Cardiovascular Business - November/December 2008 - (Page 17)

Clinical Study Digest › By Justine Cadet - Triple-antiplatelet therapy beats dual - Ex-Vioxx users still at-risk at one year - D2B time in 55 minutes TCT: Triple-antiplatelet therapy superior to dual-antiplatelet treatment A collection of studies from various South Korean researchers found that triple-antiplatelet therapy—with the addition of cilostazol (Pletal, Otsuka America Pharmaceutical)—for patients undergoing PCI with drug-eluting stents (DES) achieves greater platelet inhibition than conventional dualantiplatelet therapy. The results were presented at the 2008 Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium in October. In one favorable study, Young-Hoon Jeong, MD, from the Gyeongsang National University Hospital, and colleagues found in 90 AMI patients that triple-antiplatelet therapy achieves greater platelet inhibition when compared with high maintenance dose clopidogrel (150 mg/d). In another study, Kang-Yin Chen, MD, et al from Korea University Guro Hospital studied more than 2,000 diabetic patients with AMI. The triple group was associated with significantly lower incidence of death and major adverse cardiac events (MACE) up to eight months without increasing major bleeding. In a final study, Seung-Whan Lee, MD, et al from the Asan Medical Center found that six-month restenosis and nine-month target lesion revascularization in the triple group was significantly lower than in the dual-antiplatelet group. cerous polyps in the bowel. In 2004, Merck voluntarily withdrew Vioxx from the market because of increased risk of heart attack and stroke associated with long-term, high-dosage use. This study analyzed data from 84 percent of participants followed up for one year that stopped treatment due to cardiovascular toxicity. Researchers found that a year after discontinuing Vioxx, participants still had a 79 percent increased risk of MI, stroke or death compared with those who had received placebo. This finding was consistent with the increased risk observed during the trial, where the odds for cardiovascular trouble was more than double for those taking Vioxx. For individual patients, the risk of heart attack or stroke was doubled during the year after stopping the drug. The increased risk of dying was 31 percent compared with those who had taken placebo, the researchers noted. TCT: New method reduces D2B time to 55 minutes A new approach called the Cardio Team One (CTO) method was able to cut the door-to-balloon treatment time for ER patients with suspected MIs approximately in half, according to a study presented at the 20th annual Transcatheter Cardiovascular Therapeutics (TCT) symposium in October. Theodore L. Schreiber, MD, cardiovascular medicine specialist-in-chief at the Detroit Medical Center (DMC), developed the CTO method, which seeks to eliminate physician and staff delays by having a specialized team onsite all day, every day. The method involves having more than two dozen specially trained cardiologists, nurses and technologists reside at the hospital throughout alternating 48-hour shifts. Schreiber noted that the data from 99 MI patients in the first six months of using the new method showed they are able to reduce the ER door to balloon time to 30 minutes or less. Among the 23 patients who required immediate catheterization for apparent heart attacks, the door-to-balloon treatment average time was 55 minutes, he said. “This represents a marked improvement over the national target of 90 minutes, which only 20 percent of hospitals are achieving at present,” he said. Lancet: Vioxx substantially increases risk of stroke, MI and death Long-term follow-up data confirm that Vioxx—after it is discontinued— substantially increases the risk of stroke, MI and death compared with placebo, according to a study published in the Lancet (online Oct. 14). The APPROVe trial aimed to assess the effects of three-year treatment with rofecoxib (Vioxx, Merck) on recurrence of can- CardiovascularBusiness.com Cardiovascular Business 17 http://www.CardiovascularBusiness.com

Table of Contents Feed for the Digital Edition of Cardiovascular Business - November/December 2008

Cardiovascular Business - November/December 2008 Contents First Word Cover Story: Practice Management Software Moves Beyond Bean Counting The Death of CME as We Know It? Clinical Study Digets: Triple-Antiplatelet Therapy; Ex-Vioxx Users Beware Shockwaves Subside from the FDA's Echo Contract Warning Burning Question: Does Laser Heart Therapy for Angina Really Work? Advanced Visualization Adds New Practive Dimension Coronary Calcium Scoring Program Reaps Dividends Interventionalists Get Pumped Up About Mechanical Chest Compression Trials Force Physicians to Re-Examine Oral Anti-Diabetic Drug Protocols News & Views Calendar Reader Resources The ACC Corner

Cardiovascular Business - November/December 2008

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