ESC Focus on Interventions & PC - 17
ESC Congress 2017
In Review
Interventions &
Peripheral Circulation
Figure 1. Patients With PAD Are Undertreated
Secondary Prevention Drug Therapy Treatment Pattern for Re-and Non-revascularised
MI
Statins
P2Y12 inhibitors
β-blockers
ASA
ACEi or ARB
80
60
40
20
0
Statins
P2Y12 inhibitors
β-blockers
ASA
ACEi or ARB
80
60
40
20
0
-12
-9
-6
-3
Index
3
6
9
-9
-6
Proportion on Treatment (%)
60
40
20
0
-3
Index
3
6
9
12
6
9
12
Not Revascularised
Statins
P2Y12 inhibitors
β-blockers
ASA
ACEi or ARB
100
Statins
P2Y12 inhibitors
β-blockers
ASA
ACEi or ARB
80
-12
12
NON- REVASCULARISED
No PCI
100
Proportion on Treatment (%)
PAD
Revascularised
100
Proportion on Treatment (%)
Proportion on Treatment (%)
100
REVASCULARISED
PCI
80
60
40
20
0
-12
-9
-6
-3
Index
3
6
9
12
Time Relative to Index (Months)
-12
-9
-6
-3
Index
3
Time Relative to Index (Months)
Significantly higher use of guideline-recommended secondary preventive drugs among Ml patients invasively treated
ACEi, angiotensin-converting enzyme inhibitor; ASA, acetyl salicylic acid; ARB, angiotensin II receptor blocker; MI, myocardial infarction; PAD, peripheral arterial
disease; P2Y12, receptor involved in the activation of the glycoprotein IIb/IIIa receptor.
Reproduced with permission from B Sigvant, MD, PhD.
Among 4,060 patients in the AFFIRM study, 282
(6.7%) had a history of PAD. Compared with patients
without PAD, those with PAD were slightly older (median age 72 vs 71 years), more likely to be male (65.2% vs
60.4%), and had a worse risk-factor profile including a
higher prevalence of hypertension, diabetes, and smoking. They were also more likely to have a previous history
of CAD, MI, congestive HF, stroke, or CV intervention.
Patients with PAD also had worse outcomes, having
higher rates of death (29.4% vs 15.4%; P < .01), CV death
(16.0% vs 7.6%; P < .01), and stroke or death (31.2% vs
18.1%; P < .01).
Multivariate analysis also showed that PAD is an independent predictor for death (HR, 1.41; 95% CI, 1.11 to 1.79;
P < .01), CV death (HR, 1.45; 95% CI, 1.05 to 2.01; P = .02),
and stroke or death (HR, 1.31; 95% CI, 1.04 to 1.64; P = .02).
Given the high risk associated with PAD in AF
patients, Dr Vitalis highlighted the importance of identifying PAD and implementing secondary prevention
measures against adverse outcomes.
Patients with AF and PAD are at higher risk for bleeding complications, and Prof Espinola-Klein emphasised
that current guidelines recommend oral anticoagulation
in those with a CHA2DS2-VASc score of ≥ 2 or greater (I A);
consideration of oral anticoagulation in all other patients
(IIa B); and consideration of oral anticoagulation alone in
patients with PAD who have an indication for oral anticoagulation (IIa B) [Aboyans V et al. Eur Heart J. 2017].
PAD and Heart Failure
According to Serge Kownator, MD, Cardiology Center,
Thionville, France, HF patients with PAD have a worse overall prognosis than those without PAD, and have significantly increased rates of all-cause mortality, CV mortality, and
hospitalisation for HF [Wei B et al. Heart Lung Circ. 2016].
Because up to one-third of patients with symptomatic
PAD have reduced left ventricular ejection fraction (LVEF),
Dr Kownator advised that assessment of LVEF function
in PAD patients may help clinicians to identify and better manage individuals with unknown CAD, allowing
improved risk stratification for future CV events and
comprehensive management of CV disease. Because
physical limitation in HF can mask symptoms in patients
with PAD, the ankle-brachial test may also be helpful in
Official Peer-Reviewed Highlights From ESC Congress 2017
17
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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