Hotline sessions of the 26th European Congress of Cardiology

Of the 12 presentations at the two Hotline sessions of the 25th European Congress of Cardiology, held in Vienna, Austria, 30 August – 3 September 2003, six are summarized, since the other half of the presentations have been published recently (CHARM studies: Lancet 2003; 362:759–781, the EUROPA study: Lancet 2003;362:782– 788 and the ESTEEM trial: Lancet 2003;362:789–797). The authors of this summary collected the information given during the presentations of the studies, as well as from press releases prepared by most speakers. This report only shows preliminary results. During the first Hotline Session, studies on the medical treatment of heart failure were presented. Of the six presented studies, five have already been published. Dr Christian Mueller from Basel, Switzerland presented the BASEL study. In this open single-centre study patients with acute dyspnoea presenting at the emergency room were randomized to be diagnosed and treated according to standard clinical practice or to standard clinical practice with an additional rapid BNP (Brain Natriuretic Peptide) analysis. Hypothetically, additional BNP analysis improves diagnostic speed and accuracy which may reduce admission time, treatment costs and potentially improves outcome. In this study BNP levels were always interpreted in conjunction with clinical information: a BNP level of <100 pg/ml almost certainly ruled out heart failure as the primary cause of dyspnoea, while a level of >500 pg/ml was strongly suggestive of heart failure as the principal cause of dyspnoea. In case of an intermediate BNP value clinical judgement prevailed. The baseline characteristics of the 452 study patients were well balanced, the mean age was 70 years, 50% had a history of coronary artery disease and 50% had known pulmonary disease. The two primary endpoints consisting of admission time and treatment costs were significantly reduced by additional rapid BNP analysis compared to traditional clinical assessment (10.6 days vs 13.7 days P=0.009 and $5410 vs $7264 P=0.006, respectively). The secondary endpoint of admission rate was significantly lower in the BNP group: 75% vs 85%, P=0.008. The pre-defined 30-day mortality and readmission rate did not differ significantly between both groups. This positive study shows the potential benefit of a rapid BNP analysis in triage in the emergency room, improving overall treatment delay and reducing costs. However, these results should be interpreted with caution because of the open study design. Finally, the cutoff values of BNP are somewhat arbitrarily chosen and the role of intermediate ‘grey-zone’ BNP values remains unclear. The topics of the second Hotline Session were acute coronary syndromes and percutaneous coronary interventions. Of the six presented studies, one has already been published. Dr Arnoud W. J. van't Hof from Zwolle, the Netherlands presented a randomized double-blind multicentre trial in patients presenting with acute ST-elevation myocardial infarction in the ambulance or in a referral hospital: the On-TIME trial. In a placebo controlled design pre-transportation initiated tirofiban treatment (early) was compared to cath-lab initiated tirofiban treatment (late) in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. The primary endpoint was TIMI-3 flow at initial coronary angiography. In total, 507 medium risk patients (mean age 62 years, 45% anterior myocardial infarction and 15% Killip 2) were randomized and received standard aspirin and heparin at presentation: 251 patients received pre-transportation tirofiban at a median of 59 min earlier than the 256 patients in whom tirofiban was initiated at the cath-lab. The total ischaemic time was 192 min in both groups. The initial pre-procedural TIMI-3 flow did not differ significantly between the early and late tirofiban group (19% vs 15% respectively, P=0.22). The combined incidence of thrombus or fresh occlusion at initial angiography was significantly less in the early treated group compared to the late treated group (60% vs 73%, respectively * Correspondence: Freek W. A. Verheugt, MD, FESC, University Medical Centre St. Radboud, Heartcentre, 540 Cardiology, P.O. Box 9101, Nijmegen, The Netherlands 6500 HB. Tel: +31-24-3614533; Fax: +31-24-3540537 E-mail address: f.verheugt@cardio.umcn.nl (F.W.A. Verheugt). European Heart Journal (2003) 24, 2156–2158