Date of preparation April 2014 │BRI001081

ACC.14Annual Scientific Sessions of the American College of Cardiology

Washington DC

29-31 March 2014

Date of preparation April 2014 │BRI001081

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• These highlights have been suggested by a group of cardiologists who attended ACC.14, compiled by an external medical writer and sponsored by AstraZeneca. 

• Statements of fact and opinions expressed are those of the speakers individually and, unless expressly stated to the contrary, are not the opinion or position of AstraZeneca. AstraZeneca does not endorse or approve, and assumes no responsibility for, the content, accuracy, or completeness of the information presented.  Presentations are intended for educational purposes only and do not replace independent professional judgement.

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Date of preparation April 2014 │BRI001081

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Poster presentations:• Antiplatelet therapy after cardiac arrest• Cocaine-associated STEMI • Device-detected atrial fibrillation: thresholds• Stem cell transplantation for cardiac AL amyloidosis

Selected by:

Associate Professor Chris Zeitz Queen Elizabeth Hospital, Adelaide

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Efficacy of prasugrel in resuscitated patients during therapeutic hypothermia after PCI for acute myocardial infarction

Dr Andreas SchaeferHannover Medical School, Germany

Abstract 1151-233

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• AMI is the leading cause for out-of-hospital cardiac arrest. Therapeutic hypothermia substantially improves neurological outcomes.

• However, cardiogenic shock, post resuscitation syndrome and hypothermia markedly reduce platelet inhibition by clopidogrel.

• Efficacy of prasugrel during therapeutic hypothermia after resuscitation has not been evaluated.

Background

Date of preparation April 2014 │BRI001081

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• 21 consecutive patients (mean age 62±2 years) admitted following out-of-hospital cardiopulmonary resuscitation during AMI underwent urgent revascularisation and immediate therapeutic hypothermia for 24 hours.

• Prasugrel efficacy was assessed by the platelet-reactivity-index (PRI; VASP assay) before and 2, 4, 6, 12, 24, 48, and 72 hours following a loading dose of 60 mg via a gastric tube.

Methods

Date of preparation April 2014 │BRI001081

ACC.14Washington DC

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• Prasugrel reduced platelet reactivity determined by PRI despite intensive hypothermia (p=0.0002).

• Mean PRI (±SEM) was:- 70±3% before

- 62±3% at 2 h

- 54±5% at 4 h

- 44±6% at 6 h

- 39±5% at 12 h

- 29±5% at 24h

- 18±4% at 48 h

- 13±3% at 72h

Results

Date of preparation April 2014 │BRI001081

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• Previous reports described a lack of effect of clopidogrel on platelet reactivity in resuscitated patients during therapeutic hypothermia after PCI for AMI.

• In contrast, prasugrel rapidly and significantly reduced platelet reactivity despite disturbed haemodynamic conditions, vasopressor use and therapeutic hypothermia.

• Prasugrel given via a gastric tube might therefore be a useful therapeutic strategy in this patient cohort at high risk, to provide strong and effective P2Y12 inhibition.

Conclusions

Date of preparation April 2014 │BRI001081

ACC.14Washington DC

29-31 March 2014

Clinical profile, acute care and outcome of cocaine-associated STEMI

Dr Noel KayoMontefiore Medical Centre, Bronx, New York

Abstract 1151-257

Date of preparation April 2014 │BRI001081

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• Cocaine use is a well-recognised risk factor for coronary heart disease.

• Systematic information is lacking on the clinical features and outcomes related to cocaine-associated ST-elevation myocardial infarction, particularly in low-income urban communities.

Background

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• Cocaine use was assessed in patients with acute STEMI evaluated for primary revascularisation.

• Between 2008 and 2012, clinical information on all such patients was collected in a prospective registry.

• This was supplemented and linked to outcomes using an electronic search engine for clinical and administrative data across the Montefiore Medical Center, the principal provider for the 1.4 million residents of the Bronx, NY.

• Active cocaine use was documented by medical interview.

