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BWH had a significant presence this week during the American College of Cardiology's annual scientific session in Atlanta. The latest research from the TIMI trials was released, several BWH cardiologists lent their voices and expertise to major discussions and one BWHer received a distinguished recognition.
On Tuesday in Atlanta, Elliott Antman, MD, director of BWH's Samuel A. Levine Cardiac Unit, presented findings detailing a better, more effective blood thinning strategy for patients who suffer an acute heart attack. Antman presented findings from the ExTRACT-TIMI 25 (Enoxaparin and Thrombosis Reperfusion for Acute Myocardial Infarction Treatment - Thrombolysis in Myocardial Infarction) trial in an early release of his paper to be published in the New England Journal of Medicine.
Specifically, the use of enoxaparin, a low molecular weight heparin, significantly reduced the risk of repeat heart attack or death, compared to the most commonly administered anticoagulant regimen (unfractionated heparin) in use, according to the latest TIMI findings. The ExTRACT-TIMI 25 trial was a randomized, double-blind, double-dummy comparison of the two anticoagulant strategies in more than 20,000 patients in 48 countries.
The results showed that the risk of death or recurrent non-fatal heart attack was reduced by 17 percent for patients who were administered the enoxaparin strategy compared to those who received the unfractionated heparin strategy. The benefits of the enoxaparin strategy became apparent within 48 hours. At the end of one month, the risk of recurrent non-fatal heart attack was reduced by 33 percent for patients given the enoxaparin strategy compared with those given the unfractionated heparin strategy.
"The results of this trial are dramatic and significant; a strategy using enoxaparin prevents more patients from dying or having a second heart attack within 30 days of treatment compared to the strategy using unfractionated heparin, which up to now has been considered the standard blood thinner regimen used to support fibrinolytic therapy," Antman said.
The study has critical importance for the treatment of most patients who suffer a heart attack. "Although opening a blocked coronary artery with a balloon-tipped catheter, or percutaneous coronary intervention, has shown to be an effective treatment for heart attack patients who come to specialized centers, the vast majority of patients worldwide receive clot-busting medications to treat their heart attack," Antman said.
"Based on the results of this trial, we believe that the enoxaparin strategy is now the preferred anticoagulant regimen to use in heart attack patients who receive clot-busting drugs," said Eugene Braunwald, MD, chairman of BWH's TIMI Study Group.
In addition to the stir the TIMI findings made during the ACC's science session this week, Peter Libby, MD, BWH's chief of Cardiovascular Medicine, received the ACC's Distinguished Scientist Award in the basic domain Monday evening. This award is bestowed annually to an ACC member who has made major scientific contributions to the advancement of scientific knowledge in the field of cardiovascular disease.
Libby's latest contribution came this week, too, as an investigator with the ASTEROID study, which was presented during the ACC and published online in the Journal of the American Medical Association. Aggressive statin therapy with Crestor (rosuvastatin) can lower dramatically LDL levels, or so-called bad cholesterol, raise good cholesterol, or HDL, by an unprecedented amount and partially reverse coronary artery plaques volume, according to ASTEROID findings.
"This new study is the first to show actual shrinkage of fatty plaque in the coronary arteries of atherosclerotic patients," Libby said. ASTEROID was a prospective, open-label trial with blinded endpoints performed with 349 patients over more than two years at 53 community and tertiary care centers in the U.S., Canada, Europe and Australia.
Also at the ACC scientific session, BWH cardiologists Chris Cannon, MD, Marc Pfeffer, MD, PhD, and Joseph Loscalzo, MD, PhD, chairman of the Department of Medicine, lent their voices to national media coverage this week. Pfeffer and Loscalzo authored editorials for the New England Journal of Medicine, and Cannon encapsulated many findings reported during the ACC session for national media.