ESC Congress 2017 In Review -- Main Edition - 8

Main Session

DAPT is indicated for 12 months in patients with ACS
without high bleeding risk (aspirin plus ticagrelor or clopidogrel) treated with medical therapy and for ≥ 1 month in
those with high bleeding risk (aspirin plus clopidogrel).
Among patients with an indication for oral anticoagulation who are scheduled for PCI, clopidogrel is the
only option to establish a DAPT regimen. The guidelines
include an algorithm for making decisions about the
choice and duration of therapy (Figure 5).
The recommendations for DAPT based on gender
and in special populations are shown in Table 4.
Management of Valvular Heart Disease
The updated 2017 ESC/EACTS Guidelines for the
Management of VHD has major changes compared with
the 2012 version. Developed jointly by the ESC and EACTS,
the guidelines overview was presented by ESC Chairperson,
Helmut Baumgartner, MD, University Hospital Münster,
Münster, Germany, and the EACTS Chairperson, Volkmar
Falk, MD, German Heart Center, Berlin, Germany.
Major changes in the new guidelines address heart
valve centres and the heart team, the role of transcatheter interventions, indications for surgery in asymptomatic VHD, and medical therapy. The recommended
requirements for a heart valve centre are shown in
Table 5.

Figure 5. Choice and Duration of Therapy in Patients With an
Indication for Oral Anticoagulation Undergoing PCI
Concerns about
ischaemic risk
prevailing

Time from
Treatment
Initiation
1 mo.

ACO

1 mo. Triple Therapy
Class IIa B

ACO

1 mo. Triple Therapy
Class IIa B

ACO

3 mo.

Triple Therapy
up to 6 mo.
Class IIa B

6 mo.

12 mo.

Beyond
12 mo.

Concerns about
bleeding risk prevailing

Dual Therapy
up to 12 mo.
Class IIa A

Dual Therapy up to 12 mo.
Class IIa A

O OAC alone Class IIa B
A Aspirin

C Clopidogrel

O Oral anticoagulation

Non-vitamin K antagonist oral anticoagulants (NOACs)
are not approved for AF associated with VHD (ie, rheumatic mitral stenosis) but recent trials support the use
of NOACs for patients with degenerative aortic stenosis,
aortic regurgitation, or mitral regurgitation presenting
with AF. Recommendations for the management of AF
in patients with VHD are summarised in Table 6.

Table 4. Gender Considerations and Special Populations
Recommendations

Class

Level

It is recommended to reassess the type, dose, and duration of DAPT in patients with actionable bleeding complication while on treatment.

Similar type and duration of DAPT should be considered
in patients with and without diabetes mellitus.

IIa

Prolonged (ie, ≥ 12 months) DAPT duration should be considered in patients with prior stent thrombosis, especially
in the absence of correctable causes (eg, lack of adherence or correctable mechanical stent-related issues).

IIa

Prolonged (ie, > 12 months) DAPT duration may be considered in CAD patients with LEAD.

IIb

Prolonged (ie, > 6 months) DAPT duration may be considered in patients who underwent complex PCI.

IIb

Similar type and duration of DAPT are recommended in
male and female patients.

CAD, coronary artery disease; DAPT, dual antiplatelet therapy; MI, myocardial infarction; LEAD, lower extremity artery disease; PCI, percutaneous coronary intervention.
Reprinted from Valgimigli M et al. 2017 ESC focused update on dual antiplatelet
therapy in coronary artery disease developed in collaboration with EACTS. Eur
Heart J. 2017. doi:10.1093/eurheartj/ehx419. By permission of Oxford University
Press on behalf of the European Society of Cardiology.

Table 5. Recommended Requirements of a Heart Valve Centre
Requirements
Multidisciplinary teams with competencies in valve replacement, aortic root
surgery, mitral, tricuspid and aortic valve repair, as well as transcatheter aortic and mitral valve techniques including reoperations and reinterventions.
The Heart Teams must meet on a regular basis and work with standard operating procedures.
Imaging, including 3D and stress echocardiographic techniques, perioperative TOE, cardiac CT, MRI, and PET-CT.
Regular consultation with community, other hospitals, and extracardiac departments, and between noninvasive cardiologists and surgeons and interventional
cardiologists.
Back-up services including other cardiologists, cardiac surgeons, intensive
care, and other medical specialties.
Data review:
* Robust internal audit processes including mortality and complications,
repair rates, durability of repair, and reoperation rate with a minimum of
1-year follow-up.
* Results available for review internally and externally.
* Participation in national or European quality databases.

DAPT, dual antiplatelet therapy; MI, myocardial infarction; OAC, oral anticoagulant.

CT, computed tomography; MRI, magnetic resonance imaging; PET, positron
emission tomography; TOE, transoesophageal echocardiography.

Reprinted from Valgimigli M et al. 2017 ESC focused update on dual antiplatelet
therapy in coronary artery disease developed in collaboration with EACTS. Eur
Heart J. 2017. doi:10.1093/eurheartj/ehx419. By permission of Oxford University
Press on behalf of the European Society of Cardiology.

Reprinted from Baumgartner H, Falk V et al. 2017 ESC/EACTS Guidelines for the
management of valvular heart disease. Eur Heart J. 2017. doi:10.1093/eurheartj/
ehx391. By permission of Oxford University Press on behalf of the European
Society of Cardiology.

October 2017

medicom-publishers.com/mcr

http://www.medicom-publishers.com/mcr

Table of Contents for the Digital Edition of ESC Congress 2017 In Review -- Main Edition