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STEMI ACCELERATOR-2: Regional Coordination Improves Outcomes

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STEMI ACCELERATOR-2: Regional Coordination Improves Outcomes WEDNESDAY, NOVEMBER 15 DailyNewsNovember 11-15 | Anaheim, California Today’s highlights from 3 the program chair STEMI ACCELERATOR-2: Regional Queen Latifah honored for her 4 work promoting heart failure awareness coordination improves outcomes, Small case series challenges 6 thinking about fluoropyrimidine- FMC-to-device times in STEMI patients related cardiac toxicity egional training and coor- patients having a cath lab activated within 20 dination interventions that minutes of paramedic arrival. GEMINI-ACS-1: provide timely reperfusion “For the overall project, we increased from for ST-elevation myocardial 67 percent to 74 percent of patients reaching Switching P2Y12 infarction patients improve the national standard of first medical contact inhibitor in ACS outcomes and the interval of to device within 90 minutes. This coordina- patients based on first-medical-contact-to- tion of training was associated with signif- Rdevice time, according to a study present- icant reductions in heart failure and death, pharmacogenomic ed at Scientific Sessions on Tuesday. and demonstrated a marked and statistically testing results uncommon In the study, investigators worked with significant decline in mortality,” Jollis said. leaders, healthcare professionals, paramed- The study is a collaboration of Duke An update of the GEMINI-ACS-1 ics, nurses, emergency medicine physicians and the AHA’s Mission: Lifeline program. James G. Jollis, MD, FACC trial found that switching of P2Y12 in- and cardiologists in 12 major U.S. metropol- hibitors based on the results of pharma- itan regions to develop centralized STEMI ICARE-ACS cogenomics testing and reporting for plans for EMS catheterization lab activation Results of a New Zealand study suggest Patients with Possible Acute Coronary reduced or enhanced function alleles of and rapid transfer from non-PCI hospitals. a national clinical guidance framework Syndromes trial, researchers analyzed data CYP2C19 was not common. Clopido- “At baseline across the 12 regions, 38 that assesses patients presenting to from 11,529 patients before the framework grel carries a black-box warning recom- percent of patients had cath lab activation emergency departments with possible was implemented and 19,803 post- mending testing because patients with within 20 minutes,” said James G. Jollis, acute coronary syndromes is effective and implementation at seven diverse hospitals the reduced function alleles have higher MD, FACC, of the Duke University Clinical safely reduces hospital length of stay. in New Zealand. The primary outcome platelet reactivity and a potentially high- Research Institute in Durham, North Carolina, The findings were presented Tuesday was the proportion of patients successfully er risk of ischemic events, especially who presented the findings of the Regional by Martin Than, MD, of Christchurch discharged within six hours of emergency following PCI. STEMI Systems of Care: Results of the Hospital in New Zealand. department arrival. A successful discharge Results of the update to the P2Y12 Mission: Lifeline STEMI ACCELERATOR-2 In the National Implementation of a was defined as one with no major adverse Inhibitor Switching in Response to Rou- Study. “But with the new process in place, Clinical Guidance Framework for the cardiac event during the following 30 days. tine Notification of CYP2C19 Clopido- we saw that increase to more than half of Emergency Department Assessment of ACCELERATOR-2 continued on page 14 grel Metabolizer Status Following Acute Coronary Syndromes trial were present- ed Tuesday by E. Magnus Ohman, MD, professor of medicine and member of Canagliflozin results mixed for primary, secondary the Duke Clinical Research Institute in prevention in diabetes, CANVAS update finds Durham, North Carolina. “GEMINI looked at clinical out- The sodium glucose Sixty-six percent of the — 41 percent reduction for secondary comes for rivaroxaban versus aspirin co-transporter 1 inhibitor 10,142 patients in CANVAS had prevention and 37 percent reduction for with either clopidogrel and ticagrelor,” canagliflozin showed mixed a prior cardiovascular event and primary prevention. Ohman said. “The choice of therapy results for cardiovascular were evaluated for secondary Adverse events included an expected was at the discretion of the clinician. prevention in a study pre- prevention. The 34 percent with increase in genital infections, low-trauma This update looks at switching be- sented Monday afternoon two or more cardiovascular risk fracture and volume depletion events. The tween these two agents.” at Scientific Sessions. factors were evaluated for pri- risk for lower-extremity amputations dou- In the