Hotline sessions of the 30th European Congress of Cardiology.

Of the 16 presentations at the three Hotline sessions of the 30th European Congress of Cardiology, held in Munich, Germany, 30 August–3 September 2008, nine are summarized below, since the others have already been published (BEAUTIFUL, Lancet 2008; 372; 807–821; TRANSCEND, Lancet 2008: 372; 1174– 1183; GISSI-HF (n-3-PUFA), Lancet 2008 (Epub ahead of print); GISSI-HF (rosuvastatin), Lancet 2008 (Epub ahead of print); LEADERS, Lancet 2008: 372; 1163–1173; IBIS 2, Circulation 2008: 118; 1172–1182; SEAS, N Engl J Med 2008 (Epub ahead of print). 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 shows only preliminary results. During the first Hotline Session, five studies on the medical treatment of heart failure (HF) were presented. Since three of these trials have already been published, only two of them are summarized below. The first session started with the results of the TIME-HF study (Trial of Intensified BNP-guided vs. Standard symptom-guided Medical therapy in elderly patients with Congestive Heart Failure) presented by Dr Hans Peter Brunner—la Rocca from Basel, Switzerland. Aim of this study was to compare intensified brain natriuretic peptide (BNP)-guided therapy with standard symptom-guided therapy in patients with HF, and to asses if there is a difference in response in the age groups . 75 years and younger. Previous smaller studies showed that BNP-guided therapy may improve outcome in chronic HF. Patients with symptomatic HF, left ventricular ejection fraction (LVEF) 45%, HF hospitalization within the last year, and an NT-BNP level . 2 upper limit of normal were included. Patients were randomized to standard or intensified BNP-guided therapy. The two groups were stratified by age 75 years or 65– 74 years with follow-up visits at 12 and 18 months. The standard group (n 1⁄4 948) was blinded to BNP levels. The intensified group (n 1⁄4 951) was treated as BNP-guided. All patients were treated according to the current guidelines on treatment of HF. Baseline characteristics showed a mean age of 76+8 years, the younger patients had a significantly lower LVEF (28+ 7% vs. 31+8%, P , 0.001), lower BNP levels (298 vs. 5053 pg/mL, P , 0.001) and less kidney disease (45% vs. 63%, P , 0.001) when compared with patients 75 years. Intensified BNP-guided therapy did not improve the primary endpoint of survival free of any hospitalization (P 1⁄4 0.46). However, the disease-specific endpoint of survival free of HF hospitalization did improve significantly in the BNP-guided group (P 1⁄4 0.008). Between age groups there was a significant difference in response to therapy in which patients in the age group of 60–74 had reduced mortality and improved survival free of HF hospitalization and patients aged . 75 years showed no benefit on survival and showed less improvement in quality of life. Evidence from trials in younger patients may not simply be applied to older patients according to these results. Specific HF trials in elderly patients are needed. In the second Hotline session five studies on acute coronary syndromes and interventional cardiology were presented, four of which will be reviewed. First, the DECREASE III (Dutch Echographic Cardiac Risk Evaluation Applying Stress Echo III) trial was presented by Prof Don Poldermans, Rotterdam, The Netherlands. Decrease III is a single centre, randomized double-blind placebo controlled trial with fluvastatin XL to study cardiac outcomes after major vascular surgery. Patients undergoing non-cardiac vascular surgery (e.g. abdominal aortic aneurysm, abdominal aortic stenosis, lower limb arterial stenosis, carotid artery stenosis) were included and treated with