More potent anti-clotting drugs with angiography may benefit patients with acute chest pain

TRILOGY-ACS trial compares 2 anti-platelet drugs for cardiovascular outcomes

2013-08-16

(Press-News.org) Boston, MA – Current methods to treat acute coronary syndrome conditions, such as heart attack, include artery-clearing procedures (e.g., percutaneous coronary intervention or coronary artery bypass grafting) with medications, or medications alone for those that do not undergo procedures.

In a new report from the TRILOGY ACS trial from Brigham and Women's Hospital (BWH) and Duke Clinical Research Institute (DCRI), in patients without artery-clearing procedures, those who had an angiography (a type of x-ray to view the inside of blood vessels) followed by prasugrel (Effient) had fewer heart attacks and strokes compared to those who had an angiography followed by clopidogrel (Plavix). Prasugel is a stronger blocker of blood-clotting cells called platelets compared to clopidogrel. This benefit of prasugrel was not seen in patients who did not have angiography.

The study will be published in the August 17, 2013 issue of The Lancet.

"These data may have implications for patient care, since the patients who seem to benefit most from intensified anti-platelet treatment are those with confirmed coronary artery disease. However, these data would need to be verified in another study before making such a recommendation," said Stephen Wiviott, MD, BWH Cardiovascular Division, lead study author.

"These results are one of the more important observations from the TRILOGYACS trial, which was set up to address the long-term use of dual anti-platelet therapy for patients managed medically after acute coronary syndrome," said E. Magnus Ohman, MD, senior investigator at the DCRI and chairman of the TRILOGY ACS trial.

There were 7,243 patients (younger than 75 years old) included in the randomized, controlled trial, which was done at more than 800 sites worldwide. Patients were randomly assigned to take clopidogrel or prasugrel. Forty-three percent of the patients enrolled in the study were given the drug after angiography, while fifty-seven percent were given the drug without having undergone angiography.

Researchers wanted to assess cardiovascular health outcomes based on angiography status and whether the effects of drug treatment on these health outcomes differed between patients who had angiography versus those who had not before enrolling in the study.

Researchers followed the patients to track cardiovascular health outcomes—cardiovascular death, heart attack or stroke—at 30 months.

The group of patients who had angiography and took prasugrel had fewer cardiovascular deaths, heart attacks or strokes compared to those who had angiography and took clopidogrel. However, for patients whose condition was managed first with medicines only and no angiography, there was no clear benefit of one drug over the other.

"This study supports the potential benefit of strong anti-platelet medications in patients with heart attacks where there are known blockages in heart arteries demonstrated by angiography, and reaffirms the value of cardiac catheterization in the management and triage of patients with acute chest pain," said Deepak L. Bhatt, MD, MPH, VA Boston Healthcare System and BWH Cardiovascular Division, senior study author.

Similarly, Wiviott added, "Patients should discuss with their doctors whether heart procedures such as angiography are right for them and which medications they should use to help reduce the chance of recurrent events."

### This research was supported by Daiichi Sankyo and Eli Lilly.

Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 3.5 million annual patient visits, is the largest birthing center in New England and employs more than 15,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving nearly 1,000 physician-investigators and renowned biomedical scientists and faculty supported by nearly $625 million in funding. BWH continually pushes the boundaries of medicine, including building on its legacy in organ transplantation by performing the first face transplants in the U.S. in 2011. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies, OurGenes and the Women's Health Initiative. For more information and resources, please visit BWH's online newsroom.

ELSE PRESS RELEASES FROM THIS DATE:

Slow earthquakes may foretell larger events

2013-08-16

Monitoring slow earthquakes may provide a basis for reliable prediction in areas where slow quakes trigger normal earthquakes, according to Penn State geoscientists. "We currently don't have any way to remotely monitor when land faults are about to move," said Chris Marone, professor of geophysics. "This has the potential to change the game for earthquake monitoring and prediction, because if it is right and you can make the right predictions, it could be big." Marone and Bryan Kaproth-Gerecht, recent Ph.D. graduate, looked at the mechanisms behind slow earthquakes ...

A new approach assembles big structures from small interlocking pieces

2013-08-16

CAMBRIDGE, Mass-- MIT researchers have developed a lightweight structure whose tiny blocks can be snapped together much like the bricks of a child's construction toy. The new material, the researchers say, could revolutionize the assembly of airplanes, spacecraft, and even larger structures, such as dikes and levees. The new approach to construction is described in a paper appearing this week in the journal Science, co-authored by postdoc Kenneth Cheung and Neil Gershenfeld, director of MIT's Center for Bits and Atoms. Gershenfeld likens the structure — which is made ...

Voyager 1 has left the solar system, says new study

2013-08-16

COLLEGE PARK, Md. – Voyager 1 appears to have at long last left our solar system and entered interstellar space, says a University of Maryland-led team of researchers. Carrying Earthly greetings on a gold plated phonograph record and still-operational scientific instruments – including the Low Energy Charged Particle detector designed, built and overseen, in part, by UMD's Space Physics Group – NASA's Voyager 1 has traveled farther from Earth than any other human-made object. And now, these researchers say, it has begun the first exploration of our galaxy beyond the ...

