{"id":32872,"date":"2012-11-06T15:46:45","date_gmt":"2012-11-06T20:46:45","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=fellowship-training&p=32872"},"modified":"2012-11-06T16:29:11","modified_gmt":"2012-11-06T21:29:11","slug":"what-tack-to-take-in-thinking-about-tact","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/11\/06\/what-tack-to-take-in-thinking-about-tact\/","title":{"rendered":"What Tack to Take in Thinking about TACT?"},"content":{"rendered":"

Several Cardiology Fellows who are attending AHA.12 in LA this week are blogging together for CardioExchange. The Fellows include\u00a0Tariq Ahmad<\/strong><\/a>,\u00a0Reva Balakrishnan<\/strong><\/a>,<\/em>\u00a0<\/em>Megan Coylewright<\/strong><\/a>,<\/em>\u00a0<\/em>Eiman Jahangir<\/strong><\/a>,<\/em>\u00a0<\/em>Amit Shah<\/strong><\/a>, and\u00a0John Ryan<\/strong><\/a>\u00a0(moderator). Read the previous post\u00a0here<\/a>.\u00a0Find the next one here<\/a>. For\u00a0related CardioExchange content, go to our<\/em>\u00a0<\/em>AHA 2012 Headquarters<\/strong><\/a>\u00a0page.<\/em><\/p>\n

In my short experience at AHA.12,\u00a0I have noticed several differences\u00a0this year,\u00a0most\u00a0notably that\u00a0several presentations at the early Late-Breaking Clinical Trials sessions left us with mostly negative results and more questions.<\/p>\n

During the first session, one presentation with a positive result seemed to catch the fellows\u00a0(and perhaps many others in the audience)\u00a0off guard — TACT (Trial to Assess Chelation Therapy)<\/a>. When the introductory slide appeared, we all seemed to be thinking, \u00a0“What is chelation? And why is this important?” Although some presentations at these conferences can seem beyond our knowledge base or secondary to our personal experiences within the specialty and training, it is rare that during a major session a therapy is presented that only few of us are even remotely familiar with. Except for reading about chelation therapy for lead poisoning in medical school, the most experience I have had with\u00a0it was seeing an old enrollment binder sitting in the back of one of the fellows rooms and asking an attending about it (who quickly dismissed it with an “oh, nobody does that anymore, don’t worry about it” type of statement).\u00a0<\/p>\n

The surprising trial results\u00a0raised more questions than answers, showing that chelation therapy was significant (HR 0.82, with an upper limit of 0.99) in reduction of the primary composite endpoint of all-cause mortality, MI, stroke, revascularization, and anginal hospitalization, with what appeared to be a stronger benefit in the subgroup of diabetics (39% reduction in events, p=0.002). \u00a0<\/p>\n

I searched the internet for some information on plausible mechanisms of action — and could find no strong evidence, instead seeing mostly theories. \u00a0<\/p>\n

Later that night, our fellowship program convened for a reception. One aspect that makes the conference valuable for fellows is the opportunity to discuss the presented\u00a0results with a diverse group of people at different levels of training, plus researchers and clinicians, which allows us to more fully synthesize the data and explore different approaches to thinking about the information.\u00a0<\/p>\n

At the reception, I\u00a0was able to discuss the trial with more senior faculty with extensive research backgrounds. One highlighted thought-provoking point was that our impression of a major finding is oftentimes shaped by the bias of the presenter. Although this trial had a significant result, the overall tone from the panel was negative, and the author at an AHA press conference\u00a0even called for caution in interpretation. The attending at my evening reception believed that if similar results were presented on a new drug or stent, people would likely be more excited about it and the study\u00a0might\u00a0change their practice. Yet, given that biologic plausibility is not established and closer analysis of the data remains to be seen, it seems appropriate to approach these results with a critical eye.<\/p>\n

As a fellow, have you had any exposure to the practice of chelation therapy for CAD, either first-hand or through the grapevine? More generally, how do you think about studies with surprising results?<\/p>\n","protected":false},"excerpt":{"rendered":"

A fellow encounters a little-understood intervention and startling study results; can informal discussions with senior faculty at AHA provide insight?<\/p>\n","protected":false},"author":325,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,7],"tags":[476,1546,1545,195],"class_list":["post-32872","post","type-post","status-publish","format-standard","hentry","category-general","category-prevention","tag-aha","tag-alternative-medicine","tag-chelation","tag-fellowship-training-2"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/32872","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/325"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=32872"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/32872\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=32872"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=32872"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=32872"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}