Meeting highlights. Highlights of the 20th congress of the European society of cardiology.

Abstract

The following studies were presented at the 22nd Congress of the European Society of Cardiology in Amsterdam, the Netherlands, August 26 to 30, 2000. ### GUSTO IV ACS (Global Use of Strategies To Open Occluded arteries in Acute Coronary Syndromes) Presenter : Maarten Simoons, MD, Thoraxcentrum, Erasmus University, Rotterdam, the Netherlands The study : A multicenter, randomized trial of adjunctive abciximab (a glycoprotein IIb/IIIa antagonist) in patients with acute coronary syndromes in whom an invasive/interventional strategy was not planned. A total of 7800 patients with a history of at least 5 minutes of chest pain at rest and either a positive troponin test or at least 0.5 mm ST-segment depression were treated with aspirin and heparin (or the low-molecular-weight heparin dalteparin in a predefined subset of patients in Scandinavia, Switzerland, and some US centers) and were randomized to receive placebo, a bolus and 24-hour infusion of abciximab, or a bolus and 48-hour infusion of abciximab. The primary end point of the study was the composite incidence of death or myocardial infarction (MI) at 30 days. The results : As per the prespecified protocol, only 1.4% of patients were referred for urgent revascularization in the first 48 hours after randomization. At 30 days, the incidence of death (placebo, 3.9%; 24-hour abciximab, 3.4%; and 48-hour abciximab, 4.2%), or death/MI (placebo, 8.0%; 24-hour abciximab, 8.2%; and 48-hour abciximab, 9.1%) were not significantly improved in either of the abciximab groups. Troponin status and the presence of documented ST-segment changes were predictors of worse outcomes, but did not identify a group of patients who prospectively benefited from abciximab. In the Scandinavian low-molecular-weight heparin subset, dalteparin provided an adequate alternative to unfractionated heparin, but it did not seem to convey significant incremental benefit. Summary : In patients with acute coronary syndromes who are not going forward to percutaneous coronary intervention, a 24- or 48-hour infusion of abciximab provided no incremental clinical benefit, …