• PRATO-ACS trial: The open-label Statin Contrast Induced Neuropathy Prevention (PRATO-ACS) trial randomized patients with non–ST-elevation acute coronary syndrome who are undergoing PCI to usual care or to taking a 40-mg dose of rosuvastatin at admission and then 20 mg/day for 1 month, to see if the statin will reduce acute kidney injury from the angiographic contrast medium.
"This is a very interesting look at the efficacy of a medication which, in this context, is likely to be extremely safe," Dr. O’Gara said.
Dr. Gary S. Mintz, chief medical officer at the Cardiovascular Research Foundation, New York, added, "This is an important problem. When you have a patient presenting acutely, you really don’t have much of a choice" but to send the patient to a catheterization lab, where almost invariably a stent is implanted, a procedure requiring angiographic contrast, which can induce acute renal insufficiency or worsen preexisting renal insufficiency. "Patients who develop significant renal insufficiency have an awful outcome, both acutely and long-term. If there’s any safe way, any easy, efficacious way to prevent acute renal insufficiency in this setting, this will become the standard of care."
• MASS COMM trial: The use of PCI is increasing in smaller hospitals as more of them develop non-open coronary artery based practices, and there’s controversy over whether these practices should have the backup of on-site cardiac surgery services, Dr. Davies said. The PCI Outcomes in Community Versus Tertiary Settings (MASS COMM) trial randomized nearly 4,000 Massachusetts residents undergoing elective PCI to one of 10 hospitals without on-site surgical backup or one of 7 hospitals with on-site backup.
• REMINDER trial: Despite all the advances in treating acute MI, a subgroup of patients still suffer enough heart damage that they go on to develop heart failure. The large, multicenter Impact of Eplerenone on Cardiovascular in Patients Post Myocardial Infarction (REMINDER) trial randomized more than 1,000 patients who’d had heart attacks within 24 hours to treatment with placebo or the aldosterone-blocker eplerenone. Outcomes to be reported include some clinical signs of worsening heart function, clinical signs that predict heart failure, and some biomarkers of worsening cardiac function.
• Select ACS trial: This multicenter, randomized, double-blind, placebo-controlled study looks at whether or not giving the investigational drug inclacumab to patients with non–ST-elevation MI who are undergoing PCI reduces short-term markers of infarct size. Inclacumab is a fully human antibody targeting P-selectin, a molecule that plays a role in sending white blood cells to the site of injury during inflammation.
"If, in fact, this agent reduces the size of the heart attack in this subgroup of patients, it potentially could have benefits long term," said ACC.13 Chairman Dr. Miguel A. Quiñones, chair of the department of cardiology in the Methodist Hospital System, Houston, and professor of medicine at Weill Cornell Medical College, New York.
• ASTRONAUT trial: Can add-on therapy with the potent direct renin inhibitor aliskiren improve outcomes in patients presenting with acute heart failure? Results of a trial in roughly 1,600 patients – the Six Months Efficacy and Safety of Aliskiren Therapy on Top of Standard Therapy, on Morbidity and Mortality in Patients with Acute Decompensated Heart Failure (ASTRONAUT) trial – may tell us.
Dr. Christie M. Ballantyne
• TERISA trial: The Type 2 Diabetes Evaluation of Ranolazine in Subjects with Chronic Stable Angina (TERISA) trial looked at whether the drug reduced the weekly average frequency of angina in patients with diabetes, coronary artery disease, and chronic stable angina. Revascularization procedures can be challenging in diabetics, who often have small vessels, so a helpful medical therapy would be a boon, said ACC.13 Cochair Dr. Christie M. Ballantyne, director of the Center for Cardiovascular Disease Prevention at Methodist DeBakey Heart Center, Houston.
• DIG trial: An analysis of data from the Digitalis Investigation Group (DIG) trial will report whether giving the inexpensive drug digoxin to patients aged 65 years or older who have heart failure reduced hospitalizations and mortality.
• STOP-HF trial: The St. Vincent’s Screening To Prevent Heart Failure (STOP-HF) study took a "very creative approach" to try and reduce the impact of the current epidemic of heart failure by catching patients before they develop symptoms, Dr. Ballantyne said. They screened people over age 40 who had risk factors for heart failure using a blood test for natriuretic peptide; those with high levels of the peptide were sent for echocardiography and were comanaged by their primary care physician with recommendations from a specialty cardiology service. The control group of patients with risk factors for heart failure received usual care without the blood test screening or collaborative management. Results will compare the prevalence and severity of left ventricular dysfunction over 5 years in the two groups.