ESC Focus on Interventions & PC - 11A
ADVERTORIAL
Sponsored Session Highlights
Rivaroxaban: The Next Step in
Vascular Protection for Patients
With Coronary Artery Disease
In 2015, coronary heart disease accounted for 8.8 million deaths and remains the number one cause of death
worldwide.1 By 2030, it is estimated that 23.6 million
people will die from cardiovascular (CV)-related issues.2
We know that coronary artery disease (CAD) is a heterogeneous condition. It ranges from silent to overt
and stable to unstable with a wide spectrum of acuteness and severity. The category includes patients with
'nonsignificant' to 'significant' CAD, silent myocardial
ischaemia, or angina with or without ischaemia, as well
as those with prior percutaneous coronary intervention
(PCI) or coronary artery bypass graft (CABG), myocardial infarction (MI), or acute coronary syndrome (ACS).
To better understand the epidemiology of CAD, clinicians and researchers have relied on registries, 2 of which
are CLARIFY and REACH. Gabriel Steg, MD, Hôpitaux
de Paris, Université Paris, Paris, France, reviewed the
CLARIFY registry,3 an international, prospective, observational, and longitudinal registry containing data for
> 30,000 consecutive outpatients with chronic CAD
from 45 countries. In the registry, CAD is defined as
at least 1 of the following: documented MI > 3 months
before enrolment; angiographic demonstration of coronary stenosis ≥ 50%; chest pain with evidence of myocardial ischaemia (stress electrocardiogram); or CABG
or PCI > 3 months before enrolment.4 Five-year followup data from the CLARIFY registry shows that patients
with chronic CAD remain at substantial risk (all-cause
mortality about 8%; CV death about 5%). CLARIFY
has also shown that 65% of patients with chronic CAD
have neither angina nor ischaemia but that 70% of CV
events occur in these patients. The data also indicate
that angina is more prognostic than ischaemia in this
patient population (Figure 1).5
Deepak L. Bhatt, MD, Brigham and Women's Hospital
and Harvard Medical School, Boston, Massachusetts,
USA, discussed REACH, another prospective international registry that examined atherothrombotic risk
factors and ischaemic events in an outpatient setting in
> 60,000 patients aged ≥ 45 years with either symptomatic CV disease (CAD, peripheral artery disease [PADs],
or cerebrovascular disease) or ≥ 3 atherothrombotic
risk factors.6 Four-year data from REACH showed that
Figure 1. Prognostic Value* of Angina vs Ischaemia in Patients With Chronic CAD
HR (95% CI)
HR (95%)
P-value
Ischaemia only
0.89 (0.67-1.19)
.44
Angina only
1.46 (1.09-1.95)
.01
Both
1.76 (1.34-2.30)
< .001
0.89 (0.70-1.15)
.37
CV death, nonfatal MI
CV death, MI-stroke
Ischaemia only
Angina only
1.38 (1.06-1.80)
0.02
Both
1.58 (1.24-2.02)
< .001
Ischaemia only
0.85 (0.58-1.26)
.42
Angina only
1.23 (0.80-1.90)
.35
Both
1.90 (1.33-2.70)
< .001
0.92 (0.65-1.31)
.66
Angina only
1.67 (1.18-2.36)
.004
Both
1.66 (1.18-2.34)
.004
CV death
MI (fatal and nonfatal)
Ischaemia only
0 Lower Risk
1
Higher Risk
2
3
HRs adjusted for age, sex, geographical region, smoking status, hypertension, dyslipidaemia and diabetes.
CAD, coronary artery disease; CV, cardiovascular.
Adapted from Steg P et al. JAMA Internal Medicine.2014; 174(10):1651-1659.
This peer-reviewed article was based on scientific-clinical content presented at the European Society of Cardiology (ESC) Congress 2017. The content of this article
was entirely developed by Content Ed Net Medicom, and the opinions expressed herein do not necessarily represent those of the ESC, nor of Bayer AG. The development of this article was supported by Bayer AG. This material is intended for educational purposes. G.MA.GM.XA.10.2017.1852
Table of Contents for the Digital Edition of ESC Focus on Interventions & PC
Contents
ESC Focus on Interventions & PC - Cover1
ESC Focus on Interventions & PC - Cover2
ESC Focus on Interventions & PC - 1
ESC Focus on Interventions & PC - 2
ESC Focus on Interventions & PC - Contents
ESC Focus on Interventions & PC - 4
ESC Focus on Interventions & PC - 5
ESC Focus on Interventions & PC - 6
ESC Focus on Interventions & PC - 7
ESC Focus on Interventions & PC - 8
ESC Focus on Interventions & PC - 9
ESC Focus on Interventions & PC - 10
ESC Focus on Interventions & PC - 11
ESC Focus on Interventions & PC - 11A
ESC Focus on Interventions & PC - 11B
ESC Focus on Interventions & PC - 11C
ESC Focus on Interventions & PC - 11D
ESC Focus on Interventions & PC - 12
ESC Focus on Interventions & PC - 13
ESC Focus on Interventions & PC - 14
ESC Focus on Interventions & PC - 15
ESC Focus on Interventions & PC - 16
ESC Focus on Interventions & PC - 17
ESC Focus on Interventions & PC - 18
ESC Focus on Interventions & PC - 19
ESC Focus on Interventions & PC - 20
ESC Focus on Interventions & PC - Cover3
ESC Focus on Interventions & PC - Cover4
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