- 1. Date of preparation April 2014 BRI001081ACC.14Annual
ScientificSessions of theAmerican College ofCardiologyWashington
DC29-31 March 2014
2. Date of preparation April 2014 BRI001081Disclaimer
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indications. These highlights have been suggested by a group of
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areintended for educational purposes only and do not replace
independent professionaljudgement. Please refer to the appropriate
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in these highlights. 3. Date of preparation April 2014
BRI001081ACC.14Washington DC29-31 March 2014ACS poster
presentations: Non-culprit lesion revascularisation during
primaryPCI Consequences of non-infarct-related CAD Hypothermia for
STEMI Is new LBBB equivalent to STEMI?Selected by:Dr Greg
BellamyJohn Hunter Hospital, Newcastle 4. Date of preparation April
2014 BRI001081ACC.14Washington DC29-31 March 2014Meta-analysis of
randomized trialscomparing culprit vessel only versussingle-setting
multivesselrevascularization during primary PCIDr Partha SardarNew
York Medical College-Metropolitan Hospital CenterAbstract 1189-221
5. BackgroundDate of preparation April 2014
BRI001081ACC.14Washington DC29-31 March 2014 The optimal
interventional approach for multi-vesseldisease during primary PCI
remains inconclusive. A meta-analysis of randomised trials was
performed tocompare the one setting multi-vessel intervention
(MVI)strategy versus culprit only intervention (CVI) strategiesfor
STEMI. 6. MethodsDate of preparation April 2014
BRI001081ACC.14Washington DC29-31 March 2014 Databases to September
2013 were searched. Two reviewers reviewed the trials for inclusion
andextracted data from the RCTs. The primary outcome measure was a
composite ofcardiovascular death or new myocardial infarction. 7.
ResultsDate of preparation April 2014 BRI001081ACC.14Washington
DC29-31 March 2014 Data were pooled from 3 RCTs with 1,323 patient
years offollow-up (HELP AMI, Politi et al 2009, PRAMI). The primary
outcome occurred in 19 patients assigned to MVIstrategy versus 48
patients with CVI strategy (odds ratio0.36). Compared to the CVI
strategy, the MVI strategy significantlyreduced the risk of:-
myocardial infarction (OR 0.33)- repeat revascularization (OR
0.28)- major adverse cardiac events (OR 0.26). ORs for cardiac
mortality and all-cause mortality showed atrend towards benefit
with MVI. 8. Date of preparation April 2014
BRI001081ACC.14Washington DC29-31 March 2014Results 9.
ConclusionsDate of preparation April 2014 BRI001081ACC.14Washington
DC29-31 March 2014 Compared with an infarct artery only strategy
duringprimary PCI, a single setting multivessel
interventionstrategy including non-infarct coronary
arteriessignificantly reduced the risk of adverse
cardiovascularevents. 10. Commentary: Dr Greg BellamyDate of
preparation April 2014 BRI001081ACC.14Washington DC29-31 March 2014
The meta-analysis suggests that patients are more likelyto benefit
than be harmed by revascularisation of non-culpritlesions during
primary PCI, compared to astrategy of subsequently revascularising
non-culpritvessels only in response to ischaemia. 11. Date of
preparation April 2014 BRI001081ACC.14Washington DC29-31 March
2014Extent, location, and clinical significanceof non-infarct
related coronary arterydisease among patients with
ST-elevationmyocardial infarctionDr Duk-Woo ParkDuke Clinical
Research Center, Durham NCAbstract 1190-246 12. BackgroundDate of
preparation April 2014 BRI001081ACC.14Washington DC29-31 March 2014
Little information exists about the anatomiccharacteristics and
clinical relevance of non-infarctrelated artery (IRA) disease in
acute STEMI. 13. MethodsDate of preparation April 2014
BRI001081ACC.14Washington DC29-31 March 2014 Patient data was
pooled from 8 independent,international, randomised STEMI clinical
trials. Among the 68,765 STEMI patients enrolled in the
trials,28,282 patients with valid angiographic information
wereincluded in this analysis. 14. ResultsDate of preparation April
2014 BRI001081ACC.14Washington DC29-31 March 2014 52.8% of patients
had obstructive non-IRA disease; 29.6% had 1-vessel and 18.8% had
2-vessel non-IRA disease. There was no substantial difference in
extent of non-IRA diseaseaccording to the IRA territory. About
one-third of the patients had obstructive disease in each non-IRA
territory as opposed to the IRA territories. This pattern
wasconsistent regardless of the IRA location. 30-day mortality was
higher in patients with non-IRA disease than inthose without (4.3%
vs. 1.7%). After multivariable adjustment, the presence of non-IRA
diseasewas significantly associated with an increase of 30-day
mortality(adjusted hazard ratio, 1.79). 15. Date of preparation
April 2014 BRI001081ACC.14Washington DC29-31 March 2014Results 16.
ConclusionsDate of preparation April 2014 BRI001081ACC.14Washington
DC29-31 March 2014 More than half of the patients with STEMI
hadobstructive non-IRA disease, which was significantlyassociated
with increased 30-day mortality. These findings highlight the need
for further researchaimed at informing the appropriateness and
timing ofnon-IRA revascularisation in patients with STEMI. 17.
Commentary: Dr Greg BellamyDate of preparation April 2014
BRI001081ACC.14Washington DC29-31 March 2014 This very large
patient database confirms that disease innon-infarct-related
arteries is very common in STEMIpatients. The findings support a
closer focus on non-IRA diseaseduring treatment of STEMI. However,
the potential clinical benefits of treating non-IRA lesions during
STEMI management needs to bebalanced against the technical
challenges and risks. 18. Date of preparation April 2014
BRI001081ACC.14Washington DC29-31 March 2014Therapeutic hypothermia
for thetreatment of AMI: Pooled analysis of theRAPID MI-ICE and the
CHILL-MI trialsDr David ErlingeLund University, SwedenAbstract
1190-256 19. BackgroundDate of preparation April 2014
BRI001081ACC.14Washington DC29-31 March 2014 The randomised RAPID
MI-ICE and CHILL-MI studiesrapidly induced hypothermia in awake
patients withSTEMI by a combination of cold saline andendovascular
cooling. 20. MethodsDate of preparation April 2014
BRI001081ACC.14Washington DC29-31 March 2014 20 patients in RAPID
MI-ICE and 120 in CHILL-MI with largeSTEMIs, planned to undergo
primary PCI 50% stenosis in leftmain and >70% stenosis
elsewhere. 27. ResultsDate of preparation April 2014
BRI001081ACC.14Washington DC29-31 March 2014 127 of 3908 patients
with suspected ACS (3.25%) hadnew/presumed new LBBB:- 90/127 had
coronary angiography during the indexhospitalisation- in 49/90
patients (54%), no significant stenosis wasidentified- in 21/41
patients (51%) with an identifiable culpritvessel, the incidence of
significant stenosis wasequally distributed among the major
epicardialcoronary arteries without any predominance ofLM/LAD. 28.
ConclusionsDate of preparation April 2014 BRI001081ACC.14Washington
DC29-31 March 2014 Contrary to conventional wisdom, new or presumed
newLBBB in the setting of suspected ACS was notassociated with
predominant LM or LAD culprit stenosis. In fact, in more than half
of these patients, no significantcoronary stenosis was found.
