ESC Congress 2017 In Review – Focus on CAD&ACS - 15
ESC Congress 2017
In Review
CAD & ACS
using dabigatran 150 mg was also associated with fewer bleeds (20.2% vs 25.7%; HR, 0.72; 95% CI, 0.58 to
0.88; P < .001 for noninferiority, P = .002 for superiority;
Figure 1), representing a 5.5% ARR.
Figure 1. Rates of Major Bleeding or Clinically Relevant Nonmajor
Bleeding in RE-DUAL
40
HR, 0.52 (95% CI, 0.42-0.63)
Noninferiority P < .0001
P < .0001
Probability of Event (%)
35
Beta-Blocker Therapy Before
Primary PCI Did Not Improve
Outcomes in STEMI Patients
30
25
20
Written by Toni Rizzo
15
10
Warfarin
triple therapy
5
Dabigatran 110 mg
dual therapy
0
0
90
180
270
360
450
540
630
750
Time to First Event (days)
40
HR, 0.72 (95% CI, 0.58-0.88)
Noninferiority P < .0001
P < .002
Probability of Event (%)
35
30
25
20
15
10
Warfarin
triple therapy
5
Dabigatran 150 mg
dual therapy
0
the triple-therapy group (HR, 1.13; 95% CI, 0.90 to 1.43;
P = .30). In the patients treated with 150-mg dual therapy,
the incidence was 11.8% versus 12.8% in the triple-therapy
group (HR, 0.89; 95% CI, 0.67 to 1.19; P = .44).
Dr Cannon concluded that these dabigatran dualtherapy regimens, using doses approved worldwide for
stroke prevention, offer clinicians 2 additional options
for managing AF patients following PCI.
0
90
180
270
360
450
540
630
750
Time to First Event (days)
From The New England Journal of Medicine, Cannon CP et al, Dual
Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation. EPub
28 August 2017. Copyright © 2017 Massachusetts Medical Society. Reprinted
with permission from Massachusetts Medical Society.
Compared with the triple-therapy regimen, both dualtherapy groups also had lower rates of intracranial haemorrhage, with a 0.7% ARR (HR, 0.3; 95% CI, 0.08 to 1.07;
P = .064) using dabigatran 110 mg, and a 0.9% ARR (HR, 0.12;
95% CI, 0.02 to 0.98; P = .047) using dabigatran 150 mg.
The investigators also performed a prespecified analysis of thrombotic events that occurred during the trial,
evaluating the effect of dual versus triple therapy on the
incidence of a composite of death, thromboembolic events
(myocardial infarction, stroke, or systemic embolism), or
unplanned revascularisation. Combining the 2 dabigatran
dose groups, they found that dual therapy met the threshold for noninferiority for the composite endpoint (incidence,
13.7% vs 13.4%; HR, 1.04; 95% CI, 0.84 to 1.29; P = .005 for
noninferiority). In the patients treated with 110-mg dual
therapy, the incidence of death, thromboembolic events,
or unplanned revascularisation was 15.2% versus 13.4% in
The METOCARD-CNIC trial is the only randomised study
of early β-blockers in the primary percutaneous coronary
intervention (PCI) era, but it was not placebo controlled
and only studied early β-blockers in patients with anterior infarcts [Ibanez B et al. Circulation. 2013; Pizarro G et
al. J Am Coll Cardiol. 2014]. Vincent Roolvink, MD, Isala
Hospital, Zwolle, The Netherlands, presented the 1-year
results from the EARLY-BAMI trial, which assessed the
long-term clinical effect of early (pre-primary PCI) intravenous β-blockers in patients with ST-segment elevation myocardial infarction (STEMI).
Patients > 18 years aged with > 30 minutes and < 12
hours since symptom onset and electrocardiogram (ECG)
showing > 2 mm to > 1 mV ST-elevation or new left bundle
branch block were included in the EARLY-BAMI trial, if
systolic blood pressure was > 100 mm Hg and heart rate
> 60 bpm. The patients (n = 683) were randomised to
treatment with intravenous metoprolol (one 5 mg bolus
given in the ambulance, and a second 5 mg bolus in the
catheterisation laboratory if blood pressure and heart
rate permitted) versus placebo before primary PCI. All
patients were planned to receive oral metoprolol < 12
hours after PCI, according to current guidelines.
All infarct locations were included in this 1-year planned
secondary analysis. Magnetic resonance imaging (MRI)
was performed at 1 month and clinical follow-up at 1 year.
The 1-year clinical outcomes were major cardiac adverse
events (MACE), defined as the composite of cardiac death,
nonfatal reinfarction, or target vessel revascularisation.
A total of 336 patients were randomised to metoprolol, 312 of whom participated in the 1-year follow-up.
Of the 347 patients randomised to placebo, 317 participated in the 1-year follow-up. The median time from first
study dose to reperfusion was 54 minutes.
At 1 year, MACE occurred in 7.7% of patients in the
metoprolol group compared with 7.3% in the placebo
group (P = .835). No significant difference was observed
between the metoprolol and placebo groups in the rate
of MACE or any of the other outcomes.
A prespecified subgroup analysis at 1 year found
no significant difference between the metoprolol and
Official Peer-Reviewed Highlights From ESC Congress 2017
15
Table of Contents for the Digital Edition of ESC Congress 2017 In Review – Focus on CAD&ACS
Contents
ESC Congress 2017 In Review – Focus on CAD&ACS - Cover1
ESC Congress 2017 In Review – Focus on CAD&ACS - Cover2
ESC Congress 2017 In Review – Focus on CAD&ACS - 1
ESC Congress 2017 In Review – Focus on CAD&ACS - 2
ESC Congress 2017 In Review – Focus on CAD&ACS - Contents
ESC Congress 2017 In Review – Focus on CAD&ACS - 4
ESC Congress 2017 In Review – Focus on CAD&ACS - 5
ESC Congress 2017 In Review – Focus on CAD&ACS - 6
ESC Congress 2017 In Review – Focus on CAD&ACS - 7
ESC Congress 2017 In Review – Focus on CAD&ACS - 8
ESC Congress 2017 In Review – Focus on CAD&ACS - 9
ESC Congress 2017 In Review – Focus on CAD&ACS - 10
ESC Congress 2017 In Review – Focus on CAD&ACS - 11
ESC Congress 2017 In Review – Focus on CAD&ACS - 11A
ESC Congress 2017 In Review – Focus on CAD&ACS - 11B
ESC Congress 2017 In Review – Focus on CAD&ACS - 11B
ESC Congress 2017 In Review – Focus on CAD&ACS - 11C
ESC Congress 2017 In Review – Focus on CAD&ACS - 12
ESC Congress 2017 In Review – Focus on CAD&ACS - 13
ESC Congress 2017 In Review – Focus on CAD&ACS - 14
ESC Congress 2017 In Review – Focus on CAD&ACS - 15
ESC Congress 2017 In Review – Focus on CAD&ACS - 16
ESC Congress 2017 In Review – Focus on CAD&ACS - 17
ESC Congress 2017 In Review – Focus on CAD&ACS - 18
ESC Congress 2017 In Review – Focus on CAD&ACS - 19
ESC Congress 2017 In Review – Focus on CAD&ACS - 20
ESC Congress 2017 In Review – Focus on CAD&ACS - Cover3
ESC Congress 2017 In Review – Focus on CAD&ACS - Cover4
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