trial, reporting of the The agent improved car- Kenneth W. Mahaffey, MD mary prevention. bled in the secondary prevention group CYP2C19 status was mandatory. diovascular and renal out- As expected, the secondary compared to placebo. A central lab reported CYP2C19 comes, but increased risk for lower extremi- prevention arm had a higher cardiovascu- Larger and longer-term studies already metabolizer status for 99.9 percent ty amputations in patients with diabetes. lar burden. These patients also showed under way will provide additional insight of the 3,037 patients. A total of 34.4 Kenneth W. Mahaffey, MD, professor greater benefit from canagliflozin — an into the effects of canagliflozin and other percent were ultra-metabolizers (UM), and director of the Stanford Center for 18 percent reduction in the risk for car- SGLT2 inhibitors. 37.8 percent extensive metaboliz- Clinical Research at Stanford University diovascular death, nonfatal MI or nonfatal ers (EM), 24.5 percent intermediate in California, presented the update to the stroke. Primary prevention patients had a EXSCEL metabolizers (IM) and 3.2 percent CANVAS (Canagliflozin for Primary and 2 percent reduction. The treatment effects of the GLP-1 recep- reduced metabolizers (RM). The trial Secondary Prevention of Cardiovascular Both groups had a similar benefit for tor agonist exenatide don’t vary based on protocol made no recommendations Events in Type 2 Diabetes) trial. Initial hospitalization for heart failure — 32 per- the patient’s baseline cardiovascular risk, regarding P2Y12 inhibitors or switch- results of CANVAS released earlier this cent reduction for secondary prevention according to an update to the Effect of Ex- ing agents based on CP2C19 status. year showed a 14 percent reduction in and 36 percent reduction for primary pre- enatide Once-Weekly on Clinical Outcomes cardiovascular events. vention. Renal outcomes were also similar GEMINI-ACS-1 continued on page 14 CANVAS continued on page 13 AHASESSIONSDAILYNEWS.org #AHA17 PAID ADVERTISEMENT Committed to Coronary Artery Disease (CAD) & Peripheral Artery Disease (PAD) Come visit Janssen booth #2548 for more information © Janssen Pharmaceuticals, Inc. 2017 November 2017 081247-171012 Janssen Pharmaceuticals, Inc. WEDNESDAY, NOVEMBER 15, 2017 3 HIGHLIGHTS FROM THE PROGRAM CHAIR TODAY AT By Eric D. Peterson, MD, MPH, FAHA, Committee on Scientific Sessions Program Chair SESSIONS Don’t miss today’s highlighted presentations and the hottest research in population, It’s the final day of Scientific events. For a complete schedule, download the Sessions! Over the past four days, basic and clinical science that was Mobile Meeting Guide, see the Final Program or we’ve heard exciting reports on presented over the past four days view the online program at scientificsessions.org. important breakthroughs in research. at Scientific Sessions. Each session 9-10:15 a.m. Additionally, we learned about novel offers a unique opportunity to hear Innovative Therapies and Novel Applications advances in clinical care, many of commentary from international Ballroom CD, 3rd Level, Main Building which can immediately impact how leaders. 9-10:15 a.m. we treat our patients. And there is The first of these sessions, “Trending Trending Topics in Population Science more to come today! Topics in Population Science,” begins Ballroom A, 3rd Level, Main Building Today’s program includes the at 9 a.m. in Ballroom A, 3rd Level, 10:45 a.m.-Noon week’s final Late-Breaking Science Main Building. “Trending Topics in Eric D. Peterson, MD, MPH, FAHA Trending Topics in Basic Science Ballroom A, 3rd Level, Main Building session, “Innovative Therapies and Basic Science” and “Trending Topics Novel Applications,” which begins at in Clinical Science” run concurrently 10:45 a.m.-Noon 9 a.m. The session will feature the at 10:45 a.m. in Ballroom A and Trending Topics in Clinical Science Ballroom CD, 3rd Level, Main Building latest results from the REDUCE LAP- Ballroom CD, respectively. maintaining the Scientific Sessions’ HF, TNT-POAF, PROPEL, ALLSTAR Before we adjourn today and head reputation as the world’s premier and HOPE-Duchenne trials. The back to our practices, hospitals, meeting in cardiovascular science HEARTY HUMOR by Jonny Hawkins presentations feature novel findings clinics and labs, I want to thank my and medicine. in the fields of preventive therapies, fellow members of the Committee And finally, I want to thank all of my heart failure, atrial fibrillation, peripheral on Scientific Sessions Program for colleagues and friends who attended artery disease, myocardial infarction putting together an outstanding this year’s meeting. I look forward and Duchenne cardiomyopathy. educational program. I must to seeing all of you again next year The schedule also includes three also thank the AHA staff for their at the 2018 Scientific Sessions
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