Practice Update: Cardiology

ACC 2016 5

Session 406: Featured clinical research I: interventional cardiology and surgery Ten-Year outcome of coronary artery bypass graft surgery versus medical therapy in patients with ischemic cardiomyopathy: Results of the Surgical Treatment for Ischemic Heart Failure Extension study. EJ Velazquez, KL Lee, RH Jones, et al • In the STICH Extension study, researchers evaluated the 10-year survival of coronary artery bypass grafting (CABG) with medical therapy versus medical therapy alone in patients with ischaemic cardiomyopathy. A total of 1212 patients were randomised. The rate of death from any cause was significantly higher inmedical therapy group than in the CABG group (66.1% vs 58.9%, respectively; P = 0.02). Cardiovascular mortality was also higher in the medical therapy group than in the CABG group (49.3% vs 40.5%, respectively; P = 0.006). • After 10-year follow-up, results showed that CABG plus medical therapy was associated with lower rates of death and cardiovascular events than medical therapy alone among patients with ischaemic cardiomyopathy.

or deferred stent implantation. They did not find differences in death, heart failure, myocardial infarction, or repeat revascularisation. • Researchers concluded that deferred stent implantation resulted in similar outcomes to standard PCI procedure. Effect of early administration of intravenous beta blockers in patients with ST-elevation myocardial infarction before primary percuta- neous coronary intervention. The Early-BAMI trial. V Roolvink, B Ibanez, JP Ottervanger, et al • The use of beta blockers before primary PCI is not well studied; therefore, in the Early-BAMI trial, researchers randomised 683 patients with ST-segment elevation myocardial infarction (STEMI) to receive intravenous metoprolol or placebo before PCI. The mean age was 62 years, and majority of patients were male (75%). Researchers did not find a significant difference in infarct size between the groups or in the rate of adverse events. The metoprolol group had a lower incidence of malignant arrhythmias than the placebo group (3.6% vs 6.9%, respectively; P = 0.05). • Metoprolol administered before primary PCI did not reduce infarct size when compared with placebo among patients with STEMI.

cardiovascular death and events (P = 0.005 and P = 0.003, respectively). Adverse events associated with combined therapy included muscle weakness and dizziness. • In patients with an intermediate risk for cardiovascular disease, researchers concluded that combined blood pressure and lipid-lowering therapy is associated with fewer cardiovascular events than placebo. Session 405: Joint American College of Cardiology/TCT late-breaking clinical trials The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction: DEFERred stent implantation in connection with primary PCI. H Kelbæk, L Kober, S Helqvist, et al The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction: iPOST conditioning during primary PCI. T Engstrøm, H Kelbæk, S Helqvist, et al • Stent implantation can result in thrombotic embolisation; therefore, in the DANAMI-3 DEFER trial, researchers randomised 1215 patients with ST-segment elevation myocardial infarction to undergo standard primary percutaneous coronary intervention (PCI) with stent implantation

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DECEMBER 2016