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ESC Congress 2013: What are the lessons?

30 September 2013 Praful Mehta

Earlier this month, the European Society of Cardiology (ESC) concluded its most prestigious event - ESC Congress 2013 - amid much fanfare. The congress was a huge success with an estimated 30,000 people attending the event in Amsterdam.

A record number of hot line and scientific discussions were organised for the attendees to freely interact with study investigators, academic KOLs and industry experts.

In 2012, we provided a cheat sheet to the event. This year, we are sharing our take on some of the most important results presented.

Hokusai-VTE Comparative Investigation of Low Molecular Weight (LMW) Heparin/Edoxaban Tosylate (DU176b) Versus (LMW) Heparin/Warfarin in the Treatment of Symptomatic Deep-Vein Blood Clots and/or Lung Blood Clots Drug: Lixiana (Edoxaban Tosylate; codenamed DU-176b) Company: Daiichi Sankyo Results: In the treatment of venous thromboembolism (VTE), the oral anticoagulant edoxaban resulted in equal efficacy and better safety compared to standard warfarin when either drug was used with initial low molecular weight heparin (LMWH) Implications: In the landscape of new trials with oral anticoagulants, the Hokusai-VTE findings offer fresh insight into a previously under-represented subgroup of patients with pulmonary embolism (PE), suggesting that treatment for this group might need to be different than for other VTE patients.

PURE The Prospective Urban Rural Epidemiology (PURE) study: examining the impact of societal influences on chronic noncommunicable diseases in low-, middle-, and high-income countries. Drug: Epidemiology Study on Risk Factors Company: Population Health Research Institute, McMaster University / Hamilton Health Sciences Results: Despite being weighed down by more cardiovascular risk factors, people living in higher income countries are able to avoid many of the severe and even fatal consequences of cardiovascular disease (CVD) compared to their counterparts in lower income parts of the world. Implications: The findings of the PURE study underscore the value of a good healthcare system in addition to healthy heart habits.

CHAMPION Cangrelor for Percutaneous Coronary Intervention (PCI) Drug: Cangrelor Company: The Medicines Company Results: At 48 hours, cangrelor reduced approximately 19% both the primary composite quadruple outcome (3.8 vs 4.7% for cangrelor and clopidogrel respectively, OR 0.81 [95%CI 0.71-0.91], p=0.0007), and reduced the key secondary outcome of stent thrombosis by 41% (0.5 vs 0.8% for cangrelor and clopidogrel respectively, OR 0.59 [95% CI 0.43-0.80], p=0.0008). However, Cangrelor increased ACUITY major bleeding (4.2 vs 2.8%), mainly due to increased hematoma ≥ 5 cm. It also increased GUSTO mild and TIMI minor bleeding, with increases in ecchymosis, puncture site oozing and hematoma ≤ 5 cm. Implications: Compared with clopidogrel, cangrelor may be useful as an adjunct to aspirin and anticoagulation for patients undergoing PCI in order to decrease periprocedural thrombotic complications, albeit at the expense of increased non-fatal bleeding

TAO Effect of Otamixaban Versus Unfractionated Heparin + Eptifibatide in Patients With Unstable Angina/Non ST Elevation Myocardial Infarction Undergoing Early Invasive Strategy Drug: Otamixaban (XRP0673) Company: Sanofi Results: The investigational anticoagulant otamixaban significantly increased bleeding without reducing rates of mortality or new MI events in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS). Implications: The risk of a major or minor bleeding was approximately doubled with otamixaban across all patient sub-groups, and even a lower dose did not achieve better results.

ATOMIC-AHF Study to Evaluate the Safety and Efficacy of IV Infusion Treatment With Omecamtiv Mecarbil in Subjects With Left Ventricular Systolic Dysfunction Hospitalized for Acute Heart Failure Drug: Omecamtiv Mecarbil (CK-1827452; AMG 423) Company: Amgen Results: Omecamtiv mecarbil, a cardiac myosin-activator, did not achieve its primary efficacy endpoint in reducing dyspnoea (shortness of breath) in patients with acute heart failure Implications: According to John R. Teerlink, MD, Professor of Clinical Medicine at the University of California San Francisco and Director of Heart Failure at the San Francisco Veterans Affairs Medical Center, USA. Omecamtiv mecarbil is probably one of the most interesting new chemical entities in cardiovascular medicine now and consequently, expectations are very high in the scientific and lay communities. Physicians have struggled for decades to develop agents that improve cardiac function without increasing arrhythmias or mortality; omecamtiv mecarbil has the potential to be such an agent.

Three other studies which grabbed media's attention were: 1.Tour de France study which concluded that French participants in the event from 1947 - 2012 lived longer than their same-age French counterparts in the general population. 2.Cold weather study which highlighted that cold weather produces more heart attacks. Multivariate analysis showed that only temperature was significantly correlated with acute myocardial infarction (AMI), which increased by 7% for each 10°C decrease in minimal temperature (odds ratio [OR]=1.07, 95% confidence interval [CI]=1.04-1.11), and that there was no significant effect of air pollution (OR=1.01, 95%CI=1.00-1.02). 3. The Statin study - a metanalysis which included 2,399,200 persons and 25,618 cataracts - highlighted that statins lower the rate of cataract by 20%. It also highlighted that the risk of cataract was reduced by 50% when treatment was initiated in younger individuals (in their 40s) and the duration of therapy was longer (e.g. up to 14 years).

Conclusion
Over the years, the ESC congress has evolved into an arena of open intellectual debate between cardiovascular theory and practice. Researchers and practitioners discuss and debate on major areas of investigation, and gain unique perspective from each others' viewpoint, so as to develop better clinical solutions and integrated models of care.

This year's congress emerged out to be a huge success. There were detailed discussions on many important issues within cardiovascular research and practice such as the effect of diabetes and obesity on cardiovascular disease risk, experience with new age anti-coagulants, effect of exercise and cold on heart disease etc.

The congress also highlighted that cardiovascular diseases have become the number one killer in Europe, and there is greater need to develop more effective solutions to improve clinical outcomes and patient's quality-of-life (QOL).

I congratulate ESC committee on organising an amazing event and look forward to a more exciting event next year.

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