FREEDOM Follow-On Study: More Support of CABG Over PCI in Diabetes

Coronary revascularization with CABG was associated with lower all-cause mortality in long-term follow-up in patients with diabetes and coronary artery disease (CAD) compared with PCI with drug-eluting stents (PCI-DES), based on findings from the FREEDOM Follow-On Study. The results were presented at AHA 2018 by Valentin Fuster, MD, PhD, MACC, and published in the Journal of the American College of Cardiology.

The FREEDOM Follow-On Study evaluated long-term survival in 943 of the 1,900 patients with diabetes and CAD at 25 of the 140 centers that participated in the overall FREEDOM trial comparing PCI-DES to CABG. Median follow-up in this smaller subgroup was 7.5 years. Read More >>>

Study Shows Promise For AV Block During VA Ablation

Complete atrioventricular (AV) block only occurs in a small proportion of patients undergoing ventricular arrhythmias (VA) ablation and does not appear to be associated with a worse outcome of a combined endpoint of heart failure and mortality. These are among the findings of research presented at AHA 2018 and published in JACC: Clinical Electrophysiology.

Tomofumi Nakamura, MD, PhD, et al., looked at 1,418 patients who had catheter ablation for drug-refractory VAs. Results showed that 21 patients developed AV block. VAs recurred in 33 percent of patients with AV block, 17 percent of the 1:2 propensity score-matched control group, and 35 percent of patients with pre-existing AV block before ablation.

In addition, the composite outcome of heart failure hospitalization, heart transplantation or death occurred in 29 percent of patients with AV block, 17 percent of the control group and 45 percent of patients with pre-existing AV block.

The authors conclude that "for patients with drug-refractory VA, the risk of heart block from ablation may be adequately offset if VAs are controlled." Moving forward, "further studies are needed to address the influence of persistent bundle branch block in patients with impaired LV systolic function who are also thought to be affected. Studies to evaluate outcomes during the long-term follow-up period are also needed."

Nakamura T, Narui R, Zheng Q, et al. JACC Clin Electrophysiol 2018;Nov 5:[Epub ahead of print].

CMR-Derived Lateral-MAPSE Predicts Mortality in HTN Patients

Cardiac magnetic resonance- (CMR) derived mitral annular plane systolic excursion (MAPSE) is a significant independent predictor of mortality in patients with hypertension and a clinical indication for CMR, according to research published in JACC: Cardiovascular Imaging and presented at AHA 2018.

Simone Romano, MD, et al., examined 1,735 patients with hypertension and a clinical indication for CMR. Lateral-MAPSE was measured in the four-chamber cine-view. Cox proportional hazards regression modeling was used to examine the association between lateral-MAPSE and the primary endpoint of all-cause death. Read More >>>

History of AFib Weakens Decongestion in Patients With Acute HF

Among patients hospitalized for acute heart failure, history of atrial fibrillation (AFib) or atrial flutter may be independently associated with a blunted course of in-hospital decongestion, according to research published in JACC: Heart Failure and presented at AHA 2018.

Using covariate-adjusted linear and ordinal logistic regression models, Ravi B. Patel, MD, et al., sought to assess the association between history of AFib or atrial flutter and in-hospitals changes in various metrics of congestion. They pooled patients from three randomized trials of acute heart failure conducted within the Heart Failure Network: the DPSE trial, ROSE trial and CARRESS-HF trial. Read More >>>

ODYSSEY OUTCOMES Analysis: Twofold Reduction of Total CV Events, Death Over First Events

In patients with acute coronary syndrome (ACS), the total number of nonfatal cardiovascular events and death prevented with alirocumab was twice the number of first events prevented, according to research presented at AHA 2018 and published in the Journal of the American College of Cardiology.

In this analysis of the ODYSSEY OUTCOMES trial, Michael Szarek, PhD, et al., applied a joint semiparametric model allowing for multiple nonfatal cardiovascular events within a given patient, while simultaneously assessing and adjusting for possible informative censoring of the nonfatal event process by death. The model provided separate hazard functions for nonfatal events and fatal events, linked by a shared frailty and provided accurate relative estimates of nonfatal event risk if nonfatal events were associated with increased risk for death.

Patients were followed for survival for a median of 2.8 years, consisting of 27,014 patient-years for the alirocumab group and 26,915 patient-years for the placebo group. With 3,064 first and 5,425 total events, 190 fewer first and 385 fewer total nonfatal cardiovascular events or deaths were observed with alirocumab compared with placebo. Alirocumab reduced total nonfatal cardiovascular events and death in the presence of a strong association between nonfatal and fatal event risk.

"The ODYSSEY OUTCOMES trial demonstrated that adding the PCSK9 monoclonal antibody, alirocumab, to intensive statin therapy decreases the first occurrence of major adverse cardiovascular events compared with placebo," the authors write. "The present analysis illustrates that this treatment effect is magnified when total nonfatal cardiovascular events and death are considered, with approximately twice as many total as first events prevented.

Therefore, while the efficacy of alirocumab treatment after ACS was established on analysis of time to first primary endpoint event, the efficiency of the intervention to reduce morbidity and mortality after ACS, and its benefit to reduce the total burden of disease and health-care costs, is best reflected by an analysis of total events."

Szarek M, White HD, Schwartz GG, et al. J Am Coll Cardiol 2018; Nov 11:[Epub ahead of print].