Cardiologists from the Cardiac & Vascular Institute at NYU Langone Medical Center presented new research findings at the American College of Cardiology 60th Annual Scientific Session held April 2-5, 2011 in New Orleans, Louisiana. Significant research findings presented by NYU Langone cardiologists included:
The Relationship between Bleeding and Mortality in Patients on Dual Antiplatelet Therapy vs. Aspirin Alone: Results from the CHARISMA Trial
Author: Jeffrey S. Berger, MD, MS, FACC, assistant professor, Medicine and director of Cardiovascular Thrombosis
Little is known about the association between bleeding and death and the actual cause of death in patients on different antiplatelet agents. Researchers investigated the association between bleeding and mortality to assess whether this association differs in patients on dual antiplatelet therapy (DAPT) versus aspirin alone. Researchers examined the association between moderate or severe bleeding and all-cause, cardiovascular and cancer mortality in 15,603 patients with cardiovascular disease or multiple risk factors enrolled in the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance trial (CHARISMA). The study shows patients with moderate or severe bleeding had a higher incidence of all-cause, cardiovascular and cancer mortality. After multivariable adjustment, moderate/severe bleeding remained independently associated with not only all-cause mortality but cancer mortality as well. There was a significant interaction between bleeding and potency of antiplatelet therapy for all-cause, cardiovascular, and cancer mortality. In subjects on aspirin alone, moderate/severe bleeding was associated with all-cause, cardiovascular, and cancer mortality, but not in subjects on dual antiplatelet therapy. The study shows in stable patients, moderate or severe bleeding is associated with a significantly increased risk of all-cause, cardiovascular and cancer mortality. However, this risk differed in patients on aspirin alone versus dual antiplatelet therapy.
Abstract 1101-142: Monday, April 4, 2011, 9:30 AM
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Six-Year Outcomes of Patients Treated with DES, BMS or Medical Therapy in the OAT Trial
Principal Investigator: Judith S. Hochman, MD, Harold Snyder Family Professor of Cardiology and director, Cardiovascular Clinical Research
The Occluded Artery Trial (OAT) is a randomized study of routine percutaneous coronary intervention (PCI) or optimal medical therapy (MED) alone for the treatment of a totally occluded infarct-related artery 3 to 28 days after myocardial infarction in subjects who met a high-risk criterion. The study did not show any difference in death, reinfarction and congestive heart failure between study groups after a 6-year mean follow-up. Although the majority of percutaneous coronary intervention patients in the study were treated with bare metal stents (BMS), drug eluting stents (DES) were also implanted in the latter part of the study. Researchers performed an exploratory analysis of long-term outcomes for drug eluting stent deployment versus bare metal stents of the target occlusion in the percutaneous coronary intervention group vs. medical therapy in the OAT Trial. They compared the clinical outcomes of percutaneous coronary intervention patients with drug eluting stents, bare metal stents and medical therapy (DES n=79, BMS n=393, MED n=552) up to a maximum follow-up of 6 years (mean survivor follow-up 5.1 years). In the analysis, the 6-year occurrence of death, reinfarction and class IV congestive heart failure was similar (20.4% of DES, 18.9% of BMS and 18.4% of MED). During the follow-up period, 33.4% of DES, 44.4% of BMS and 48.1% of MED patients developed angina. The rate of revascularization during follow up was 11.3% of DES, 20.5% of BMS and 22.5% of MED. There is no suggestion of reduced long-term risk of death, reinfarction or class IV congestive heart failure with drug eluting stent usage compared to bare metal stent or medical treatment alone. In the study, an association between drug eluting stent use and freedom from angina and revascularization relative to medical therapy is suggested. Researchers stress the data must be interpreted with caution due to the small number of patients treated with drug eluting stents and the non-randomized nature of the analysis.
Abstract Number 2508-532: Monday, April 4, 2011, 9:30 AM
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Platelet Size is an Excellent Surrogate for Increased Platelet Activity
Authors: Michael Merolla, Medicine; Michael A. Nardi, MS, associate professor, Pediatrics; Liang Hu, Hematology; Caron B. Rockman, MD, associate professor, Surgery; Jeffrey S. Berger, MD, MS, FACC, assistant professor, Medicine and director of Cardiovascular Thrombosis Increased platelet activity is associated with an increased risk of cardiovascular morbidity and mortality. A variety of techniques used in laboratory research and clinical practice measure platelet activity, yet, there is no accepted gold standard. Mean platelet volume (MPV) is easily obtained as part of routine clinical laboratory testing. It is quick and inexpensive. Researchers investigated the association of mean platelet volume with other measurements of platelet activity. In the study, 154 patients with and without vascular disease were recruited for analysis. In addition to measuring mean platelet volume, researchers measured platelet count, immature platelet fraction, percent reticulated platelets, PAC-1 platelet marker staining, and impedance aggregometry. The study shows mean platelet volume is associated with several markers of platelet activity, most notably, markers of increased platelet turnover. Future studies should investigate whether mean platelet volume obtained as part of routine laboratory testing could identify patients at risk for cardiovascular events and help guide anti-platelet and other pharmacologic risk-factor reduction strategies.
Abstract 1146-95: Tuesday, April 5, 2011, 9:30 AM
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NYU Langone Medical Center / New York University School of Medicine