2012: CANNeCTIN Projects Funded
COMPLETE Trial: A randomized, comparative effectiveness study of complete versus culprit-only revascularization strategies to treat multi-vessel disease after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction - David A. Wood (VCH)and Shamir R. Mehta (McMaster University)
Patients with ST-segment elevation myocardial infarction (STEMI) generally undergo percutaneous coronary intervention (PCI) on the infarct-related artery (IRA). Of these patients, approximately 40-60% have a clinically important stenosis (i.e., a vessel more than 2.5 mm in diameter with a narrowing of at least 50% lumen diameter) in at least 1 vessel other than the IRA. Such patients are said to be have a significant non-culprit lesion. Observational data demonstrate that the early and long-term prognosis for these patients is considerably worse than those with only a single culprit coronary artery stenosis. The optimal management of non-culprit lesion in patients with STEMI is unknown. There are few data and no expert consensus opinion supporting routine revascularization of non-infarct related artery lesions, despite the fact it is a common finding affecting approximately one-half of all patients undergoing primary PCI. The lower mortality associated with staged PCI to non-culprit lesions found in meta-analysis requires confirmation in an adequately powered randomized trial before it can be widely recommended. The COMPLETE pilot study (5-10 sites, n = 200) will determine the feasibility of a large-scale trial (n = 4,170) comparing a strategy of complete revascularization involving PCI or CAGB surgery of all suitable non-infarct related artery lesions to a strategy of culprit lesion-only revascularization in reducing the composite outcome of CV death or new MI in patients with multi-vessel disease who have undergone successful culprit lesion PCI for STEMI.
SAHARA Project: South Asian HeArt Risk Assessment - Sonia Anand (McMaster University) and Scott Lear (Simon Fraser University)
People who originate from the Indian subcontinent known as South Asians are the fastest growing group of non-white Canadians. They suffer from an excess prevalence of abdominal obesity, type 2 diabetes and heart disease. They also develop these risk factors at a significantly lower body weight and at younger ages compared to people of European origin. The purpose of SAHARA (South Asian HeArt Risk Assessment) is to recruit 320 South Asians from Ontario and British Columbia, who use the internet, email and other multi-media devices. Among these participants we will compare the effectiveness of a one year interactive multi-media health behaviour intervention to usual care in reducing cardiac risk factors. This intervention enables participants to set their health goals and provides health messaging and feedback designed to improve their dietary habits and physical activity. In addition, we will test if knowledge of genetic risk for heart attack influences behaviour change and their heart health risk factor profile. The information generated from SAHARA will enable individuals, physicians, health professionals, and policy makers to develop risk factor modification programs to prevent cardiovascular disease in this high-risk group.
PHASE Pilot Trial: Pilot trial of Hemodialysis patients undergoing Aldosterone antagoniSm with Eplerenone - Michael Walsh (St Joseph's Hospital)
End-stage kidney failure requiring dialysis affects over 1.4 million patients globally. One out of five dialysis patients dies each year with over 40% of deaths attributed to cardiovascular causes. Progressive heart failure is an important cause of cardiovascular deaths and morbidity for dialysis but there are no know effective treatments. Eplerenone, a selective aldosterone antagonist, reduces cardiac fibrosis and lowers blood pressure and is an effective agent for reducing death and hospitalizations in heart failure patients that do not require dialysis. Eplerenone is a promising medication to reduce morbidity and mortality in dialysis patients also. Although small studies suggest aldosterone antagonism is safe in dialysis patients, further evidence is required to determine there is not an excess risk of hyperkalemia before a large study can be performed. PHASE is a pilot trial to ensure there is not an excessive risk of hyperkalemia in dialysis patients with eplerenone.
LAAOS III Vanguard: Left Atrial Appendage Occlusion Study III - Stuart Connolly (Population Health Research Institute)and Richard Whitlock (Population Health Research Institute)
Atrial fibrillation (AF) increases thrombus formation in the left atrial appendage (LAA) and increases the risk of stroke. Three approaches to stroke prevention in AF have been formulated: 1) Elimination of AF, 2) Prevention of clot formation by antiplatelet or anticoagulant therapy and 3) Occlusion or removal of the LAA, the site of almost all clot formation. Suppression of AF with antiarrhythmic drugs has not been effective and suppression with ablation has not yet been properly tested. Antithrombotic medical therapy is effective, but is limited by major bleeding and by physician and patient reluctance to us anticoagulants. LAA occlusion has been conceived as an alternative to oral anticoagulation; but if LAA occlusion can be done easily and safely it may be well suited to be an effective complement to usual antithrombotic care. LAA occlusion is permanent and it does not require further physician intervention or patient compliance. On the other hand, LAA removal only addresses a single site of thrombus formation, a limitation that is addressed by systemic anticoagulation. AF is documented in 10% of patients coming to routine cardiac surgery, a time when the LAA is readily accessible for rapid and safe removal.
Our congratulations to the many investigators, collaborators, and working groups involved in these projects!