American College of Cardiology

ACC Opening Media Briefing
News Conference: 8:15-9 a.m., EST, Sunday, March 18

(ORLANDO, FLA.)—Don't miss the annual preview of the ACC Annual Scientific Session on Sunday, March 18, at 8:15 a.m. in the ACC News Conference Room, room 311 E-F, of the Orange County Convention Center.

ACC President Dr. George Beller, ACC 2001 Program Chair Dr. John DiMarco, and ACC 2001 Program Co-chair Dr. Sanjiv Kaul, all of the University of Virginia, Charlottesville, will lead this year's discussion. They will be joined by program committee members Dr. Sharon Hunt, Stanford University Medical Center; Dr. Eric Williams, Indiana University School of Medicine, Indianapolis; John Miller, Indiana University School of Medicine; and Dr. Jeffrey Popma, Brigham and Women's Hospital, Boston.

The panel will provide a brief overview of the program, highlighting the hottest and most novel research to be presented during the four-day meeting. They will focus on the latest research in cutting-edge areas, such as technological advances, innovations in disease detection and management, and key issues and medical trends, while directing you to important symposia, late-breaking clinical trial sessions, and oral and poster presentations.

Which is the best option-medical therapy, angioplasty, stents, or surgery?
News Conference: 10:30-11:15 a.m., EST, Sunday, March 18

(ORLANDO, FLA.)—Three studies to be presented at the American College of Cardiology 50th Annual Scientific Session, March 18-21, 2001, explore some of the foremost questions in the arena of coronary revascularization, that is, the use of drugs, balloons, stents, or bypass surgery in patients with coronary disease in an attempt to restore normal blood flow to heart muscle. One of the studies compares the two most common treatments for recurrent lesions within coronary stents already placed in heart vessels. Two other trials compare different available treatment approaches in patients with narrowings in two or more heart vessels, so-called multivessel coronary disease. A news conference on the three studies is scheduled for Sunday, March 18, at 10:30 a.m.

In-stent restenosis, or the growth of scar-like tissue within a stent several months after its implantation in a blood vessel, is most often treated with inflation of an angioplasty balloon or by insertion of a new stent. A randomized comparison of the two approaches, conducted at 24 institutions in Spain and Portugal, was designed to show which, if either, may be the better treatment. In the "Restenosis Intra-Stent: Balloon Angioplasty vs. Elective Stenting" (RIBS) trial (#22-1), 450 patients with stented but renarrowed heart vessels were randomly assigned to repeat therapy with either angioplasty balloons or additional stenting. Dr. Fernando Alfonso, of Universitario San Carlos in Madrid, will report six-month outcomes data. (Original presentation on March 18, 8:45 a.m.)

The other trials featured at the news conference compare available treatments for patients with symptoms due to multivessel coronary disease, whose optimal management remains controversial.

In the "Stent or Surgery" (SoS) trial (#22-7), nearly 1,000 such patients who were eligible for either stenting or bypass surgery were randomly assigned to undergo one or the other treatment and were followed for up to four years. The trial's investigators are comparing the rates of such major clinical events as death, heart attack, and development of chest pain associated with the two treatment approaches. Early preliminary findings suggested a possible advantage for bypass surgery. However, more conclusive results from patient follow up out to one year will be presented by Dr. Rodney Stables, of the Royal Liverpool University Hospital and the Cardiothoracic Centre, Liverpool, United Kingdom. (Original presentation on March 18, 9:22 a.m.)

Treatment with medications alone for patients with multivessel coronary disease was included in a three-way comparison with stenting and bypass surgery in the "Medicine, Angioplasty, or Surgery Study" (MASS-II). Preliminary findings from the study's 1,086 patients who were randomly assigned to one of the three treatments suggest that drug therapy alone may be as good a treatment strategy as coronary bypass surgery, at least in the short term. Dr. Whady Hueb, of the Heart Institute at the University of Sao Paulo, Brazil, will present findings from the MASS-II trial (#22-9). (Original presentation on March 18, 9:34 a.m.)

