Cardiovascular Business - May/June 2008 - (Page 16)

Clinical Study Digest › BY JUSTINE CADET AND C.P. K AISER - ACE or ARB: It’s your choice - Cardiac PET volume hindered by cost - Plavix pretreatment withstands scrutiny pressure, but did not offer any additional benefit and was associated with a higher rate of hypotension-related side effects, including syncope. The commentators at the meeting agreed with the findings of the investigators, recognizing that physicians now have a choice between ACE inhibitors or ARBs. ACC: ACCOMPLISH Trial Challenges Hypertension Treatment Guidelines The interim results of the ACCOMPLISH trial showed that patients with hypertension and high risk for cardiovascular complications experienced 20 percent fewer events when treated with a single pill (Lotrel, Novartis) that combined an ace inhibitor and calcium channel blocker (ACE/CCB) compared to the control arm that received the standard diuretic treatment of an ACE inhibitor and hydrochlorothiazide. The ACCOMPLISH investigators demonstrated that the ACE/ CCB tablet not only reduced death from heart attacks, but also retarded the progression of heart disease by reducing the number of heart attacks, hospitalizations for unstable heart blockages and even the need for PCI procedures. The trial was stopped early because the control arm was faring so poorly. Investigators concluded that the results provide compelling evidence for initial combination therapy with ACE/CCB, which would require changing the current guidelines. Novartis funded the study and these results were presented at the American College of Cardiology conference in March. AR: Cost, availability overshadow PET’s ability to diagnose CAD Although myocardial perfusion PET, using either cyclotronproduced ammonia or generator-produced rubidium 82, has reported excellent diagnostic capabilities in the detection of CAD in individual studies, the technique is not widely used in practice, which may be driven by cost and availability or by unawareness of performance. Researchers from the University of Michigan Health System in Ann Arbor conducted a meta-analysis that showed on a patient level, PET demonstrated 92 percent sensitivity and 85 percent specificity. On a coronary territory level, PET showed 81 percent sensitivity and 87 percent specificity (Acad Rad 2008;15[4]:444-451). Researchers concluded that PET’s capabilities appear superior to those reported in meta-analyses for perfusion imaging with thallium-201 and sestamibi, or anatomical imaging with coronary CT angiography or MR angiography. Given that previous studies have found PET to be cost-effective and the current findings of excellent sensitivity and specificity, the modality should be more widely considered as an initial test in the diagnosis of CAD, the authors wrote. ACC: ONTARGET gives docs a choice between ACE and ARB The results of the ONTARGET study showed that telmisartan, an angiotensin receptor blocker (ARB), is as effective as ramipril, an angiotensin converting enzyme (ACE) inhibitor to control blood pressure in patients over the age of 55 years with coronary heart disease or diabetes, according to a presentation at the 2008 ACC conference. Salim Yusuf, MD, and colleagues at McMaster University in Ontario found that both ramipril (Altace, King Pharmaceuticals) alone and telmisartan (Micardis, Boehringer Ingelheim) alone were equally effective in reducing the primary outcome of cardiovascular death, stroke, MI or hospitalization for heart failure. A combination therapy of the two drugs further lowered blood ACC: Clopidogrel pretreatment beneficial, but not always given The conclusions of two separate studies led researchers at the 2008 ACC conference to recommend clopidogrel pretreatment for at-risk heart patients and standardization for pretreatment patient selection. Katharina M. Katsaros, MD, and colleagues from Medical University of Vienna in Austria included 51 patients with stable angina who underwent elective PCI with stent implantation. At the time the study was performed, the researchers said that routine use of clopidogrel (Plavix, Bristol-Myers Squibb and 16 Cardiovascular Business May/June 2008

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Cardiovascular Business - May/June 2008 Contents First Word Cover Story - Coronary CTA: Drafting the Strategic Plan Financing New Technologies: Early Adopters, Lease vs. Purchase, and Joint Ventures Clinical Study Digest: ACE or ARB: It's Your Choice Can Off-Hour D2B Times Be Reduced Without Breaking the Bank? Digital Image Management Primer: Integrating Echo SPECT/CT for Cardiac Disease Detection: An Economic Conundrum Integrating the Healthcare Enterprise Connects IT Systems News & Views Calendar Reader's Resources The Back Page

Cardiovascular Business - May/June 2008

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