CURE Works Patients With Acute Coronary Syndromes at All Risk Levels
When 12 562 patients who arrived at the hospital within 24 hours of the onset of symptoms of acute coronary syndrome were randomized to receive either clopidogrel or placebo in addition to aspirin for 3 to 12 months, the so-called “super aspirin” appeared to reduce risk consistently across risk groups, according to a report in this week’s issue of Circulation (Circulation. 2002;106:1622–1626).
According to researchers led by Andrzej Budaj, MD, of the Postgraduate Medical School at Growchowski Hospital in Warsaw, Poland, the original Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) trial showed that clopidogrel given soon after the cardiac event and continued long-term was superior to placebo in preventing recurrent events in patients with non–ST elevation acute coronary syndromes who were also receiving aspirin.
In this study, patients were stratified into risk groups according to the Thrombolysis in Myocardiac Infarction (TIMI) risk score. “The treatment effect of clopidogrel demonstrated in CURE was consistent in all categories of risk,” the authors wrote. “However, the absolute benefit increased with increasing TlMl score. This indicates that although all categories of patients will benefit from clopidogrel, the greatest absolute benefit will be in high-risk subjects.”
Two Circulation Editors Receive Gold Medal of the European Society of Cardiology
Hein J.J. Wellens, MD, Associate Editor of Circulation, and Attilio Maseri, MD, a Consulting Editor for the journal, received the Gold Medal of the European Society of Cardiology in ceremonies in Berlin, Germany, during the Society’s recent Congress.
Dr Wellens, one of the original investigators of clinical cardiac electrophysiology, unraveled the Wolff-Parkinson-White syndrome, and the systematic approach used by him and his collaborators has contributed significantly to the understanding of the mechanism and the relevance of different arrhythmias. He qualified in medicine at the University of Leiden in the early 1960s and did his internship at Mercy Hospital, Baltimore, Md. After his residency in internal medicine at Sint Antoniushove, Voorburg, he continued residency at Wilhelmina Gasthuis, Amsterdam, the Netherlands, under the supervision of Professor Dirk Durrer, and subsequently accepted a position as staff cardiologist. After 4 years as Professor of Cardiology at the University of Amsterdam, Dr Wellens accepted the post of Chairman of the Department of Cardiology at Maastrich in 1977. He subsequently became Medical Director and Chairman of the Scientific Council of the Cardiovascular Research at Institute Maastricht (CARIM), until his retirement in 2002. He is now Chairman of the Interuniversity Cardiology Institute in the Netherlands.
Dr Wellens has taken an active role in various scientific societies such as the Dutch Society of Cardiology, the Royal Academy of Sciences in the Netherlands, the American College of Cardiology, the American Heart Association, and the European Society of Cardiology. In 2000, he received the European Society of Cardiology Silver Medal for recognition of his distinguished teaching in electrocardiography.
Dr Attilio Maseri, MD, was recognized for his contributions to the understanding of the mechanisms of early myocardial ischemia, the role of vascular tone and vasospasm, and the significance of silent ischemia. More recently, he investigated the role of inflammation as a cause of acute coronary syndromes.
Born in Udine, Italy in 1935, Dr Maseri graduated from Padova University Medical School with full honors in 1960 and passed Postgraduate Boards in both Cardiology and Nuclear Medicine with full honors at Pisa University Medical School in 1963 and 1968, respectively. His colorful career led him to Columbia University in New York in 1965 and to John Hopkins University Medical Center in Baltimore, Md, in 1966. He returned to Italy as an Assistant Professor at the University of Pisa. In 1979, he accepted the Sir Johns McMichael Professorship of Cardiovascular Medicine at the Royal Postgraduate Medical School in London and served as Director of Cardiology at Hammersmith Hospital. From 1991 to 2001, he served as Professor of Cardiology at the Catholic University of Rome and Director of the Institute of Cardiology at the Policlinico Agostino Gemelli. He is currently Professor of Cardiology at the University Vita e Salute–San Raffaele in Milan and is Director of the Department of Cardiology and Cardiac Surgery of San Raffaele Hospital.
Angioplasty or Thrombolysis After Heart Attack: the Plot Thickens
A study in the September 14, 2002, issue of The Lancet finds no difference in treatment outcome between prehospital thrombolysis and emergency angioplasty after a severe heart attack (Lancet. 2002;360:825–829). It is one in a group of studies that has pitted thrombolysis against percutaneous intervention for acute coronary syndromes with differing results.
The difference in this study, which was led by Eric Bonnefoy, MD, and colleagues from the University Hospital in Lyon, France, is that the thrombolytic drug was administered before the patient reached the hospital. In this randomized, multicenter trial, 840 patients who had experienced a severe heart attack were randomly allocated to either prehospital treatment with the clot-busting agent or emergency angioplasty upon arriving at the hospital.
The was no statistical difference between the two treatment strategies in the primary end point of death, recurrence of heart attack, or disabling stroke within one month of the treatment. Providing patients with angioplasty took longer (an average of just over 3 hours) than thrombolytic therapy (2 hours). About one-fourth of patients who received the thrombolytic therapy also underwent “rescue” angioplasty upon arriving at the hospital.
In an accompanying editorial, Greg Stone, MD, of Lenox Hill Heart and Vascular Institute in New York, said that all the evidence in the area taken together tips the balance in favor of early percutaneous intervention (Lancet. 2002;360:814–815). He said the available evidence should be a “wake-up call” in favor of percutaneous intervention, which he calls the best therapy, along with immediate antiplatelet therapy, for patients with evolving acute myocardial infarction.