Tag Archives: ACC

ACC President Relays Olympic Torch

Credit: London 2012

It’s been more than a month since Dr. William Zoghbi found out about a nomination that by most measures is an opportunity of a lifetime. And the countdown to the real thing has begun.

On Monday, July 9, dressed in white, Dr. Zoghbi will relay the Olympic torch through a historic English town called Bicester.

“This is a very exciting opportunity,” said Dr. Zoghbi, who became the president of American College of Cardiology (ACC) earlier this year. “No matter how you try to imagine it, the experience would be different. But I can imagine a lot of people around me cheering me on, and your life story goes in front of you and you think about your aspirations for the future. It will be an exhilarating moment.”

The 56-year-old grew up in Lebanon. He said if it weren’t for the war, he probably wouldn’t have come to the United States in the late 1970s. “My life would have been quite different,” he said during a phone interview.

In the cheering crowd there will be his wife, his brother coming from Beirut, his friends from England and from ACC. He gets to keep the torch after his 300-meter run (roughly 0.2 miles), and he said he’s planning to display it at the Heart House, the ACC headquarters in Washington, D.C.

Dr. Zoghbi is the first from ACC to carry the Olympic torch. He is one of 22 selected by the Coca Cola Company because of his personal and professional dedication to promoting healthy lifestyles and for empowering civic engagement in communities, according to ACC. He will be representing ACC and the organization’s patient education portal, CardioSmart.

“Carrying the torch is a symbol of health in general, both mind and body,” said Dr. Zoghbi. “And my advice to physicians is that in addition to doing all the beautiful things that they do, to also think about the population in general and engage with their community in improving cardiovascular health.”

The 70-day Olympic Torch Relay leads to the Olympics Opening Ceremony on July 27. Lit in Greece, the Torch is carried by 8,000 selected participants who run through 1,000 towns and cities in the United Kingdom.

And we had to ask Dr. Zoghbi: “What is  your favorite Summer Olympics sport?” Soccer, he responded. But when we asked him which team he was pulling for, he said with a laugh, “That’s a secret.”

You can watch him live on July 9 here.

See who else is running on July 9, and learn other fun facts about the Olympic Torch Relay.

By Naseem S. Miller (@NaseemSMiller)

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Let’s Hear It for the Heart Team

A relatively new, somewhat revolutionary concept appears to be quickly crystallizing for cardiac disease management: the Heart Team. Simply put, the heart team is a collaboration of interventionalist cardiologists and cardiac surgeons (and maybe non-interventionalist cardiologists too) at a single center who work together to combine their endovascular and open-surgical skills in a collaborative and complementary way to give patients optimized treatment that thoughtfully combines the best of both approaches.

The heart team concept has even given birth to a related, new phrase: the hybrid cardiac suite, which is the ultimate collaborative site, a room that accommodates both endovascular and open-surgical procedures under one roof.

Peaceable Kingdom By Edward Hicks/courtesy Wikimedia Commons

It sounds great and makes a lot of sense, but until very recently seemed to be the stuff of dreams, as endovascularists and surgeons traditionally acted as worst enemies, jealously guarding their turf and touting their approach as best.

Those days now may be coming to an end. Get ready to root on the heart team.

When I covered the annual meeting of the American Association for Thoracic Surgery in Philadelphia earlier this month, it seemed like I kept bumping into the heart team idea. There was a report from the PARTNER study, which compared endovascular aortic valve repair to open-surgical repair, and relied on heart teams to run the show. PARTNER, a U.S.study, is also credited with providing fertile ground for the heart team idea to take root in America.

In Europe, the heart team concept got jump-started by the European-based SYNTAX trial, which compared coronary stenting and coronary bypass and relied on a heart team at each participating European center to run the trial. The SYNTAX spirit of cooperation led the major European cardiology and thoracic surgery societies, the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery to last year co-write a new set of guidelines for managing coronary revascularization, and endorsement of heart teams is a key feature of those guidelines. These days, in routine practice at the Thoraxcenter inRotterdam for example, a heart team meets every morning to discuss the pending coronary cases and how they’ll be managed, said heart surgeon A. Pieter Kappetein at the meeting.

Heart teams also got mentioned at the meeting as the new way that patients with ruptured aortic aneurysms are getting managed at selected U.S. sites, as endovascularists and surgeons quickly decide on the best way to treat an emergency aneurysm rupture.

Will U.S.guidelines soon appear that follow the European lead and give a formal nod to heart teams? Yes, said John D. Puskas, chief of cardiac surgery at Emory in Atlanta and a member of the joint American College of Cardiology and Society for Thoracic Surgeons guidelines-writing group that will soon issue their recommendations. “The new guidelines are embargoed, but all of the cardiologists and surgeons who wrote the U.S. guidelines read the European guidelines with interest with respect to the heart team,” he told me.

