Scientific news from the ESC congress 5 highlights

Transcription

1 Scientific news from the ESC congress 5 highlights Prof. Dan Atar, MD Dept. of Cardiology B Oslo University Hospital, Norway Vice-President of the ESC ( ) ESC Media Committee ( ) ESC Treasurer/Secretary ( )

2 Prof. Dan Atar Disclosures Co-author of the 2010, 2012 and 2016 ESC Guidelines on Atrial Fibrillation and 2012 ESC STEMI Guidelines, as well as the 2018 Universal Definition of AMI GL. Steering Committee member, National Coordinator for Norway, and Co-author of ACTIVE, RELY, ARISTOTLE, AVERROES, APPRAISE, GARFIELD, ENGAGE-AF, XANTUS, RE-ALIGN, RE-VERSE, ARTESIA, NOAH, ENTRUST-AF-PCI, REPORT-AF, RE-SONANCE, REPORT-HF, PARAGON, VICTORIA. Adjudication Committee member for the AVRO and Roxadustat trials, DSMB for the CHILL-MI, OPTIMUM, LUPUS, BETA-3 and HOMAGE trials. Chair of the FIRE and MITOCARE trial (EU-FP7 fundet). Fees, honoraria from Boehringer- Ingelheim, Bayer, BMS/Pfizer, Cardiome, Astra-Zeneca, MSD, Sanofi-Aventis, Amgen.

3 QUIZ

4 How many registered participants were at the ESC congress 2018 in Munich? A: B: C: D: E:

5 Which country had most delegates and abstracts at the ESC congress 2018 in Munich? A: Germany B: France C: Japan D: Spain E: USA

6 1: ASCEND

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15 2: POET

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18 Partial oral treatment of left-sided infectious endocarditis The POET trial Henning Bundgaard, MD on behalf of the POET Investigators

19 Background According to guidelines we treat left-sided infectious endocarditis with intravenous (IV) antibiotics for up to 6 weeks in-hospital Endocarditis is associated with high in-hospital complication- and mortality rates - but mainly in the early phase After stabilization the main reason for staying in hospital is to receive iv antibiotics Hospital stays per se may cause complications

20 Inclusion criteria Left-sided endocarditis based on the modified Duke criteria caused by Streptococci or Enterococcus faecalis or Staphylococcus aureus or Coagulase-negative staphylococci 10 days of appropriate intravenous antibiotic treatment, and 1 week after valve surgery T <38.0 C >2 days C-reactive protein fall to 25% of peak value or <20 mg/l White blood cell count <15 x 10 9 /L By transesophageal echocardiography 48 h prior to randomization: No sign of abscess formation or valve abnormalities requiring surgery

21 The POET trial design Investigator initiated, nationwide, randomised, unblinded clinical trial Infectious Endocarditis diagnosis Treatment period R Oral antibiotic treatment Optional: outpatient treatment Follow up 6 months 10 days IV Tx - and/ or 7 days IV Tx after surgery Intravenous antibiotic treatment In-hospital treatment

22 Primary endpoint A composite endpoint 6 months of All cause mortality Unplanned cardiac surgery Embolic events Relapse of bacteremia with the primary pathogen

23 Baseline characteristics Intravenous treatment (n=199) Oral treatment (n=201) Age (years), mean (SD) 67.3 (12.0) 67.6 (12.6) Gender (female), n (%) 50 (25.3) 42 (20.9) Co-morbidities Diabetes, n (%) Renal failure, n (%) Dialysis, n (%) COPD, n (%) Cancer, n (%) Microbiology Streptococcus spp, n (%) Enterococcus faecalis, n (%) Staphylococcus aureus, n (%) Coagulase-negative staphylococci, n (%) 36 (18.1) 25 (12.6) 13 (6.5) 17 (8.5) 14 (7.1) 104 (52.3) 46 (23.1) 40 (20.1) 10 (5.0) 31 (15.6) 21 (10.6) 15 (7.5) 9 (4.5) 18 (9.1) 92 (45.8) 51 (25.4) 47 (23.4) 13 (6.6)

24 Primary endpoint (All cause mortality, unplanned cardiac surgery, embolic events or relapse of bacteremia) Difference 3.1%, 95% CI: -3.4% - 9.6%, Non-inferioritymet HR 0.72, 95% CI

25 Components of primary endpoint

26 Conclusions Efficacy and safety of shifting to oral antibiotic treatment was non-inferior to continued intravenous antibiotic treatment in stabilized patients with left-sided endocarditis caused by streptococcus spp, Enterococcus faecalis, Staphylococcus aureus, or coagulasenegative staphylococci across co-morbidities, native vs prosthetic valve and surgically vs conservatively Tx Oral antibiotics may safely be administered during approximately half of the recommended antibiotic treatment period potentially as outpatient treatment More than 50% of patients with endocarditis may be candidates to partial oral antibiotic treatment

27 3: STUDIER OM NOAKs: COMMANDER-HF

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33 4: STUDIER OM NOAKs: MANAGE

34 Myocardial injury after non-cardiac surgery (MINS) is the most common major perioperative vascular complication, affecting more than 8 million adults worldwide annually. Patients with MINS are at increased risk of thrombotic complications and death during the first 2 years after surgery.

35 MANAGE design: Dabigatran versus placebo in MINS Devereaux PJ, Duceppe E, Guyatt G et al Lancet 2018; 391:

36 MANAGE primary outcome: Major vascular complications Devereaux PJ, Duceppe E, Guyatt G et al Lancet 2018; 391:

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38 Conclusion Among patients who had MINS, dabigatran 110 mg twice daily lowered the risk of major vascular complications, with no significant increase in major bleeding. Patients with MINS have a poor prognosis; dabigatran has the potential to help patients who have MINS to reduce their risk of a major vascular complication.

39 5: STUDIER OM NOAKs: COMPASS and CANCER

40 Prof. John W. Eikelboom Mc Master University Hamilton, Canada

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46 Oppsummering ASCEND studien gir ikke støtte til Albyl-E medisinering hos diabetes pasienter uten etablert aterosklerotisk sykdom. POET studien viser at det er trygt å skifte antibiotisk behandling hos endokarditt pasienter fra intravenøs til peroral medisinering allerede etter 10 dager. COMMANDER-HF studien viser at det er ingen fordel med lav-dose NOAC hos pasienter med kronisk postinfarkt-hjertesvikt og nedsatt venstre ventrikkel funksjon. MANAGE studien viser for første gang at pasienter med troponinutslipp etter ikke-kardial kirurgi har en bedre prognose med NOAC behandling (dabigatran i dens lave dose). COMPASS studiens etter-analyse på kreft og blødninger underbygger mistanken om at GI og UG-blødninger ofte skyldes kreft i disse organer. Det er hensiktsmessig å utrede for kreft når det inntreffer blødninger.

47 Takk for oppmerksomheten