Cardiology News /Recent Literature Review / Mid Quarter 2012

Abstract

The ESC Congress will be held in Munich, 25-29/8/2012

 TCT Meeting will take place in Miami, 22-26/10/12

 HCS Meeting to be held in Athens, 1-3/11/12

 AHA 2012 is scheduled for Los Angeles, 3-7/11/12

 TWENTE Trial: the Resolute Zotarolimus Eluting Stents are Noninferior to Xience V Everolimus Eluting Stents in Treating “Real-World” Patients with Complex Lesions and “Off-label” Indications for DES

 A total of 1,391 patients were randomly assigned to zotarolimus eluting stents (ZES) (n = 697) or everolimus eluting stents (EES) (n = 694). Acute coronary syndromes were present in 52% and “off-label” feature in 77% of patients. Of the lesions, 70% were type B2/C; the post-dilation rate was very high (82%). In ZES and EES, target vessel failure (TVF) occurred in 8.2% and 8.1%, respectively (absolute risk-difference 0.1%; p (noninferiority) = 0.001). The definite-or-probable stent thrombosis rates were relatively low and similar for ZES and EES (0.9% and 1.2%, respectively, p = NS). Definite stent thrombosis rates were also low (0.58% and 0%, respectively, p = NS). In EES, probable stent thrombosis beyond day 8 was observed only in patients not adhering to dual antiplatelet therapy. The authors concluded that resolute ZES were noninferior to Xience V EES in treating “real-world” patients with a vast majority of complex lesions and “off-label” indications for drug-eluting stents (DES), which were implanted with liberal use of post-dilation (von Birgelen C et al, J Am Coll Cardiol 2012;59:1350–1361).

 The TARGET Study: Placement of the LV Lead to the Latest Sites of Contraction and Away from the Scar Confers the Best Response to CRT

  Among 220 patients receiving cardiac resynchronization therapy (CRT), the left ventricular (LV) lead was positioned at the latest site of peak contraction (as determined by echocardiographic speckle-tracking 2-dimensional radial strain imaging) with an amplitude of >10% to signify freedom from scar (n=110, TARGET group), while in the control group (n=110) standard unguided CRT was performed. In the TARGET group, there was a greater proportion of responders at 6 months (70% vs 55%, p = 0.031) with an absolute difference in the primary endpoint (>15% reduction in LV end-systolic volume at 6 months) of 15%. Compared with controls, TARGET patients had a higher clinical response (83% vs 65%, p = 0.003) and lower rates of the combined endpoint (all-cause mortality and heart failure–related hospitalization) (p = 0.031). The authors concluded that compared with standard CRT treatment, the use of speckle-tracking echocardiography to the target LV lead placement yields significantly improved response and clinical status and lower rates of combined death and heart failure–related hospitalization (Khan FZ et al, J Am Coll Cardiol 2012;59:1509–1518)... (excerpt)