Knockout mouse grows larger, but weaker, muscles

2013-08-16

SAN ANTONIO (Aug. 15, 2013) — Although muscle cells did not reduce in size or number in mice lacking a protective antioxidant protein, they were weaker than normal muscle cells, researchers from the Barshop Institute for Longevity and Aging Studies at The University of Texas Health Science Center San Antonio found. The scientists, who are faculty in the university's School of Medicine, are studying how oxidative stress in cells impacts sarcopenia — a loss of muscle mass and strength that occurs in all humans as they age. Protein knocked out selectively The antioxidant ...

Experiences of racism linked to adult-onset asthma in African-American women

2013-08-16

(Boston) – According to a new study from the Slone Epidemiology Center (SEC) at Boston University, African-American women who reported more frequent experiences of racism had a greater likelihood of adult-onset asthma compared to women who reported less frequent experiences. The study, which currently appears on-line in the journal Chest, was led by Patricia Coogan, DSc, senior epidemiologist at SEC and research professor of epidemiology at Boston University School of Public Health. This study followed 38,142 African-American women, all of whom are participants in ...

Sugar helps scientists find and assess prostate tumors

2013-08-16

A natural form of sugar could offer a new, noninvasive way to precisely image tumors and potentially see whether cancer medication is effective, by means of a new imaging technology developed at UC San Francisco in collaboration with GE Healthcare. The technology uses a compound called pyruvate, which is created when glucose breaks down in the body and which normally supplies energy to cells. In cancer, however, pyruvate is more frequently converted to a different compound, known as lactate. Previous animal studies showed that scientists could track the levels of pyruvate ...

Sympathetic neurons 'cross talk' with pancreas cells during early development

2013-08-16

The human body is a complicated system of blood vessels, nerves, organs, tissue and cells each with a specific job to do. When all are working together, it's a symphony of form and function as each instrument plays its intended roles. Biologist Rejji Kuruvilla and her fellow researchers uncovered what happens when one instrument is not playing its part. Kuruvilla along with graduate students Philip Borden and Jessica Houtz, both from the Biology Department at Johns Hopkins University's Krieger School of Arts and Sciences, and Dr. Steven Leach from the McKusick-Nathans ...

Answering crucial questions about anthrax exposure

2013-08-16

(SALT LAKE CITY)—If terrorists targeted the United States with an anthrax attack, health care providers and policy makers would need key information – such as knowing the likelihood of an individual becoming infected, how many cases to expect and in what pattern, and how long to give antibiotics – to protect people from the deadly bacteria. Those questions gained urgency when anthrax-laced letters killed five people and infected 17 others in the wake of the terror attacks of September 2001. Now, using information from prior animal studies and data from a deadly anthrax ...

ORNL superconducting wire yields unprecedented performance

2013-08-16

The ability to control nanoscale imperfections in superconducting wires results in materials with unparalleled and customized performance, according to a new study from the Department of Energy's Oak Ridge National Laboratory. Applications for superconducting wires, which carry electricity without resistance when cooled to a critical temperature, include underground transmission cables, transformers and large-scale motors and generators. But these applications require wires to operate under different temperature and magnetic field regimes. A team led by ORNL's Amit ...

Study shows feral cat control could benefit from different approach

2013-08-16

NORTH GRAFTON, Mass. (August 15, 2013) – New research from Tufts University scientists shows that feral cats that undergo a vasectomy or hysterectomy could reduce a feral colony's numbers more effectively than the traditional approach of neutering. This may be because vasectomized cats retain reproductive hormones, in addition to not being able to reproduce, and therefore protect their turf from sexually intact competitors. The findings, derived from a computer-based model and published in the August 15 issue of the Journal of the American Veterinary Medical Association, ...

LAST 30 PRESS RELEASES:

The sound of traffic increases stress and anxiety

Global food yields have grown steadily during last six decades

Children who grow up with pets or on farms may develop allergies at lower rates because their gut microbiome develops with more anaerobic commensals, per fecal analysis in small cohort study

North American Early Paleoindians almost 13,000 years ago used the bones of canids, felids, and hares to create needles in modern-day Wyoming, potentially to make the tailored fur garments which enabl

Higher levels of democracy and lower levels of corruption are associated with more doctors, independent of healthcare spending, per cross-sectional study of 134 countries

Insilico Medicine recognized by Endeavor Venture Group & Mount Sinai Health System with Showcase AI and Biotech Innovation Award

ESMO Asia Congress 2024: Event Announcement

The pathophysiological relationship and treatment progress of obstructive sleep apnea syndrome, obesity, and metabolic syndrome

[Press-News.org] More potent anti-clotting drugs with angiography may benefit patients with acute chest pain
TRILOGY-ACS trial compares 2 anti-platelet drugs for cardiovascular outcomes