bleeding, older than 80 years, known anemia) or
high thrombotic risk (e.g., intolerance to aspirin,
intolerance to any P2Y12 inhibitor, planned surgery within 1 year, cancer). There was also a lowrestenosis risk arm, defined by no intention for a
planned stent < 3.0 mm diameter to be implanted,
regardless of lesion length, apart from left main
coronary artery or saphenous graft intervention.
The idea was to personalize
the duration of DAPT, modelled according to the patient
clinical risk profile and not
by stent type. Thus, the high
bleeding risk group received
30 days of DAPT. Patients at
To listen to the full
high risk of thrombosis had a
interview with Marco
pre-specified tailored duration
Valgimigli, MD, visit
of therapy on the basis of the
the CSWN YouTube
channel or scan
specific condition conferring
the QR. Interview
the high risk of thrombosis,
conducted by Alfred
A. Bove, MD, PhD.
which included a single antiplatelet regimen for patients
intolerant of aspirin or available P2Y12 inhibitors, and a
30-day regimen in stable, or
6 to 12 months in unstable,
patients. In those at low risk
of restenosis, their DAPT regimen was 30 days in patients
with stable coronary artery disease or 6 months or
longer if the patients were being treated for acute
coronary syndrome.
Median DAPT duration was 32 days (interquartile range: 30-180 days) and did not differ between the groups. In the ZES group, 140 patients
(17.5%) reached the primary endpoint (1-year
major adverse cardiovascular events [MACE]),
compared with 178 patients (22.1%) in the BMS
group (hazard ratio: 0.76; 95% confidence interval: 0.61-0.95; p = 0.011) mostly due to lower MI
(2.9% vs. 8.1%; p < 0.001) and TVR rates (5.9%
vs.10.7%; p = 0.001) in the ZES group. Definite or
probable stent thrombosis was also significantly
reduced in ZES recipients (2.0% vs. 4.1%; p =
0.019).
In short, ZEUS showed that, compared with
BMS, DES implantation using a ZES combined
with an abbreviated, tailored DAPT regimen, resulted in a lower risk of 1-year MACE in uncertain
candidates for DES implantation.
Dr. Valgimigli’s take-away from all this? In terms
of which patients should receive a BMS today,
based on evidence and common sense, he said,
none. ■
REFERENCES:
1. Kalesan B, Pilgrim T, Heinimann K, et al. Eur Heart J.
2012;33:977-87.
2. Valgimigli M, Sabaté M, Kaiser C, et al. BMJ.
2014;349:g6427.
3. Dai K, Matsuoka H, Kawakami H, et al. Circ J. 2016 Jun 29
[Epub ahead of print].
4. Valgimigli M, Patialiakas A, Thury A, et al. J Am Coll Cardiol. 2015;65:805-15.
ACC.org/CSWNInterventions
What’s News? The Latest in mHealth
D
igital health or mHealth (as in mobile
health) is used to describe the new technologies that bring health and fitness to patients via diet and exercise applications (or apps) or
wearable technologies, such as those that measure
steps, calories burned, and stairs climbed.
How accurate are they? Recently investigators
evaluated four different products and all the activity
monitors tested were accurate in their step detection
over the variety of different surfaces tested (natural
lawn grass, gravel, ceramic tile, tarmacadam/asphalt,
linoleum), when wearing both running shoes and
hard-soled dress shoes.1 A recent systematic review
concurred, suggesting high validity for devices used
to track steps taken, but lower validity
for energy expenditure and measurement of time spent sleeping.2 In general,
2,000 steps equal about 1 mile.
Elizabeth A. Jackson, MD, an assistant professor of medicine at the UniElizabeth A.
Jackson, MD
versity of Michigan Health Center, said
tht “there is real evidence to suggest
that people can change behavior (i.e., regular physical
activity) and evidence that these devices can change
dietary behavior when combined with peer support.”
When you are done with this issue of CardioSource
WorldNews: Interventions, go to the September issue
of ACCEL and listen to the interview with Bonnie J.
Spring, PhD, who discusses data demonstrating how
valuable this technology can be in getting patients to
make positive changes in their diet and activity habits.
This is an important topic: as the $3 trillion
health care industry moves more towards consumer
choice, increasing numbers of individuals are taking
an active role in their overall health and wellness.
Consumers are taking on more risk for managing
their own care, and the industry is responding in
kind by rolling out new products and services that
empower them to do so. One problem: the wave
of sophisticated wearables and self-diagnosis tools
may be off target. As the saying goes, all that glitters is not gold: there are tons of great-looking apps
out there that don’t do much.
David E. Conroy, MD, noted recently that more
than half of American adults own smartphones,
and half of those owners use some type of fitness
app. He and his team identified the 100 top-selling
health and fitness apps in the Apple iTunes and
Google Play marketplaces.³ They looked for any
of 93 possible behavior-changing techniques in
the apps, including social support, instructions,
demonstration, feedback, goal settings, prompt,
CardioSource WorldNews: Interventions
23