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Top Cardiology Stories of 2006

. . . selected by the physician-editors of Journal Watch Cardiology

Each year the physician-editors of Journal Watch Cardiology select the stories published during that year that they believe had the greatest impact on cardiovascular diagnosis and treatment. Here are highlights from our choices for 2006.

Several important studies addressed strategies involving clopidogrel. In the CHARISMA trial, the addition of clopidogrel to aspirin did not improve outcomes in high-risk, stable patients. In the ACTIVE W trial, clopidogrel plus aspirin was inferior to oral anticoagulation therapy in preventing stroke, systemic embolism, MI, or vascular death in patients with atrial fibrillation and at least one stroke risk factor. However, in the COMMIT trial, adding clopidogrel to aspirin yielded an early benefit in patients with ST-segment-elevation MI (STEMI): Dual therapy prevented 9 cardiovascular events per 1000 patients treated.

Several of our top stories focus on percutaneous interventions. In two STEMI trials comparing drug-eluting stents with uncoated stents, sirolimus-eluting and paclitaxel-eluting devices each were associated with significantly reduced rates of target-vessel revascularization at 1 year. Both the ASSENT-4 trial and a meta-analysis of 17 percutaneous coronary intervention (PCI) trials showed that facilitated PCI was clearly inferior to primary PCI in STEMI patients, setting the stage for an update of practice guidelines. In the REACT trial, involving acute-MI patients in whom fibrinolytic therapy had failed, rescue PCI was superior to standard medical therapy and to repeat fibrinolytic therapy. In the EVA-3S trial, carotid endarterectomy outperformed carotid stenting, an emerging technology, in patients with symptomatic carotid stenosis 60% and recent stroke or transient ischemic attack.

We also provided perspective this year on temporal trends in pacemaker and implantable cardioverter-defibrillator malfunction rates, as reported in two studies. The Heart Rhythm Society has also updated its recommendations on device performance policies and guidelines.

Among the prevention studies that stood out this year was HOPE 2, which failed to support secondary prevention of vascular disease with a strategy of vitamin B supplementation. An ALLHAT analysis showed that antihypertensive treatment with diuretics or ACE inhibitors was associated with significantly lower risk for new-onset heart failure than was treatment with a calcium-channel blocker. Finally, on the epidemiologic front, Framingham Heart Study data showed that in patients age 55 to 75, the lifetime risk for stroke was 1 in 5 for women and 1 in 6 for men.

These important studies illustrate the dynamic nature of medical knowledge and its potential to influence practice. The challenge remains how to translate this knowledge into best practice. We appreciate the opportunity to help you in that endeavor with our summaries and commentary.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology December 27, 2006