ACC年会热点亮相TCT 2008

Hot Topics from ACC’s Annual Meeting Kicks Off TCT 2008 

（阜外心血管病医院 高立建 翻译）

（来源：www.tctmd.com）

Hot Topics from ACC’s Annual Meeting Kicks Off TCT 2008 

Key Points:

• ACC and CRF held joint session on Sunday.

By TCT Daily Staff

The American College of Cardiology and the Cardiovascular Research Foundation in a joint session Sunday highlighted hot topics presented at the ACC Annual Scientific Sessions earlier this year and looked ahead to trial results to be released here this week.

Gregg W. Stone, MD, quickly reviewed 25 years of data and more than 1,000 randomized trials, highlighting therapies in the setting of acute coronary syndrome and STEMI: antithrombin therapies such as unfractionated heparin, enoxaparin, bivalirudin, and fondaparinux; and antiplatelet therapies such as aspirin, thienopyridines, and GP IIb/IIIa inhibitors.

"For most patients with ACS and STEMI, the goal of pharmacotherapy in the acute phase is to stabilize the ruptured plaque and facilitate safe, definitive revascularization," said Stone, who is professor of medicine at Columbia University Medical Center and chairman of the Cardiovascular Research Foundation in New York.

Stone said one-year results of the HORIZONS AMI trial, one of the most exciting trials of the year, will be presented on Wednesday at 11:15 a.m.

Venous disease

Raghu Kolluri, MD, director of vascular medicine at the Prairie Vascular Institute in Springfield, Ill., reviewed recent data about management of acute and chronic venous disease that affects about 20% of adults in some form.

Results of a study published by Campbell et al in the Annals of the Royal College of Surgeons of England showed that the recurrence rate of varicose veins was 20% to 50% at two to five years and 70% at 10 years. Kolluri said that "any kind of superficial or perforator vein reflux can be treated by endovascular methods in a single setting and with adjunct or repeat procedures. Surgery for varicose veins does not seem to be the gold standard anymore," he said.

Sunil V. Rao, MD, assistant professor of medicine at Duke University Medical Center in Durham, N.C., outlined current data on the treatment of anemia, defined by WHO as a decrease in red blood cell mass with a hemoglobin expressed as a concentration ,13 g/dL for men and ,12 g/dL for women.

Not all anemia in heart failure is dilutional anemia, Rao said. It is more common to have true anemia (54% of cases are true anemia vs. 46% dilutional). Anemia is a potent multiplier of risk in patients who have congestive heart failure (see Figure), Rao said.

Patients who have anemia, heart failure, and chronic kidney disease have a six times higher risk for mortality. For every 1 gm/dL decrease in hemoglobin, there is a 13% increase in annual mortality risk in patients with congestive heart failure. This raises the question of whether anemia is a marker or a mediator of mortality, according to Rao.

Marc E. Shelton, MD, president and medical director of Prairie Cardiovascular Consultants Ltd., said that interventionalists should "realize that a lot of us do noninterventional work as well. As we look at the long-term data we realize there are many things that play into the long-term outcome of our patients after initial procedures. Interventionalists need to be good general cardiologists, and it is always good to keep up to date on those topics."