The main results of the TACT trial were published in JAMA in March 2013 and can be found here.
The editorial by Steve Nissen referred to in the interview can be found here. An additional editorial by Howard Bauchner is also relevant here.
Finally below is the full DCRI grand rounds by Dan Mark and Kerry Lee on the controversial TACT trial results.
Drs. Christopher Granger and E. Magnus Ohman discuss new developments in the management of acute coronary syndromes and what this means for clinical practice.
Dr. Otavio Berwanger reflects on the BRIDGE-ACS trial, which evaluated whether a multifaceted quality improvement intervention can improve the use of evidence-based therapies and reduce the incidence of major cardiovascular events among patients with ACS in a middle-income country. The findings were simultaneously published in JAMA.
US-based clinical registries, such as the National Cardiovascular Data Registry and Get With The Guidelines, have been instrumental in identifying and addressing gaps in quality of care for patients across the country. It is fascinating to see approaches in other countries who have developed nationwide clinical registries, inclusive of all citizens. In Sweden, clinical registries like SCAAR and SWEDEHEART, have not only been used to describe trends in nationwide clinical outcomes but are now being used as a platform for the conduct of randomized trials. With rich characterization of patients and longitudinal followup, clinical registries can be used to identify, enroll, and follow patients randomized to treatments or strategies of care that need more investigation. These innovative “randomized clinical registry studies” are being conducted in the US as well. We need more of them.
Zubin and Dr. Freek Verheugt discuss novel therapies and whether it is time to replace rather than add drugs for patients with coronary artery disease.
On Saturday afternoon, a session on thrombosis in heart failure was held in a packed room. Several presented compelling data from registries like PREMIER and post hoc analyses of trial data sets, such as PLATO. In the latter, fewer HF deaths were seen with the addition of ticagrelor. Drs. Faiez Zannad and Christopher O’Connor presented data in support of coronary thrombosis and pulmonary embolism as causes of death in heart failure that have not been fully acknowledged or explored. Dr. Salim Yusuf wondered if trials of beta blockers in heart failure showed a reduction in myocardial infarction. If so, these observations would support the hypothesis of thrombosis as a cause of morbidity and mortality in heart failure. Dr. John McMurray recalled that recognized MI event rates indeed were low in previous beta blocker trials; however, he referenced the ATLAS autopsy study which suggested that coronary thrombosis caused by plaque rupture may often be an unrecognized cause of death in patients with heart failure.
As lead author of ATLAS ACS 2-TIMI 51 and ELEVATE-TIMI 56, Dr. Jessica Mega was a significant contributor to AHA.11. She discusses the importance of getting the right dose in the right patient.
Dr. Venu Menon, MD, Director of the CCU at the Cleveland Clinic sat down with Apurva Badheka, MD to discuss the evolution of the treatment of cardiogenic shock over the last two decades. Dr. Menon talks about his experiences from the early days with the SHOCK trial to his current thoughts on destination VAD therapy. It was a real treat to catch up with Dr. Menon, who is one of the best clinicians some of us have ever had the privilege to learn from.
Zubin Eapen was able to catch up with our friend and colleage, Dr. Sumeet Subherwal, MD, MBA, after his outstanding oral presentation evaluating one-year outcomes of patients with NSTEMI treated at academic medical centers versus non-academic medical centers. The results are very provocative, showing an 8% lower hazard of one-year mortality at academic centers compared to non-academic medical centers which did not change after adjusting for patient-level characteristics. One possible explanation for this is improved systems of care at academic medical centers, but much work still needs to be done to better understand this. Congratulations to Sumeet for leading the charge in this important work!