Practice Update - ESC Congress 2017

Renal DenervationLowers BloodPressure in Hypertensive Patients Not Taking Antihypertensive Medication – SPYRALHTN-OFFMEDTrial Renal denervation has been shown to lower blood pressure in hypertensive patients not taking antihypertensive medication. This outcome of the international, multicenter, prospective, randomized, sham-controlled SPYRAL HTN-OFF MED trial was reported at the 2017 European Society of Cardiology (ESC) Congress, from August 26–30.

M ichael Boehm, MD, PhD, of the University of Saarland, Homburg/Saar, Germany, explained that renal denervation is a min- imally invasive catheter-based procedure that delivers energy to the nerves in the kidneys. It was developed to treat resistant hypertension. Coinvestigator David Kandzari, MD, of the Piedmont Heart Institute, Atlanta, Georgia, said, “After SYMPLICITY HTN-3, we learned a lot about the procedure itself, medication adherence, and which patients may have less response to the renal denervation procedure – these insights have been incorporated into the revised clinical approach in the SPYRAL HTN program.” He continued, “With this new approach and pro- tocol design, coupled with new technology that allows more consistent circumferential treatment and easier access into the distal anatomy, based on these compelling results we are confident that

we’ve addressed the issues of previous renal den- ervation trials appropriately.” SPYRAL HTN-OFF MED was designed to evaluate the safety and blood pressure-lowering efficacy of the multi-electrode Symplicity Spyral renal den- ervation system. The study included patients with uncontrolled hypertension who were drug-naïve or stopped taking antihypertensive medications at least 4 weeks prior to randomization. Uncontrolled hypertension was defined as an office systolic blood pressure 150–180 mmHg and diastolic blood pressure >90 mmHg, and a 24-h mean systolic blood pressure 140–170 mmHg. Patients were randomized to renal denervation in the main renal arteries and branches or to a sham procedure. Blood pressure was measured at baseline and 3 months, and compared within each treatment group.

Dr. Michael Boehm

OxygenTherapyDoes Not Improve Survival in PatientsWith Symptoms ofMI –DETO2X-AMI

diabetes, and those with previous heart disease, mortality was similar within 1 year. European Society of Cardiology (ESC) guidelines from 2012 on ST-segment elevation myocardial infarction (STEMI) recommended oxygen (by mask or nasal prongs) for patients who were breathless, hypoxic, or suffered from heart failure. They added that systematic oxygen use in patients without heart failure or dyspnea was “at best, uncertain.” “ESC guidelines have gradually shifted towards more restrictive use of oxygen,” said author Prof Stefan James, a cardi- ologist at Uppsala University, Uppsala, Sweden. “While the current recommen- dations were based on expert opinion only, we can now add substantial new data from our large clinical trial.” The ESC has updated its guidelines for the management of patients with acute myocardial infarction. In the new 2017

Oxygen therapy has been found not to improve survival in patients with symptoms of heart attack. This conclusion, based on results of the prospective, randomized, open-label DETermination of the role of OXygen in suspected Acute Myocardial Infarction (DETO2X-AMI), was presented at the 2017 European Society of Cardiology (ESC) Congress, from August 26–30.

Dr. Robin Hofmann

R obin Hofmann, MD, of the Karolinska Institutet at Södersjukhuset, Stockholm, Sweden, explained, “The DETO2X- AMI study questioned the practice of routine oxygen therapy for all patients with suspected myocardial infarction.” DETO2X-AMI enrolled 6229 patients with suspected heart attack from 35 hospitals across Sweden. Half were assigned to oxygen given through an open face mask and the other half to room air without a mask.

The primary outcome, mortality rate 1 year after randomization, did not differ statistically between the two groups (5.0% in the oxygen group vs 5.1% in the air group). Similarly, the two groups did not differ significantly in secondary end- points, including risk of a new heart attack or heart muscle injury as measured by blood markers. Even in patients at high risk, such as smokers, older patients, patients with

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