Will the concept catch on for U.S.practice, after so many years of catheterist-surgeon animosity? Dr. Puskas said yes to that too, citing the changing character of U.S.medical practice as a major factor easing the transition.

“Cardiologists and surgeons are being bought by networks and are becoming salaried. That will lower the barriers that have led to competition. I think we’ll see better collaboration in our specialties than ever before. It gets down to patient-centered decision making.”

—Mitchel Zoler (on Twitter @mitchelzoler)

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Filed under Cardiovascular Medicine, Drug And Device Safety, Health Policy, IMNG, Internal Medicine, Internal Medicine News, Practice Trends, Surgery, Thoracic Surgery

Keeping Score on the STS Risk Score

The Society of Thoracic Surgeons has a formula for estimating a patient’s risk of dying following cardiac surgery, the STS Predicted Risk of Mortality score. Some new data reported during the past 2 months suggest that the score doesn’t predict death as well as some experts thought. It looks like when it’s applied to very sick patients, it may produce an overly pessimistic estimate and predict more deaths than patients will actually experience.

"Death's Door" by William Blake; courtesy Wikimedia Commons

A patient’s mortality risk score derives from a list of 30 clinical and demographic inputs, factors like type of surgery, age, sex, hypertension, diabetes, cardiac history, vascular health, hemodynamics, etc. Based on all this, the formula spits out a patient’s probability of dying during the 30 days following the proposed surgery.

The PARTNER trial enrolled patients with severe aortic stenosis to compare a new technique of percutaneous aortic valve replacement with standard open surgical replacement. An initial report on results from the randomized portion of the study occurred last month at the annual meeting of the American College of Cardiology, and some more details on strokes and other neurologic outcomes got reported a few days ago at the American Association for Thoracic Surgery’s annual meeting in Philadelphia.

The patients entered into PARTNER were very, very sick. Their average age was about 83 years, and about 95% had the two highest grades of heart failure, New York Heart Association class III or IV. Their STS risk scores were also high, averaging about 12, which meant these patients had a 12% predicted risk of dying during the 30 days following open surgical replacement of their dysfunctional aortic valve.

These patients “were probably the highest 10% of risk on the STS score,” said Dr. D. Craig Miller, the cardiac surgeon who presented the neurologic data at the AATS meeting. “STS scores have never been validated at this extreme. Never before were enough patients [with scores this high] operated on to validate the STS score ” at this level, Dr. Miller said.

The reality was that the scores broke down. Instead of having a 12% 30-day mortality rate, the patients who underwent open surgery had about an 8% death rate. “We were pleasantly surprised by the low death rates,” at least in comparison to what the STS scores predicted, he said.

The only caveat to this good news was that the less-than-dire outcomes of some patients might have been very specific for the high-level treatment that patients received at the 26 centers that participated in this carefully structured trial. “What would be the results in the real world? That remains unanswered,” Dr. Miller said.

—Mitchel Zoler (on Twitter @mitchelzoler)

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Video of the Week: Live From ACC — Yoga Does a Heart Good

Yes, this week, Global Medical News Network staff are bringing you the very latest news live from the Annual Scientific Sessions of the American College of Cardiology.

At the meeting, investigators reported that yoga can help reduce arrhythmia episodes in patients with atrial fibrillation, and improve their anxiety and depression. The study authors caution, however, that yoga is not a treatment for atrial fibrillation.

Our own video star Naseem S. Miller talked with the study’s lead author Dr. Dhanunjaya Lakkireddy, who is an associate professor of medicine at University of Kansas Hospital, Kansas City.

You can read her story at Internal Medicine News, where you can find all of our coverage of ACC.

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Filed under Alternative and Complementary Medicine, Cardiovascular Medicine, IMNG, Internal Medicine, Video

Thinking Outside of Clopidogrel’s Black Box

From the annual meeting of the American College of Cardiology in Atlanta 

image courtesy of Flickr user jmcraftworks

The black box warning that the FDA slapped onto its labeling for the antiplatelet drug clopidogrel (Plavix) on March 12 became the talk of the American College of Cardiology’s annual meeting when it started a couple of days later. It also abruptly changed medicine’s antiplatelet playing field. 

Cardiologists, as well as primary care physicians, prescribe clopidogrel, often with aspirin, to many patients with coronary disease to help keep blood clots from forming inside their arteries. 

