The program committee of the American Heart Association deemed the following four studies the best for the first Late-Breaking Science 1 session at the AHA scientific sessions in Anaheim, exploring solutions to periprocedural dilemmas in coronary artery bypass surgery and electrophysiology.
The session is on Sunday, Nov. 12, 3:45-5:00 p.m. in Hall D.
- TRiCS III: Opening with a transfusion study, C. David Mazer, MD, of St. Michaels Hospital, University of Toronto, will present results of the Transfusion Requirements in Cardiac Surgery (TRiCS) III trial. The international, open-label, randomized noninferiority trial compared two commonly used transfusion strategies in high-risk patients having cardiac surgery. Specifically, it compared a restrictive transfusion strategy in which patients receive a red cell transfusion if their hemoglobin was below 75 g/L intraoperatively and/or postoperatively with a liberal transfusion strategy (where the cutoff for red cell transfusion was 95 g/L intraoperatively), or below 85 g/L postoperatively in the intensive care unit and on the ward. The primary outcome is a composite of any of the following events (up to hospital discharge or postoperative day 28, whichever comes first): all-cause mortality, myocardial infarction, new renal failure, or new focal neurological deficit.
- DACAB: Second in the session is the phase 4 trial to Compare the Efficacy of Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Graft Surgery (DACAB), presented by Qiang Zhao, MD, of Shanghai Jiaotong University. This three-pronged study was designed to show the superiority of ticagrelor alone and ticagrelor plus aspirin over aspirin monotherapy for the 1-year primary efficacy endpoint of vein graft patency.
- PRESERVE: Seeking to reduce complications of angiography, presenter Steven Weisbord, MD, of the University of Pittsburgh, and his colleagues carried out the PRESERVE (Prevention of Serious Adverse Events Following Angiography) trial. It compared the effectiveness of intravenous isotonic sodium bicarbonate with intravenous isotonic sodium chloride and oral N-acetylcysteine with oral placebo for the prevention of serious adverse outcomes following angiographic procedures in high-risk patients. The primary outcome is a composite of serious, adverse, patient-centered events, including death, need for acute dialysis, or persistent decline in kidney function at 90 days.
- BRUISE CONTROL-2: The purpose of this study was to determine the best way to prevent hematoma by managing novel oral anticoagulants (NOACs) at the time of pacemaker or defibrillator surgery. Presenter David H. Birnie, MD, of the University of Ottawa Heart Institute, and his coinvestigators hypothesized that performing device surgery without interruption of the NOAC will result in a reduced rate of clinically significant hematoma. In the trial, called Strategy of Continued Versus Interrupted Novel Oral Anti-coagulant at Time of Device Surgery in Patients With Moderate to High Risk of Arterial Thromboembolic Events (BRUISE CONTROL-2), continued or interrupted anticoagulation with dabigatran, rivaroxaban, and apixaban were compared.
- ABRIDGE J: Presenter Akihiko Nogami, MD, of the University of Tsukuba (Japan), and his coinvestigators aimed to evaluate the efficacy and safety of perioperative anticoagulants during catheter ablation of atrial fibrillation. In the Clinical Benefit of Minimally-Interrupted Dabigatran versus Uninterrupted Warfarin for Catheter Ablation of Atrial Fibrillation (ABRIDGE-J) trial, patients with drug-resistant paroxysmal AF were randomized to receive dabigatran or warfarin perioperatively. The main outcome measures were incidence of embolism during the perioperative period and presence or absence of an intracardiac thrombus just before ablation.