Methods

Date of preparation April 2014 │BRI001081

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• 48 patients (6% of the total) had documented cocaine use.

• Cocaine-related STEMI was associated with:- younger age (52 vs 60)- more smoking (77% vs 36%)- HIV+ status (8% vs 2%)- less hypertension (47% vs 67%), diabetes

(18% vs 37%) and 3 disease (13% vs 26%)• Rates of death or recurrent hospitalisation for CVD did

not differ significantly between cocaine-users and non-users (16 vs 18 per 100 patient-years, p=0.62).

Results

Date of preparation April 2014 │BRI001081

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• In this low-income community, cocaine-use occurred in a substantial fraction of STEMI cases, and was associated with a high rate of adverse outcomes.

• These data suggest that programs targeting cocaine abuse and smoking could contribute importantly to CHD prevention in disadvantaged communities.

Conclusions

Date of preparation April 2014 │BRI001081

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Implanted cardiac device-detected atrial fibrillation: How much Is too much? Dr Motaz BaibarsJohns Hopkins University School of Medicine, Baltimore

Abstract 1142-105

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• AF is associated with increased thromboembolism (TE) risk.

• Implanted cardiac devices are detecting brief episodes of AF while available data is conflicting about the device-detected AF (DDA) burden associated with higher TE risk.

Background

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• DDA was defined as AF detected by a pacemaker, implantable loop recorder, cardiac resynchronization therapy or ICD.

• Literature was reviewed using PubMed, Google Scholar and Clinicaltrials.gov websites.

Methods

Date of preparation April 2014 │BRI001081

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• There was a positive association between DDA and TE events with burden ranging from from 5 minutes to 24 hours.

• Advanced heart failure and elevated CHADS2 score lowered the AF burden threshold needed for higher TE risk.

• TE risk was similar in patients with CHADS2 of 1 plus AF >24 hours and patients with CHADS2 of 2 plus AF-burden of 5 minutes.

• Patients with CRT for advanced systolic HF showed an increased TE risk with AF burden ≥ 3.8 hours / day.

Results

Date of preparation April 2014 │BRI001081

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• TE risk increased with DDA ≥5 minutes in patients with advanced HF or CHADS2 score >2.

• Evidence is lacking regarding AF <5 minutes/day.• Further studies are needed to determine AF-burden

threshold among patients with different comorbidities and/or structural heart diseases.

Conclusions

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Stem cell transplantation is associated with prolonged recurrence-free survival in patients with cardiac AL amyloidosis

Dr Julie FriedmanNorthwestern University, Chicago

Abstract 1146-164

Date of preparation April 2014 │BRI001081

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• Historically, cardiac involvement in AL amyloidosis has been associated with a poor prognosis.

• We hypothesised that hematopoietic stem cell transplantation (HSCT) would result in improved survival in cardiac AL amyloidosis patients.

Background

Date of preparation April 2014 │BRI001081

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• 20 consecutive patients with cardiac AL amyloidosis being evaluated for HSCT were studied using biomarkers, bone marrow biopsy, echocardiography, cardiac MRI, and cardiac biopsy.

• Those who underwent HSCT were compared to those who did not.

• Survival was compared to historical controls.

Methods

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• 15 of 20 subjects were able to undergo HSCT. • Subjects unable to undergo HSCT had higher baseline

BNP (median 1640 vs 311 pg/ml) and troponin-I (median 0.21 vs 0.04 ng/ml), though these differences were not statistically significant.

• 13 of 15 HSCT subjects remain alive, with improvement in NYHA functional class (2.4±0.5 [pre] vs. 1.4±0.5 [post]).

• Survival of cardiac AL amyloid patients in the current treatment era demonstrated marked improvement compared to historical controls.

Results

Date of preparation April 2014 │BRI001081

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Results

Date of preparation April 2014 │BRI001081

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• HSCT is associated with prolonged, recurrence-free survival in patients with cardiac AL amyloidosis.

• Early diagnosis is essential• Cardiac AL amyloidosis should not be considered an

untreatable condition.

Conclusions