Hotline Sessions of the 29th European Congress of Cardiology

The 29th Congress of the European Society of Cardiology was held from 1 September to 5 September 2007 in Vienna, Austria. During three Hotline sessions, the preliminary results of 15 studies were presented. One trial has been published recently (ADVANCE, Lancet 2007;370:829–840). The results in this overview were collected from the presentations of the speakers, as well as from press handouts. During the first Hotline Session, several issues were addressed. The first session started with the results of the 3CPO study (Efficacy of non-invasive ventilation in patients with acute Cardiogenic Pulmonary Oedema), presented by David Newby from Edinburgh, UK. This multicentre randomized controlled trial of the early management of patients with acute cardiogenic pulmonary oedema compared continuous positive airway pressure (CPAP) ventilation and noninvasive intermittent positive pressure ventilation (NIPPV) with standard oxygen therapy. In total, 1069 patients were recruited (mean age 78 years, 43% male), CPAP (n 1⁄4 346, 10+4 cm H2O) or NIPPV (n 1⁄4 356, 14+5/7+2 cm H2O). At entry, patients were tachycardic (HR 113+22/min), tachypneic (respiration rate 32+7/min), acidotic (pH 7.22+0.09), and hypoxic (O2 saturation 90+8%). In comparison to standard oxygen therapy non-invasive ventilation was associated with greater improvement in tachycardia (102+23 vs. 96+22 min, P, 0.001), tachypnea (26+ 6 vs. 25+6, P 1⁄4 0.023), and acidosis (pH 7.30+0.08 vs. 7.32+0.08, P , 0.001) at 1 h. There was no difference between the two treatment modalities. The 7-day and 30-day mortality was similar for standard oxygen therapy and non-invasive ventilation [9.8 vs. 9.5% (P 1⁄4 0.87) and 16.6 vs. 15.6% (P 1⁄4 0.69) respectively]. The combined endpoint of 7-day death or intubation rate was similar for both forms of non-invasive ventilation CPAP/NIPPV (11.7 vs. 11.1%, P 1⁄4 0.81). Thus, in patients with acute cardiogenic pulmonary oedema non-invasive ventilation produces a more rapid resolution of metabolic abnormalities and respiratory distress with both CPAP an NIPPV appearing to be equally efficacious and safe. However, non-invasive ventilation has no major effect on 7-day or 30-day mortality over standard oxygen therapy. John McMurray from Glasgow, UK presented the ALOFT (ALiskiren Observation of heart Failure Treatment) trial. ALOFT tested the safety and efficacy of adding a direct renin inhibitor (Aliskiren 150 mg once daily) in patients (n 1⁄4 302) with chronic heart failure already treated with an ACE inhibitor (or angiotensin receptor blocker) and b-blocker. Inclusion criteria were stable NYHA classes II–IV heart failure 1 month and past or current diagnosis of hypertension. Aliskiren inhibited plasma renin activity (20.97 vs. 25.71 ng/mL/h, P, 0.0001) and significantly reduced the BNP levels (212.2 vs. 261 pg/mL, P 1⁄4 0.0160) over placebo. There were no difference between the pre-specified safety assessments in Aliskiren and placebo [renal dysfunction (1.9 vs. 1.4%), symptomatic hypotension (3.2 vs. 1.4%), or hyperkalemia (6.4 vs. 4.8%)]. Aliskiren effectively inhibited plasma renin activity, even though most patients were treated with a b-blocker. Adding Aliskerin in patients also treated with an ACE inhibitor (or angiotensin receptor blocker) appeared to be well tolerated. The potential therapeutic role of Aliskiren as alternative or ‘add-on’ therapy to an ACE inhibitor (or angiotensin receptor blocker) in chronic heart failure is worth further investigation. A comparison of the EUROASPIRE I, II, and III surveys was given by David A. Wood from London, UK. The three EUROASPIRE surveys of coronary patients have been conducted over 12 years in 8 countries. A total of 8547 patients with coronary artery disease have been interviewed and examined over this period. Time trends in the management of lifestyle, other risk factors such as blood pressure, lipids and diabetes, and drugs in the prevention of cardiovascular disease are described. The three surveys show that lifestyle management is a growing cause of concern. The prevalence * Corresponding author. Tel: þ31 24 3614533; fax: þ31 24 3540537. E-mail address: [email protected]