Showing posts from August, 2011

High marks for novel LVEF-boosting agent stir hope in heart failure

The heart-failure drug development field is so strewn with casualties that researchers tend to express caution rather than optimism when discussing new candidates. Hopes are stirring again, however, for an LVEF-boosting drug with mechanistic underpinnings and safety data suggesting it could be an effective, lower-risk alternative to conventional inotropic agents, and perhaps more. That potential was on display in two studies published in the August 20, 2011 issue of the  Lance t , phase-1 and -2 evaluations aimed at pinning down the most effective and best-tolerated IV dosage of the novel myosin-activator  omecamtiv mecarbil  (Cytokinetics, San Francisco, CA). In earlier research, the drug was identified as CK-1827452. Dr John R Teerlink  (San Francisco Veterans Affairs Medical Center, CA), lead author of one of the studies, acknowledges that the drug is still early in development but is impressed enough with its positive effect on cardiac output and apparent safety to say that omec

Novel agent reduces emboli after carotid endarterectomy

Inhibition of von Willebrand factor (vWF) activity with the investigational agent   ARC1779   (Archemix, Cambridge, MA) has been shown to reduce cerebral embolization after carotid endarterectomy in a   randomized trial. ARC1779 is an aptamer that inhibits the prothrombotic function of vWF by binding to the A1 domain of vWF, blocking its interaction with glycoprotein, the study authors, led by   Dr   Hugh S   Markus   (St Georges University of London, UK), write. "Our results show for the first time that vWF inhibition improves a clinically relevant end point, cerebral embolization in humans," Markus and colleagues conclude. "Further studies are now required to determine whether this treatment approach reduces clinical cardiovascular events and to assess the risk of bleeding complications in a nonoperative situation." The results are published in the August 2011 issue of   Stroke .  

Multivessel PCI during STEMI associated with higher short- and long-term mortality

Two new studies published this week confirm clinical recommendations that a deferred angioplasty strategy of nonculprit lesions should remain the standard interventional approach in patients with ST-segment elevation MI (STEMI) undergoing primary PCI. In the first study, an analysis of the   Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction   (HORIZONS AMI) study, investigators, led by   Dr Ron Kornowski   (Tel Aviv University, Israel), observed significantly higher one-year mortality and stent-thrombosis rates among patients undergoing multivessel PCI compared with individuals undergoing staged PCI. In the second study, a meta-analysis that included 18 studies and more than 40 000 patients, the investigators report that multivessel PCI was associated with the highest rates of death in short- and long-term follow-up when compared with culprit-lesion PCI and staged PCI. Dr Pieter Vlaar   (University Medical Center, Groningen, the Netherlands),

Erosions with ASD devices quantified by FDA

  The US   FDA   has provided   with figures from its   MAUDE   database on erosions with Amplatzer septal-occluder devices (St Jude Medical) until July 21, 2011. This follows a report last week in which some doctors expressed concerns about the   safety of these devices , particularly with regard to erosions. Karen Riley   (Office of Public Affairs, FDA, Silver Spring, MD) told    that the FDA has received and entered into its database 742 medical device reports for these septal occluders. "Of these, 72 can be considered as either confirmed or possible erosion events. Seven of these were reported as death, and the remaining ones as serious injuries," she says. The devices have been approved in the US for percutaneous closure of atrial septal defects (ASD) for more than 10 years. Interventionalists are divided as to whether erosions are an issue, with one saying last week that this was the one adverse effect that made him pause before using the devices, because of the

Cochrane salt/blood-pressure message blasted in the Lancet

Two preventive-medicine experts in the UK are crying foul over a recent and   controversial meta-analysis   that concluded   cutting salt consumption   would have no clear health benefits [ 1 ]. In a Comment published in the July 30, 2011 issue of the   Lancet ,   Dr Feng J He   (Queen Mary University, London, UK) and   Dr   Graham A MacGregor   (Wolfson Institute of Preventive Medicine, Barts, London, UK) say that the meta-analysis published simultaneously by Taylor and colleagues in the   Cochrane   Review   [ 2 ] and the   American Journal of   Hypertension   [ 3 ] and press release that accompanied it "reflect poorly on the reputation of the Cochrane Library and the authors." As previously reported, Taylor et al's meta-analysis included seven randomized controlled trials of dietary salt reduction in normotensives (three studies), hypertensives (two studies), a mixed population (one study), and one trial of patients with heart failure. At follow-up, relative risk

Low-molecular-weight heparin beats unfractionated in STEMI

  A new meta-analysis has found that low-molecular-weight heparins (LMWHs) are associated with a reduction in mortality and major bleeding rates in STEMI patients treated with primary PCI as compared with unfractionated heparin (UFH) [ 1 ]. And patients at greatest risk seem to derive the most benefit from LMWHs, report   Dr Eliano Pio Navarese   (Nicolaus Copernicus University, Bydgoszcz, Poland) and colleagues in their paper published online July 20, 2011 in the   Journal of Thrombosis and Haemostasis .   UFH has generally been recognized as the standard anticoagulant for use in STEMI patients undergoing primary PCI, and current   AHA/ACC   and   European Society of Cardiology   (ESC) guidelines recommend the use of UFH in this setting, Navarese. And although preliminary data from the ATOLL study , which is not yet published, show the efficacy and safety of the LMWH   enoxaparin   for this use, ATOLL was underpowered to assess the effect of LMWHs on a single outcome such as mor