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No Benefit ofEarlyACEI After Bypass
BY BRUCE JANCIN
Denver Bureau
S
TOCKHOLM
— The initiationofACE inhibitor therapy within7 days ofcoronary artery bypassgraft surgery does not improveclinical outcomes in low-risk pa-tients without a conventional in-dication for it, Wiek H. van Gilst,M.D., said at the annual congressofthe European Society ofCar-diology.In fact, just the opposite wasobserved in the 2,553-patientIschemia Management With Ac-cupril Post Bypass Graft viaInhibition ofAngiotensin-Con-verting Enzyme (IMAGINE) tri-al, conducted in Europe andCanada. The incidence ofis-chemic events was 52% greater inthe quinapril (Accupril) groupthan with placebo during the first3 months offollow-up, althoughat the end ofthe full 43 months,there was no significant differ-ence between the two treatmentgroups, noted Dr. van Gilst, pro-fessor ofcardiovascular and clin-ical pharmacology at UniversityMedical Center, in Groningen,the Netherlands.The rationale behind theIMAGINE trial was that thepost–coronary artery bypassgraft (CABG) period is known to be a time ofincreased local andsystemic inflammation, throm- botic activity, and endothelial dys-function, and ACE inhibitorshave been shown to curb en-dothelial dysfunction and exertan anti-inflammatory effect. Thehypothesis ofthe study was thatquinapril, at a target dose of40mg once daily, would slow ath-erosclerotic progression and re-duce ischemic events.This specific issue had not beenexamined before. The earlierHeart Outcomes PreventionEvaluation (HOPE), EuropeanTrial on Reduction ofCardiacEvents With Perindopril in StableCAD (EUROPA), and PreventionofEvents With Angiotensin-Converting Enzyme Inhibition(PEACE) trials included collec-
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The rate of ischemic events at 3 months was 52% greater inquinopril- than placebo-treated patients, said Dr. Wiek H. van Gilst.
Chest PainThreefer
One quick scan can rule out three conditions.
PAGE 21
ECGs for All
Screening all newborns for long QT syndrome isworth it.
PAGE 9
Avian Flu
What you can do to protect yourselves and your patients.
PAGE 31
See
Bypass
page 9
Many Patients ‘Strongly Favor’ Physicians’Use of New Medical Technologies
Note: Based on a nationwide survey of 2,048 adults conducted Sept. 30to Oct. 4, 2005.Sources: The Wall Street Journal Online, Harris Interactive
Personal digital deviceElectronic recordsImaging by e-mailE-mail with patientHome monitoring
51%49%44%42%37%
VITAL SIGNS
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The Leading Independent Newspaper for the Cardiologist
N
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2005
www.ecardiologynews.com
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BY ROBERT FINN
San Francisco Bureau
D
riven by concerns over therising cost ofcardiovascularcare and looming pay-for-perfor-mance rules, a technical panelconvened by the American Col-lege ofCardiology Foundationand the American Society of Nuclear Cardiology has releasedthe first set ofappropriatenesscriteria for a cardiac-imaging modality.The panel considered which of 52 clinical scenarios were appro-priate indications for single-pho-ton emission computed tomog-raphy myocardial perfusionimaging (SPECT MPI), whichwere inappropriate indicationsfor SPECT, and which were un-certain indications (J. Am. Coll.Cardiol. 2005;46:1587-605). Thecriteria have been endorsed bythe American Heart Association.The panel judged SPECT to bea generally acceptable and rea-sonable approach in 27 oftheclinical scenarios. These includedevaluation ofasymptomatic pa-tients with high Framingham risk ofcoronary heart disease (CHD),asymptomatic patients withcoronary calcium scores of400
Certain high-risk subgroups are exceptions.
Routine Use ofDrug-Eluting StentsNot Cost Effective
Groups Issue AppropriateUse Criteria for Imaging
BY BRUCE JANCIN
Denver Bureau
S
TOCKHOLM
— Routine useofdrug-eluting stents in a real-world patient setting is not goodvalue for money, according tothe findings ofthe first-ever ran-domized trial that compareddrug-eluting stents with bare-metal stents in unselected pa-tients in a study free ofindustrysponsorship.The results ofthe Basel StentCost Effectiveness Trial (BAS-KET) suggest that the use of drug-eluting stents (DESs) couldreasonably be restricted to se-lected high-risk patient sub-groups, Matthias Pfisterer, M.D.,said at the annual congress oftheEuropean Society ofCardiology.“Based upon these data, wecan define some subgroupswhere these stents are more at-tractive. They are more cost ef-fective in patients older than 65 years with three-vessel disease,more than one treated segment,longer lesions, and small treatedvessels. This will hold true untilthe price ofdrug-eluting stentsfalls significantly,” said Dr. Pfis-terer ofthe University ofBasel(Switzerland).In a typical catheterization lab-oratory, perhaps two-thirds ofpa-tients fit that description, headded.“Turning the data around,” hecontinued, “we can say that
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