MD Conference Express ACC 2012 - (Page 19)

had an 80% lower 90-day mortality (2%) compared to a matched cohort of patients who were not prescribed the WCD (10%). CABG patients had a 57% lower 90-day mortality (3%) compared with a matched cohort of patients who were not prescribed the WCD (7%). In both PCI and CABG patients, the survival benefit continued over a mean follow-up period of 3 years, with risk of SCD lowered 57% (p<0.0001) and 38% (p=0.048), respectively (Figure 2). Figure 2. Mortality in Patients with WCD vs Control. 100 2% A post-market registry by the Cleveland Clinic assessed compliance of patients who were wearing WCDs, determined efficacy of the WCD for detection and treatment of VT/VF, compared long-term survival of patients who were wearing WCDs with patients with ICDs, and assessed event rates as an indicator of appropriate use.15 Patients in the US who wore the WCD from August 2002 through December 2006 were followed for an average of 52.6 days and more than 50% of patients wore the device 90% of the time. During WCD use (mean 53 days), 3541 of 3569 patients (99.2%) survived overall, with 0.78% dying of sudden death. Survival was 72 of 80 (90%) for ventricular tachyarrhythmia events and 78 of 106 (73.6%) for all events, including nonVT/VF events. There were 80 occurrences of sustained VT/VF in 59 patients (1.7% of those wearing a WCD). The success rates for the first shock were 100% (76 of 76) for unconscious VT/VF and 99% (79 of 80) for all VT/VF. Eight patients died after successful conversion of unconscious VT/VF (89.5% survival of VT/VF events). Asystole occurred in 0.6% or 23 patients (17 died), pulseless electrical activity occurred in 2, and respiratory arrest occurred in 1 (3 died), representing 24.5% of sudden cardiac arrests. Kaplan-Meier Estimate (n=530) 90 10% WCD 57% risk reduction over 3 years Survival (%) 80 80% lower mortality at 3 months 70 Control 60 HR 0.33 (0.21 to 0.52) p<0.0001 0 0 0.25 210 186 1 172 134 Years 2 82 65 3 19 36 WCD Control 265 265 100 3% Kaplan-Meier Estimate (n=404) Long-term survival in the WCD group (20.5% after a median of 36 months) was comparable with that of an implantable ICD patient (22.1% after a median of 36 months, p=0.29). The WCD is an effective means to detect and treat lifethreatening arrhythmias in the high-risk period prior to ICD implantation. However, patient education on sudden cardiac arrest is important to drive compliance in wearing a WCD, and of course, practitioners must remember to prescribe it. “Our job doesn’t end when the stent is deployed,” concluded Dr. Rao. References 1. Halkin A et al. J Am Coll Cardiol. 2005 May 3;45(9):1397-405. Adabag AS et al. JAMA. 2008 Nov 5;300(17):2022-9. Solomon SD et al. N Engl J Med. 2005 Jun 23;352(25):2581-8. Ortolani P et al. Eur Heart J. 2008;29(10):1241-9. Epub 2007 Aug 31. Toda K et al. Ann Thorac Surg. 2002 Dec;74(6):2082-7; discussion 7. Kaul TK et al. Eur J Cardiothorac Surg. 1998 Jun;13(6):629-36. Exner DV et al. J Am Coll Cardiol. 2007 Dec 11;50(24):2275-84. Fonarow GC et al. Arch Intern Med. 2005 Jul 11;165(13):1469-77. Cavender MA et al. Circulation. 2008;118(18):S853. Newby LK et al. Circulation. 2006 Jan 17;113(2):203-12. Zipes DP et al. Circulation. 2006 Sep 5;114(10):e385-484. Jessup M et al. J Heart Lung Transplant. 2006 Sep;25(9):1003-23. Wilkoff BL et al. Heart Rhythm. 2009 Jul;6(7):1085-104. Zishiri ET et al. Circulation. 2011;124(21:Suppl2). Abstract 9816 Chung MK et al. J Am Coll Cardiol. 2010 Jul 13;56(3):194-203. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 90 7% WCD Survival (%) 80 57% lower mortality at 3 months 70 Control 38% risk reduction over 3 years HR 0.42 (0.23 to 0.74) p=0.002 60 0 0 0.25 202 202 162 133 1 123 85 Years 2 58 36 3 24 25 WCD Control Zishiri ET et al. AHA 2011 Abstract 9816. This peer-reviewed article was based on an Industry Expert Theater presentation from the ACC 2012 Scientific Session. The development of this advertorial was supported by ZOLL. 

Table of Contents for the Digital Edition of MD Conference Express ACC 2012

MD Conference Express ACC 2012
Table of Contents
Treatment of AMI in the Post-Herrick Era
The State of Hypertension Guidelines: 2012
ACRIN PA 4005: Coronary CTA in the ED Identifies Low-Risk Patients and Shortens Length of Stay
One-Year STAMPEDE Trial Results
TAVR Associated with Increased Late Mortality from Paravalvular Regurgitation
The CABG Surgery Off- or On- Pump- Revascularization Study (CORONARY)
The Moderate PE Treated with Thrombolysis Study (MOPETT)
Pacemaker Therapy In Patients With Neurally Mediated Syncope and Documented Asystole
Outcomes from the BRIDGE-ACS Trial
ROMICAT II: More Data Evaluating CT-First for Acute Chest Pain ED Triage
Elective PCI at Community Hospitals With Versus Without On-Site Surgery
Results from the TRA 2P-TIMI 50 Trial
The HOST-ASSURE Randomized Trial
New Monoclonal Antibody to PCSK9 Markedly Lowers LDL-C in Patients on Atorvastatin
Oral Rivaroxaban Alone for Symptomatic PE
Neutral Outcomes But Important Insights From FOCUS-CCTRN
Imaging
STEMI
Acute Coronary Syndrome
Antiplatelet Therapy
New Anti-Diabetes Agents Offer Promise in the Fight Against CVD
The New Hypertrophic Cardiomyopathy Practice Guidelines

MD Conference Express ACC 2012

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