Considering Guidant's ( GDT) recall woes last year and the bidding war Boston Scientific ( BSX) ultimately won for the medical-device maker, investors might be forgiven if they temporarily forgot that stents and defibrillators weren't all there was to cardiac care.

The American College of Cardiology's annual meeting, beginning this weekend in Atlanta, will serve to remind everyone that heart care is a much broader field, because one of the main focuses of the gathering will be on drugs for heart attacks and other vascular conditions.

While the ACC meeting doesn't have the hype machine of the American Society of Clinical Oncology's yearly extravaganza, it's at least equally important. After all, heart disease is still the leading cause of death in the U.S.

Old Is New Again

New treatments for heart disease will certainly be discussed at the cardiology conference in Atlanta, but a recurring theme will be companies that are trying to find additional uses for existing drugs.

For instance, Medicines Co. ( MDCO) is pitting its drug Angiomax against heparin in treating what are called "acute coronary syndromes," a group of conditions that includes angina and heart attacks.

Heparin is commonly used to break up blood clots that can lead to those conditions, but it's also associated with serious side effects, such as bruising and bleeding -- bleeding that can be fatal in up to 2% of patients who receive it. Medicines wants to show that Angiomax can treat the same clots, but more safely than heparin.

Angiomax is currently approved as a blood thinner for patients preparing for a procedure known as percutaneous coronary intervention. During the procedure, plaque in a clogged artery is pushed out of the way to promote free blood flow. The market for clot-fighting drugs is worth about $3 billion a year, according to the Cambridge Healthtech Institute.

Medicines expects to report the initial results of a head-to-head comparison at the ACC on Sunday. The trial enrolled more than 13,800 patients who were smokers, have high blood pressure, high cholesterol, diabetes or a family history of heart disease.

Previous studies of Angiomax showed a reduction in bleeding complications compared with heparin, even in high-risk patients, the company says.

If the results of the head-to-head trial, dubbed Acuity, are positive for Angiomax, biotech analyst Joseph Schwartz of Leerink Swann says the potential for new labeling could lift Medicines' stock and eventually serve as a key revenue driver.

Should the data prove compelling enough, Schwartz expects the company to seek Food and Drug Administration clearance to market Angiomax as a treatment for acute coronary syndromes, in addition to its use with percutaneous coronary intervention. Schwartz believes the company might apply for the new indication in the second quarter of this year for a possible approval early in 2007.

Leerink has provided noninvestment-banking services to Medicines Co.

Drugs and Debates

Another drug being investigated in a new indication is Arixtra, from GlaxoSmithKline ( GSK). Arixtra was originally approved to treat deep-vein thrombosis, a condition in which restricted blood flow leads to clotting, most often in the pelvis and legs.

Arixtra is now in clinical trials for acute coronary syndromes. New data on the drug, from a trial dubbed Oasis-6, will be presented Tuesday.

However, should Arixtra ever be approved for this new use, the Sanofi-Aventis ( SNY) drug Lovenox and hospital contracts for that treatment could serve as barriers to entry, according to pharmaceuticals analyst Gbola Amusa of Bernstein Research.

"The Oasis trial results are unlikely to be sufficient to overcome some of these economic issues in the near term but could provide some longer-term negotiating leverage," he said in a recent research report.

Bernstein has provided Glaxo with noninvestment-banking services in the past 12 months.

Among newer treatments, Vasogen ( VSGN) is expected to present results on a late-stage trial with its Celacade device for patients with peripheral artery disease. PAD is a condition in which clogged arteries cut off circulation to the legs, leading to pain and difficulty walking.

Meanwhile, Encysive Pharmaceuticals ( ENCY) is scheduled to report results from its late-stage safety and efficacy trial of a drug for treating pulmonary arterial hypertension, a rare disease in which constant high blood pressure in the pulmonary artery causes stiffness and thickening in the artery walls, hampering circulation.

Of course, don't think the big device makers are going to be shut out. Johnson & Johnson's ( JNJ) Cordis unit is set to release trial data on its Cypher drug-eluting stent in patient groups such as those experiencing heart attacks and those with long coronary lesions. J&J was on the losing end of the fight for Guidant.

And what would a cardiology meeting be without a debate on the safety of implanted defibrillators, namely, how and when to use them and who should receive them? That's scheduled for Sunday.

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