The hotline sessions of the 23rd European congress of cardiology.

Abstract

Of the 18 presentations at the three HotlineSessions of the 24th European Congress ofCardiology, held in Berlin, August 31–September 4, 2002, 16 are summarised, since two of the Hotline presentations have been published recently(Lancet, 2002; 360: 743–751, 752–760). Theauthors collected the information given during the presentations of the studies, as well as from press releases prepared by most of the speakers. This report only shows preliminary results. During the first Hotline Session, studies on early treatment of acute coronary syndromes werepresented. Professor Francisco Fernandez-Aviles fromValladolid, Spain, presented the GRACIA study. To 500 patients with ST-segment elevation acutemyocardial infarction, front-loaded rt-PA wasadministered within 12h of symptom onset. About 3h following thrombolytic therapy, patients were randomised to early angiography and subsequent percutaneous intervention to be performed within 24h, or to an ischaemia-guided conservativestrategy. The average time to percutaneous intervention in the invasive group was 17h afterfibrinolysis. In the conservative arm 19% of patients underwent revascularisation during hospital stay, but this was not considered an endpoint in this study. The primary endpoint of 30-day death,reinfarction and (re-) revascularisation wasreduced by 20%, from 6.0% in the alteplase groupto 4.8% in the alteplase plus intervention group \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((p=0.55)\) \end{document}. Thirty-day mortality was similar in both groups (2.5 and 2.0%) as was major bleeding (1.6 and 1.6%). The patients who required periprocedural abciximab, had nearly 3% bleedingversus 1% in those who did not need abciximab. These results show that percutaneous intervention after fibrinolysis beyond the time of myocardial salvage is feasible and safe. Mortalitywas similar and astonishingly low for a fibrinolytic trial. More studies on an early invasive strategy after fibrinolysis in a less selected population are warranted. The second study was presented by Professor Petr Widimsky from Prague, Czech Republic. In the PRAGUE-2 study 850 patients with acute ST-elevation myocardial infarction were randomised in hospitals without intervention …