Moderator: Dr. David Faxon, University of Chicago

Clinical trials examine a novel pacing technique to prevent atrial fibrillation and radiation for in-stent restenosis
News Conference: 11:30 a.m.-12:15 p.m., EST, Sunday, March 18

(ORLANDO, FLA.)—Three late-breaking clinical trials—one in electrophysiology and two in interventional cardiology—being presented at the American College of Cardiology 50th Annual Scientific Session in Orlando, Fla., March 18-21, 2001, will reveal new information about preventing a life-threatening heartbeat irregularity as well as using the new technique of radiation to prevent vessel reclosure after stenting. These important, new treatment options are the subject of a news conference on March 18 at 11:30 a.m.

Patients with chronic atrial fibrillation may also have bradyarrhythmias, a slow heart beat that is usually treated by implantation of a pacemaker with or without the use of medications. Certain atrial pacing techniques seem to improve the effectiveness of such antiarrhythmic drugs in suppressing atrial fibrillation episodes.

One of the largest prospective, randomized studies of these issues—called the "Dual-Site Atrial Pacing for Prevention of Atrial Fibrillation" trial (DAPPAF, #61-5)—has found that a specific, nonstandard atrial pacing strategy prolonged the interval between episodes of drug-resistant atrial fibrillation better than did other standard atrial pacing methods.

"This trial for the first time establishes a synergistic relationship between an atrial pacing technique and antiarrhythmic therapy in patients with drug-refractory atrial fibrillation," said Dr. Sanjeev Saksena, who is director of the Cardiovascular Institute at the Atlantic Health System, Millburn, N.J., and professor of medicine at Robert Wood Johnson School of Medicine.

"It shows that dual-site right atrial pacing suppresses the atrial fibrillation that breaks through despite drug therapy," said Dr. Saksena, "allowing patients who would otherwise be considered treatment failures to maintain control of their arrhythmia." (Original presentation on March 18, 9:15 a.m.)

The lengths of vein or artery surgically implanted to bypass blood flow around narrowings in the major heart vessels can also start to close off from disease. Such restenosis or renarrowing in bypass grafts can be treated with coronary stents, but the risk that recurrent lesions will grow within those stents is frustratingly high. Now, a radiation therapy technique that has been approved for the treatment of in-stent restenosis in native heart vessels has been tested for effectiveness in bypass grafts.

In the "Washington Radiation for In-Stent Restenosis Trial for Saphenous Vein Grafts" (SVG-WRIST, #22-11), 120 patients with recurrent, diffuse narrowings in stented bypass grafts were randomly assigned to undergo the radiation treatment, called brachytherapy, or a sham brachytherapy procedure that served as a placebo. The radiotherapy source consisted of a string of pellets containing iridium-192, an emitter of gamma radiation. The seed string is inserted through a catheter and temporarily positioned within the restenotic stented bypass graft. Dr. Ron Waksman, of the Washington Hospital Center in Washington, D.C., will present preliminary results of the trial.

Several devices for performing brachytherapy were approved last year by the U.S. Food and Drug Administration specifically for use on restenoses within stents that had been previously placed in native coronary arteries. (Original presentation on March 18, 9:46 a.m.)

But it is unknown whether radiation therapy will also prevent renarrowing of coronary lesions that are being stented for the first time. That may change with the reporting of the "Beta-Cath System Trial" (#22-3), which has tested the effectiveness of brachytherapy in patients with narrowings in either previously treated or yet untreated heart vessels.

"This is the only trial in the world with sufficient statistical power to test the potential for radiation therapy for treating coronary lesions that have not previously been stented," said Dr. Richard E. Kuntz.

If the study shows brachytherapy to reduce the risk of renarrowing after first stenting procedures as well as later ones, then "it could extend the radiation treatment to the broader population of patients with new lesions," said Dr. Kuntz, who is with the Division of Clinical Biometrics at Brigham and Women's Hospital, Boston. (Original presentation on March 18, 8:58 a.m.)

Moderators: Dr. Douglas Zipes, ACC president-elect, Indiana University School of Medicine, Indianapolis, and Dr. David Holmes, Jr., Mayo Clinic, Rochester, Minn.