Cardiology News / Recent Literature Review / Third Quarter 2018

Abstract

Rhythmos 2018;13(4):81-88.

HCS 39^th Meeting: Athens, 18-20/10/2018

AHA Meeting: Chicago, IL, USA, 10-12/11/2018

ACC.19 Meeting: New Orleans, LA, USA, 16-18/3/2019

EHRA Congress: Lisbon, 17-19/3/2019

HRS Meeting: San Francisco, CA, USA, 8-11/5/2019

EuroPCR: Paris, 21-24/5/2019

ESC Meeting: Paris, 31/8-4/9/2019

NOACs are All Associated With a Significant Standardized Absolute Risk Reduction of MI Compared With VKA

Among 31,739 patients with atrial fibrillation (AF) (median age, 74 years; 47% females), the standardized 1-year risk of MI for VKA was 1.6%, 1.2% for apixaban, 1.2% for dabigatran, and 1.1% for rivaroxaban. No significant risk differences were observed in the standardized 1-year risks of MI among the NOACs: dabigatran vs apixaban (0.04%), rivaroxaban versus apixaban (0.1%), and rivaroxaban versus dabigatran (−0.1%). The risk differences for NOACs vs VKA were all significant: −0.4% for apixaban, −0.4% for dabigatran, and −0.5% for rivaroxaban (Lee CJ-Y et al, J Am Coll Cardiol 2018;72: 17–26). 

ATLAS ACS 2-TIMI 51 Trial: In Patients With ACS, Addition of Rivaroxaban, 2.5 mg bid, to Dual Antiplatelet Therapy With Aspirin and Clopidogrel Was Associated With a Net Reduction in Fatal or Irreversible Events Compared to Dual Antiplatelet Therapy Alone

Rivaroxaban, 2.5 mg bid, in ACS patients treated with aspirin and clopidogrel/ticlopidine was associated with 115 fewer fatal or irreversible ischemic events (663 for placebo vs 548 for therapy) and 10 additional fatal or irreversible seriously harmful events (33 vs 23 for placebo) per 10,000 patient-years of exposure. Thus, there would be 105 fatal or irreversible events prevented per 10,000 patient-years of exposure to rivaroxaban compared with placebo, with 11 (10 of 115) fatal or irreversible ischemic events prevented for each fatal or irreversible seriously harmful event caused. If only nonbleeding cardiovascular death is included as a fatal or irreversible event, then 95 events would be prevented per 10,000 patient-years of exposure in the group taking 2.5 mg bid (Gibson CM et al, J Am Coll Cardiol 2018;72: 129-36)

XANTUS Program: In a Pooled Analysis of Several practice-Based Registries, AF Patients on Rivaroxaban Had Generally Low Rates of Stroke, Bleeding, and Treatment Discontinuation and Results Were Broadly Consistent Across Different Regions of the World

Among 11,121 AF patients receiving rivaroxaban (mean age 70.5±10.5 years; female 42.9%) with comorbidities including heart failure (21.2%), hypertension (76.2%), and diabetes (22.3%), event rates were: events/100 patient-years: major bleeding 1.7 (lowest: Latin America 0.7; highest: Western Europe, Canada, and Israel 2.3); all-cause death 1.9 (lowest: Eastern Europe 1.5; highest: Latin America, Middle East, and Africa 2.7); and stroke or systemic embolism 1.0 (lowest: Latin America 0; highest: East Asia 1.8). One-year treatment persistence was 77.4% (lowest: East Asia 66.4%; highest: Eastern Europe 84.4%) (Kirchhof P et al, J Am Coll Cardiol 2018;72:141-53)... (excerpt)