Cardiovascular Business - March/April 2008 - (Page 18) Clinical study Digest › By JUsTiNE CAdET - pCi beyond 12 hours - Cardiac Mri vs. speCt JaCC: pCi of infarct-related artery works beyond 12 hours Successful PCI of the nonreperfused infarcted-related artery—beyond 12 hours after the onset of symptoms—with or without the presence of ischemia is associated with improved long-term survival and improved cardiac function and remodeling parameters. Led by Antonio Abbate, MD, from the Virginia Commonwealth University Pauley Heart Center in Richmond, researchers retrieved 10 studies that enrolled 3,560 patients, with median time from AMI to randomization of 12 days and follow-up of 2.8 years (J Am Coll Cardiol 2008;51:956-964). Mortality rate in the PCI group was 6.3 percent, compared with 8.4 percent in the medical treatment arm. The difference was significant. The PCI group also showed improved left ventricular ejection fraction (+4.4 percent change). “The clinical implications of such findings are potentially very significant. The number of patients treated within 12 hours of the onset of symptoms is still disappointing, with 8.5 percent to 40 percent of patients presenting beyond that timeframe,” the authors wrote. 14 12 10 Change in LVEF (%) 8 6 4 2 0 0 20 Follow-up duration (months) 40 60 80 100 120 140 Analysis shows significantly greater benefits of late PCi with increasing duration of follow-up for improvement in left ventricular ejection fraction. (Provided by A. Abbate) Crt: ‘off-hour’ pCi leads to higher death rates, longer door-to-balloon times. Patients undergoing primary PCI for acute STEMI during “off hours” had significantly greater mortality and significantly longer door-to-balloon times, according to a presentation at the CRT 2008 meeting in Washington, D.C. Roberto J. Cubeddu, MD, of the department of vascular medicine and interventional cardiology at Massachusetts General Hospital in Boston, and colleagues examined 747 consecutive patients presenting with acute STEMI, who underwent primary PCI between 2003 and 2007. Of these, 44 percent were admitted during “on hours.” The authors found that patients admitted during off hours had significantly greater mortality. The total in-hospital morality rate was 3.5 percent in the on hours, compared to 8 percent in the off hours. The researchers suggested revising strategies to reduce doorto-balloon times during off hours, particularly among STEMI presenting to the ED. eHJ: Cardiac Mr surpasses speCt for CaD detection Perfusion-cardiac MR (CMR) is a valuable alternative to SPECT for coronary artery disease detection showing equal performance in a head-to-head comparison, according to results from the MRIMPACT trial. Juerg Schwitter, MD, of the University Hospital Zurich in Germany, and colleagues conducted the double-blind, randomized, phase II clinical trial at 18 centers in Europe and the United States (Eur Heart J 2008;29[4]:480-489). The researchers found that diagnostic performance of perfusion-CMR was better versus the entire SPECT population of 212 patients—including gated and ungated SPECT studies. MR-IMPACT is the largest multi-center perfusion-CMR study performed so far, and even more important, it also evaluates its test performance in a multi-vendor design, which is expected to reflect true diagnostic performance of widely applied perfusionCMR more appropriately than single centre, single vendor studies, the authors wrote. 1 Cardiovascular Business March/April 2008
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