ESC Focus on Interventions & PC - 9

ESC Congress 2017

In Review

Interventions &
Peripheral Circulation
2.5 mg BID plus aspirin was superior to aspirin alone in
reducing the primary outcome of MACE, as well as the
key outcome for PAD, major adverse limb events (MALE;
defined as severe limb ischaemia leading to an intervention and major amputation due to vascular insufficiency
above the forefoot).
For eligibility purposes, PAD was defined as previous aortofemoral bypass surgery, limb bypass surgery,
or percutaneous transluminal angioplasty revascularisation of the iliac, or infra-inguinal arteries; previous
limb or foot amputation for arterial disease; history of
intermittent claudication of 1 or more of the following:
ankle/brachial blood pressure ratio < 0.90; significant
peripheral artery stenosis (≥ 50%); previous carotid
revascularisation or asymptomatic carotid artery stenosis
(≥ 50%) [Bosch J et al. Can J Cardiol. 2017].
A MACE event occurred in 5.1% of patients receiving
rivaroxaban 2.5 mg plus aspirin (HR, 0.72; 95% CI, 0.57
to 0.90; P = .005) and 6.0% receiving rivaroxaban 5 mg
alone (HR, 0.86; 95% CI 0.69 to 1.08; P = .19) compared
with 6.9% of patients receiving aspirin alone.
MALE events were significantly reduced with both combination therapy (HR, 0.54; 95% CI, 0.35 to 0.84; P = .005)
and rivaroxaban alone (HR, 0.63; 95% CI, 0.41 to 0.96;
P = .03) compared with aspirin alone. Major amputation
was low (< 1%) in all groups, but significantly lower for
rivaroxaban plus aspirin (HR, 0.30; 95% CI, 0.11 to 0.80;
P = .01) compared with aspirin alone.
The key composite of MACE or MALE or major amputation occurred in 6.3%, 7.6%, and 9.0% of patients
receiving combination therapy, rivaroxaban alone, or
aspirin alone, respectively. There was a 31% reduction
in MACE or MALE with rivaroxaban plus aspirin compared with aspirin alone (HR, 0.69; 95% CI, 0.56 to 0.85;
P = .0003), while the difference was not significant for
rivaroxaban alone compared with aspirin alone (RRR:
14%; P = NS).
There was a significant increase in major bleeding
(P = .009) among patients receiving rivaroxaban but no
significant increase in fatal or critical organ bleeding.
There was a significant net clinical benefit from combination therapy in this population of patients (HR, 0.72;
95% CI, 0.59 to 0.87; P = .0008).
In concluding, Dr Anand noted that rivaroxaban 2.5
mg BID plus aspirin is significantly superior to aspirin
alone in reducing MACE or MALE or major amputation.
There is an increase in major bleeding with the combination, but no significant increase in fatal or critical
organ bleeding.

M E D I C A L

P U B L I S H E R S

The editors would like to thank the many
members of the ESC Congress 2017
presenting faculty who generously gave
their time to ensure the accuracy and
quality of the articles in this publication

Official Peer-Reviewed Highlights From ESC Congress 2017

9



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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