The FDA said it decided to impose the boxed warning because anywhere from 2%-14% of people are “poor metabolizers” of clopidogrel, which makes them unable to effectively convert it into its active form. In other words, when a poor metabolizer receives clopidogrel it’s as if the drug were never administered, because the person cannot change the drug to make it active. 

The implications of the FDA’s action were clear to many physicians at the ACC meeting. They now had three options for dealing with patients who needed antiplatelet therapy. They could: 

1. Treat patients with clopidogrel and then test their platelets’ reactivity to see if it had been properly blunted by clopidogrel treatment. If not, switch to a different drug. 

2. Test each patient before starting clopidogrel to see if they carried a mutation in one or both of their genes for the liver enzyme (cytochrome P2C19) responsible for producing the active metabolite of clopidogrel. If they carried a mutation, switch to a different drug. 

3. Skip either test and jump straight to an alternative drug. The most obvious alternative right now is prasugrel (Effient), an agent that’s very similar to cloipidogrel except it does not require enzymatic activation. 

What the FDA’s action precluded was maintaining the status quo. By adding the black box warning to clopidogrel last week, the FDA eliminated prescribing clopidogrel blindly as standard of care. 

—Mitchel Zoler (on Twitter @mitchelzoler) 

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Filed under Cardiovascular Medicine, Drug And Device Safety, Health Policy, IMNG, Internal Medicine, Medical Genetics, Practice Trends

The Beginning of the End for Warfarin?

Dr. Holmes

From the annual scientific session of the American College of Cardiology, Orlando

Warfarin, the reigning standard therapy for stroke prevention in atrial fibrillation, has long been viewed by the pharmaceutical industry as a big fat sitting duck: it’s a widely prescribed, cheap drug that’s just begging for replacement by one of a host of easier to use and perhaps safer antithrombotic agents in the developmental pipeline.

But warfarin may finally be dethroned not by a better antithrombotic, but by a little plug made of nitinol wire and fabric called the Watchman. It’s a percutaneously implanted permanent device designed to seal off the left atrial appendage, the source of most atrial thrombus.

Here at the ACC meeting Dr. David Holmes of the Mayo Clinic presented the results of the Phase-3 PROTECT AF trial, in which during 900 patient-years of followup the Watchman resulted in a 91% reduction in hemorrhagic strokes and a 32% decrease in the combined endpoint of any stroke or all-cause mortality compared to warfarin.

Atritech, the Watchman’s developer, has a marketing approval hearing before an FDA advisory panel in late April.

—Bruce Jancin

Photo of Dr. David Holmes (above) taken by Bruce Jancin.

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The Reticent Dr. Ridker

From the annual scientific session of the American College of Cardiology in Orlando.

Sunday, March 29, was arguably the best day of Dr. Paul M. Ridker’s distinguished career.

The father and champion of the hsCRP hypothesis–the idea that blood levels of the inflammatory marker high-sensitivity C-reactive protein is an important and modifiable risk factor for cardiovascular diseases–was part of two major reports on the subject delivered at the American College of Cardiology’s annual scientific session. Both reports came out of the JUPITER study, which examined the effect of the lipid-lowering drug rosuvastatin (Crestor) on hsCRP and on the rate of cardiovascular disease events like myocardial infarctions, strokes, and deaths. The study enrolled people with no history of cardiovascular disease who wouldn’t qualify for statin treatment based on current U.S. guidelines.

One report, previewed at a press conference by Dr. Ridker before his talk on the meeting’s main program the next day, delivered the money shot on hsCRP.  The new evidence showed that cutting hsCRP levels with the statin produced a beneficial effect that was similar to but completely independent of the drug’s effect on low-density lipoprotein (LDL) cholesterol. The finding will likely drive a shift in medical practice toward more hsCRP testing and put more people on statin treatment.

Dr. Paul M. Ridker

Dr. Paul M. Ridker (Photo by Mitchel Zoler)

The second report, delivered on Sunday by a colleague, was not as central to the hypothesis but carried its own jaw-dropping punch: A fairly potent statin regimen was capable of substantially cutting the rate of venous thromboembolism, a benefit that statins had never before been proven to have.

So, the logical question for Dr. Ridker was what all this means for the future roles of hsCRP and hsCRP screening.

His reply, one he’s delivered many times before, is “I can’t comment on screening.” That’s because he and his hospital, Brigham and Women’s in Boston, hold a patent on using inflammatory biomarkers like hsCRP in patient care.

When it comes to hsCRP, “My job is reporting the data; others figure out what guidelines should be,” Dr. Ridker says.

Undeniably a noble sentiment, but frustrating too when it comes from the guy who probably knows more about hsCRP than anyone.

—Mitchel Zoler @mitchelzoler

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