORONARY (Coronary Artery Bypass Grafting Surgery Off or On Pump Revascularization) study.
• STREAM trial: Guidelines recommend that patients with acute ST-elevation MI who present to a facility that does not perform percutaneous coronary intervention be transferred to a PCI-capable facility if the procedure can be performed within 2 hours of first medical contact. But rural residents don’t live within a stone’s throw of a catheterization lab, and even urban traffic congestion can block this strategy. The multinational STREAM (Strategic Reperfusion Early After Myocardial Infarction) trial compared this routine-transfer strategy with routine administration of a potent bolus dose of a fibrinolytic agent if PCI cannot be performed within 1 hour, instead of the usual 2-hour window.
Dr. Patrick T. O'Gara
"This gets to the question of whether we have embedded an unnecessary and potentially dangerous time delay in a patient’s total ischemic period by stipulating that all patients should be transferred routinely for primary PCI, and whether we’re not taking advantage of this 1-hour window of opportunity, said ACC Vice President Patrick T. O’Gara, director of clinical cardiology at Brigham and Women’s Hospital, Boston. The field of STEMI has not seen a trial of this type for many years, he said.
A list of these and other late-breaking clinical trial presentations can be found on the ACC.13 website.
Dr. Quiñones and Dr. Davies reported having no financial disclosures. Dr. Ballantyne reported receiving speaker and consulting fees and research funds from many pharmaceutical companies. Dr. O’Gara has been on the data and safety monitoring board of Lantheus Medical Imaging.
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