While Caribbean playwright/poet Derek Walcott expressed awe about the energetic culture of the Spanish port cities, this week, one such port city—Barcelona—percolated with cardiovascular clinical data because it hosted the 2009 European Society of Cardiology (ESC) Congress. While much data proved positive for new therapies, caveats also have been raised about cost and necessity.
MADIT-CRT showed that cardiac-resynchronization therapy combined with an ICD decreased the risk of heart failure events in relatively asymptomatic patients, compared with ICD alone, out to 4.5 years. However, a NEJM editorial, after acknowledging the positive outcomes, questioned the economic value of adopting more expensive treatment plans in less symptomatic patients.
The PLATO trial found that AstraZeneca’s ticagrelor (Brilinta), compared with clopidogrel, significantly reduced the rate of death from vascular causes, MI or stroke without an increase in the rate of overall major bleeding in patients who have an acute coronary syndrome with or without STEMI. However, ticagrelor was associated with an increase in the rate of non–procedure-related bleeding. In a different NEJM editorial, Dr. Albert Schömig praised the reduced procedural bleeds, especially in comparison to TRITON-TIMI 38, but also questioned the results if the drug had been administered for at least one year.
In the SEPIA-ACS1 TIMI 42 trial, Sanofi Aventis’ anti-coagulant otamixaban, in all dosing groups except the lowest, reduced the rate of death, second MI or additional coronary complications compared with heparin plus eptifibatide for patients with acute coronary syndromes. A Lancet commentary noted that while the results were impressive, there doesn’t seem to be a need for another anti-clotting drug on the market, especially because of the presence of bivalirudin (Angiomax from The Medicines Company).
In fact, Dr. Roxana Mehran presented the bivalirudin data from HORIZONS-AMI out to one year, which showed that the anti-clotting drug continues to result in less complications and clinical events in MI patients undergoing angioplasty than does the use of the conventional treatment of heparin plus a glycoprotein inhibitor.
As Walcott wrote in his poem “Night in the Gardens of Port of Spain”:
As daylight breaks...[he] turns his tumbril
of hacked, beheaded coconuts towards home.
So do cardiologists return home equipped with a myriad of new data to better manage their patients.
On these topics, or any others, please feel free to contact me.