Latest Science From ESC Congress 2015
ACC Around the World | Several late-breaking clinical trials presented during the European Society of Cardiology (ESC) Congress in London, explored new technologies, and the latest advances in cardiovascular medicine.
In the OPTIDUAL trial, results showed that extending dual antiplatelet therapy (DAPT) beyond the recommended 12 months after coronary stenting “should be considered” in patients at low risk for bleeding. The trial included 1,385 patients from 58 French sites who had undergone percutaneous coronary intervention with placement of at least one drug-eluting stent for either stable coronary artery disease or acute coronary syndrome. All patients had been on DAPT for one year and were randomly assigned to continue or to remain on aspirin alone for an additional 36 months. Overall results found no statistical difference between the groups for the primary endpoint of a composite of all-cause death, myocardial infarction, stroke and major bleeding. Rates of death were 2.3 percent in the extended-DAPT group compared to 3.5 percent in the aspirin group.
Meanwhile, results of the LEADLESS II trial, which assessed the safety and efficacy of a leadless pacemaker, found that the pacemaker may be capable of providing effective pacemaker function in a varied group of patients needing long-term pacing therapy. The multicenter study enrolled 526 patients requiring permanent single-chamber ventricular pacing. The intention-to-treat primary efficacy endpoint was met in 270 of the 300 patients in the primary cohort (90 percent) and the primary safety endpoint was met in 280 of 300 patients (93.3 percent). Device-related serious adverse events were observed in roughly one in 15 patients at six months, including device dislodgement with percutaneous retrieval (1.7 percent), cardiac perforation (1.3 percent) and pacing-threshold elevation requiring percutaneous retrieval and device replacement (1.3 percent). Vascular complications occurred in 1.3 percent of patients.
“Leadless cardiac pacemakers create a paradigm shift in how we are going to look at pacemaker therapy over the coming years,” said Jagmeet P. Singh, MD, DPhil, deputy editor of JACC: Clinical Electrophysiology. “While leadless cardiac pacemakers are only available as single-chamber pacemakers at this juncture, there will be opportunities for dual- as well as three-chamber approaches in the future. Hopefully this technology will continue to evolve and incorporate the device diagnostic and remote monitoring capabilities that are present in currently available pacemakers.”
A study conducted during ACC’s Annual Scientific Sessions from 2011 to 2014 and presented during ESC Congress 2015 found that cardiologists failed to identify more than half of basic and about 35 percent of advanced pre-recorded murmurs, but skills improved after a 90-minute training session.
The study used training tools from Heart Songs 3, an online, downloadable training program developed by the ACC to help health professionals improve their auscultation skills. The program is based on psychoacoustic research that shows it takes the human brain intensive repetition to master a new sound.
“These findings confirm the widely held view that auscultation skills among cardiologists have eroded over time,” said Patrick T. O’Gara, MD, MACC, immediate past president of the ACC and a co-investigator on the study. “As shown in this and other studies, however, these skills can improve with repetition and training. Accurate auscultation is the first step in the cost-effective evaluation of patients with suspected valvular heart disease.”
For complete ACC coverage of ESC Congress 2015, visit ACC.org/ESC2015.
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