Oct 28, 2015 - analysis in the acute phase showed no significant differences between ADO and placebo groups concerning relative infarct mass (20.8% vs ...
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State of the Art – ACS – current guidelines and future prospects / State of the Art – Rethinking exercise and exercise training
Results: There were no baseline differences in age (59 years) sex (13.7% female), prevalence of risk factors, comorbidities or treatment, or in the proportion of anterior infarction (48%) between both groups. No serious adverse effects were related to treatment; 4 patients died during the acute phase. Intention to treat analysis in the acute phase showed no significant differences between ADO and placebo groups concerning relative infarct mass (20.8% vs 22.5% of LV; p=0.40) and relative MVO mass (2.75% vs 2.90%; p=0.85). Six months after reperfusion LVEF increased significantly in the ADO group by 3.32% (p=0.006) but not in the placebo group (1.49%, p=0.25). In a pre-specified subgroup analysis in patients with SO-Rtime < median (200 min; n =85) ADO was associated to smaller infarct mass, (19.4 vs 25.7%, p=0.043), a trend towards smaller relative MVO mass (1.91 vs 2.94%, p=0.29), and improved LVEF recovery (3.6%, p=0.042 vs 0.43%, p= 0.76)In patients with proximal LAD involvement (n=43) 6-month differences in MVO (1.80 vs 5.53%, p=0.059) and in the increase of LVEF (6.8%, p=0.01 vs 0.46%, p=0.897) were more pronounced. Conclusions: In patients with a first STEMI receiving primary PCI, a single 2-min intracoronary infusion of ADO prior to reperfusion was associated to improved functional recovery, significantly limited infarction in patients with shorter ischemic times (< 200 min), and was associated to a trend towards less MVO and in those with proximal LAD occlusion.
Q. Zhang 1 , J.P. Qiu 2 , T.Q. Zhu 1 , R. Zhang 1 , Z.K. Yang 1 , J. Hu 1 , F.H. Ding 1 , R. Du 1 , W.F. Shen 1 . 1 RuiJin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China, People’s Republic of; 2 Shanghai Pudong Gongli Hospital, Shanghai, China, People’s Republic of Background: Sirolimus-eluting stents (SES) with biodegradable polymer coating showed promising results in registry studies. We investigated whether their efficacy and safety were noninferior to those of durable polymer-coated SES in primary percutaneous coronary intervention (PCI) for patients with acute STsegment elevation myocardial infarction (STEMI). Methods: A total of 1192 STEMI patients within 12 hours of symptom-onset were randomly assigned, in an open-label fashion with 1:1 ratio, to receive SES coated with biodegradable (n=596) or durable polymer (n=596) during primary PCI. Primary endpoint was composite major adverse cardiac events (MACE) at one-year follow-up, including all-cause mortality, recurrent myocardial infarction, and target lesion revascularization. Secondary endpoint included individual components of primary endpoint and stent thrombosis according to the ARC definition. Results: Compared with durable polymer coated SES, the non-inferiority of SES with biodegradable polymer coating was established by an absolute risk difference of -0.9% in primary endpoint (12.4% vs. 13.3%, p=0.67) and an upper limit of one-sided 95% CI at 2.96% (one-sided p value for non-inferiority=0.001). And the finding of non-inferiority of SES with biodegradable polymer coating was consistent across the subgroups of patients with left ventricular dysfunction, door-toballoon time 65 years in age. Despite similar occurrence of acute and subacute stent thrombosis (definite or probable), late stent thrombosis was lower after implantation of biodegradable polymer coated SES (0.7% vs. 2.2%, p=0.03). Conclusions: Our results indicate that a stent eluting sirolimus from a biodegradable polymer represents an effective and safer alternative to a stent eluting sirolimus from a durable polymer in STEMI patients treated by primary PCI.
STATE OF THE ART – RETHINKING EXERCISE AND EXERCISE TRAINING 3747 | BEDSIDE High intensity interval training decreases progression of cardiac allograft vasculopathy in heart transplant recipients - a randomized controlled trial K. Nytroen 1 , L.A. Rustad 1 , I. Erikstad 1 , P. Aukrust 2 , T. Ueland 2 , E. Gude 1 , A. Hervold 1 , S. Aakhus 1 , L. Gullestad 1 , S. Arora 1 . 1 Oslo University Hospital, Rikshospitalet, Department of Cardiology, Oslo, Norway; 2 University of Oslo, Rikshospitalet University Hospital, Research Institute for Internal Medicine, Oslo, Norway Purpose: Cardiac allograft vasculopathy (CAV) is a progressive form of atherosclerosis occurring in heart transplant (HTx) recipients, leading to increased morbidity and mortality. Given the atheroprotective effect of exercise on traditional atherosclerosis, we hypothesized that high intensity interval training (HIIT) would reduce the progression of CAV among HTx recipients Methods: Forty-three (mean±SD age 51±16 years, 67% males, time post HTx 4.0±2.2 years) clinically stable HTx recipients > 18 years old, were randomized to either HIIT or control group (standard care) for one year. The effect of traing on CAV progression was assessed by intravascular ultrasound (IVUS). Results: IVUS analysis revealed a significantly less mean increase [95% CI] in percent atheroma volume (PAV) of 0.9 [-0.3, 1.9] % in the HIIT group as compared to the control group: 2.5 [1.6, 3.5] % (p=0.021). Similarly, mean increase [95% CI]
Change in percent atheroma volume (PAV%)
Conclusions: HIIT among maintenance HTx recipients resulted in a significantly impaired rate of CAV progression. Further and larger studies should examine if exercise rehabilitation strategies should be included as part of CAV management protocols.
3748 | BEDSIDE High intensity, interval exercise improves the Quality of Life and psychological status of patients with chronic heart failure: a phase III randomized clinical trial C. Chrysohoou 1 , G. Tsitsinakis 1 , D. Tsiachris 1 , J. Vogiatzis 1 , A. Tsantilas 1 , D. Dimopoulos 1 , D. Panagiotakos 2 , C. Pitsavos 1 , N. Koulouris 1 , C. Stefanadis 1 . 1 University of Athens, Athens, Greece; 2 Harokopio University, Athens, Greece Background: The guidelines of the European Society of Cardiology recommend structured exercise training in heart failure; however, this has been poorly implemented in daily practise. The aim of this work was to evaluate the effect of high intensity, interval exercise on the quality of life (QoL) among chronic heart failure (CHF) patients. Methods: A phase III clinical trial. Of the 100 consecutive CHF patients (NYHA class II-IV, ejection fraction
