Heart(y) news, Sept 3

Let us look at the recent results from several cardiology clinical trials.

CURRENT-OASIS 7 published: Double-dose clopidogrel in PCI debated
CURRENT-OASIS stands for Clopidogrel Optimal Loading Dose Usage to Reduce Recurrent Events/Optimal Antiplatelet Strategy for Interventions and is a randomized factorial trial that compared “double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes.” The study results which were recently published in 2 separate papers, one in the New England Journal of Medicine (NEJM) and the other in the Lancet showed.
“…no significant benefit of doubling the dose of clopidogrel for the first seven days in the overall population of [acute coronary syndrome] ACS patients referred for an invasive strategy but suggesting benefit in the patients who actually underwent [percutaneous coronary intervention] PCI.

KYOTO HEART analyses show benefit of valsartan in Japanese hypertensive patients
The KYOTO HEART study investigated the effects of the angiotensin-receptor blocker (ARB) valsartan as add-on therapy to conventional antihypertensive non-ARB treatment in Japanese patients. The results showed that the add-on therapy of valsartan reduced the risk of cardiovascular events that included “a composite of stroke; acute MI or angina; PCI or CABG; hospitalization due to heart failure, peripheral arterial disease, or aortic dissection; or transition to dialysis or doubling of creatinine levels.” However, no significant differences in blood pressure measurements suggesting that “the benefit is not derived from any antihypertensive effects.”

PACE: Dyssynchrony leads to lower ejection fraction in RVA-paced heart-failure patients
PACE stands for Pacing to Avoid Cardiac Enlargement (PACE). The study investigated whether “biventricular pacing is superior to right ventricular apical [RVA] pacing in preventing deterioration of left ventricular systolic function” in heart failure patients. The results showed that RVA pacing is linked to systolic dyssynchrony that reduces left ventricular function. Half of the patients who underwent RVA mode of pacing present with systolic dyssynchrony.

AVERROES: Apixaban yields significant reductions in stroke, no increased bleeding
AVERROES stands for Apixaban versus Acetylsalicylic Acid to Prevent Strokes and is one of the few trials which were stopped early because of positive results. The results from the trail indicate that apixaban, an oral factor Xa inhibitor still in the clinical trial stage, seems to be more effective than aspirin in lowering the risk for stroke and systemic embolic events. In addition, apixaban seems to have a better safety profile, “with no observed increases in the risk of major bleeding, minor bleeding, or intracranial hemorrhage.” AVERROES was stopped early because a prespecified interim analysis showed significant benefits with apixaban. A repeat trial confirmed the benefits.
According to lead investigator Dr Stuart Connolly of McMaster University, Hamilton, Ontario (source heartwire):

“It’s a very easy to use drug to give. You take it twice a day, and it’s well tolerated. It didn’t have any liver toxicity, no particular adverse events that we saw. If anything, it’s extremely safe. We consider aspirin to be a drug we can just about give any patient, but aspirin does cause bleeding. It’s not completely benign.”