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Meeting highlights. Highlights of the 71st scientific sessions of the American Heart Association.

The study: A randomized, placebo-controlled trial of spironolactone (an aldosterone antagonist) in patients with severe congestive heart failure (CHF). A total of 1663 patients with a left ventricular ejection fraction (cid:35) 35% and NYHA class III or IV CHF who were taking ACE inhibitors were randomized to spironolactone (25 mg/d) or placebo. The dose of spironolactone could be increased to 50 mg/d or decreased to 25 mg QOD at the 8-week follow-up point at the investigator’s discretion. All patients were taking ACE inhibitors (if tolerated) and a loop diuretic, with or without digoxin. Sixty percent of patients had an ischemic origin of their CHF; 89% were taking ACE inhibitors at baseline. The primary end point was the composite of total mortality and rehospitalization. The study was originally designed to con-tinue for 3 years but was terminated early (after 2 years) on the recommendation of the data safety monitoring board because of excess benefit in the spironolactone group. The results: There were a total of 372 deaths in the placebo group (44%) and 283 deaths in the spironolactone group (34%). Rehospitalization was also significantly reduced in the spironolactone group, most prominently in rehospitalizations for exacerbation of CHF, which were reduced 36% in the spironolactone group. The advantages of spironolactone were evident at 3 months of follow-up and persisted through the 2-year time point. The mortality benefit was consistent across a broad range of patient subsets. Age, sex, and ischemic/ nonischemic origin of CHF did of 900 patients 12 of the onset of acute MI were randomized to either primary PTCA or implantation of a heparin-coated stent (Palmaz-Schatz, Cor-dis). The primary end point of the study was the 6-month composite of death, recurrent MI, disabling stroke, or ische-mia-driven target-vessel revascularization. The results: Acute procedural success was high ( (cid:46) 99%) in both groups, although the incidence of postprocedure TIMI grade III flow was somewhat lower in the stent group (89% versus 92% by core laboratory analysis). Stented patients had significantly lower residual stenosis and significantly higher minimum lumen diameters (MLDs). There were 67 PTCA patients (15.1%) who crossed over to a stent because of suboptimal results. At 6-month follow-up angiography, stented patients continued to have significantly larger MLDs, resulting in a significantly lower binary angiographic restenosis rate (20.3% versus 32.5% with PTCA). Primary composite events at 6 months were significantly lower the stent group versus PTCA), patients undergoing stenting. The study: A randomized trial of catheter-based low-dose (cid:103) -radiation therapy for treatment of in-stent restenosis. One hundred thirty patients with in-stent restenosis in native coronary arteries (n (cid:53) 100) and vein grafts (n (cid:53) 30) undergoing percutaneous therapy were randomized to catheter-delivered fixed-dose (cid:103) -radiation therapy (15 Gy at a distance of 2 mm from the 192 Ir ribbon source) or placebo. The average lesion length was (cid:39) 29 mm. The primary end point was the composite of death, MI, and target-lesion revascularization at 6 months. Diabetes was present in 38% to 45% of the patients. The results: Radiation therapy was successfully delivered in 129 of 130 patients. The mean dwell time for the 192 Ir source was (cid:39) 22 minutes. At 6 months, radiation therapy was associated with a significant reduction in composite events and significant reductions in angiographic restenosis (16% versus 48% with placebo) and target-lesion revascularization (26.2% versus 67.7% with placebo). There appeared to be particular benefit in diabetic patients, in whom there were dramatic reductions in angiographic restenosis (13.8% in the radiation group versus 63.1% with placebo) and target-vessel revascularization (26.2% versus 67.7% with placebo). Summary: In this study, low-dose (cid:103) -radiation therapy appears to be a very effective adjunctive modality for the treatment of patients with in-stent restenosis. The study: A randomized trial comparing 2 types of contrast media in patients undergoing high-risk PTCA. A total of 853 patients undergoing high-risk interventions at 13 clinical centers were randomized to either the nonionic iso-osmolar contrast agent Iodixanol in of the results: Preliminary results indicate that at a mean follow-up of 3.1 years, the incidence of cardiovascular death or stroke 4.78% per year in the physiological pacing group and 5.43% per year in the VVI pacing group, a nonsignificant difference. The event curves to overlap for the first 2 years of follow-up, and then some divergence of the curves was were no significant differences between walk CHF. The physiological pacing group was noted (AF) (5.34% per year versus per year); again, these differences appeared to emerge after 2 years.