European Society of Cardiology (ESC) Congress 2017 was held from August 26th to August 30th at Barcelona.

More than 31,700 healthcare professionals from a 153 countries attended the conference. More than 500 scientific sessions and more than 4500 abstracts were presented on latest discoveries in cardiovascular medicine.

Best of ESC Congress 2017

Some significant trials presented in ESC Congress 2017 that has the potential to change existing practice are cited here.

Cardiovascular outcomes for people using anticoagulation strategies (COMPASS) trial

According to the COMPASS trial, rivaroxaban plus aspirin improves survival by reducing stroke and heart attack in patients with coronary or peripheral artery disease. In this study, it was demonstrated that combination of rivaroxaban and aspirin reduced cardiovascular death, stroke, or heart attack by 24% and improved survival by 18%. Rivaroxaban is an oral anticoagulant. FDA approved its use for deep vein thrombosis in June 2011, and for stroke prevention in people with non-valvular atrial fibrillation in November 2011.

Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS) trial

Results from CANTOS trial showed that canakinumab lowers cardiovascular disease and decreases incidence of cancer, especially lung cancer by reducing inflammation. In this randomized, double-blinded trial involving patients with stable coronary artery disease after previous myocardial infarction and a high-sensitivity C-reactive protein (hsCRP) level, IL-1β inhibitor canakinumab was used as an anti-inflammatory agent. Canakinumab was approved in 2009 for cryopyrin-associated periodic syndromes (CAPS).

Catheter ablation versus standard conventional treatment in patients with left ventricular dysfunction and atrial fibrillation (CASTLE-AF) trial

CASTLE-AF results showed that catheter ablation improves outcomes in patients with left ventricular dysfunction and atrial fibrillation. Patients showed lower mortality and decreased hospitalization rate compared to results of conventional drug treatment arm. In CASTLE-AF, 397 patients with symptomatic paroxysmal or persistent atrial fibrillation and heart failure with pump function less than 35% were enrolled, out of which 153 patients were treated with catheter ablation and 184 with conventional treatment. It is the only clinical trial which compares a procedure and a pharmacological therapy in a patient with left ventricular dysfunction and atrial fibrillation with hospitalizations and mortality as primary endpoints.

Determination of the role of oxygen in suspected acute myocardial infarction (DETO2X-AMI) trial

Results from DETO2X-AMI trial showed that oxygen therapy does not improve survival in patients with myocardial infarction. It was a prospective, randomized, open-label trial, which involved 6229 patients with suspected heart attack who were randomized to receive oxygen through a facemask or from ambient air. The results contradict the common belief that oxygen therapy to the ischemic myocardium reduces myocardial damage and subsequent complications such as heart failure or arrhythmias.

Prospective Urban Rural Epidemiology (PURE) study

High carbohydrate intake increases the incidence of total mortality and non-cardiovascular (CV) mortality; whereas high fat intake is associated with lower risk. These results emanated from the PURE study. It was also concluded that moderate intake of fruit, vegetables and legumes lowers the incidence of cardiovascular disease and death. The study was performed in 18 countries and 7 regions. In this analysis, consumption of carbohydrate, total fat, and types of fat were recorded and occurrence of cardiovascular disease and mortality was assessed.

Improve treatment with anticoagulants in patients with Atrial Fibrillation (IMPACT-AF) trial

Results of IMPACT-AF showed that education and feedback caused an absolute increase of 9 % in the use of anticoagulants in atrial fibrillation treatment. The treatment rate increased to 80 % from 68 % at baseline. This trial was done in 2281 atrial fibrillation patients, out of which 1187 were randomized to educational intervention and 1094 to usual care. Besides this, the educational arm has shown reduced stroke incidence. Anticoagulant therapy is usually needed life-long and therefore, compliance is a major limiting factor.

Apixaban lowers stroke risk in atrial fibrillation patients undergoing cardioversion (EMANATE) trial

Results of EMANATE trial showed that administration of apixaban before the scheduled cardioversion results in few strokes and have bleeding risk similar to warfarin and heparin. Apixaban has the potential to be an alternative option to conventional therapy with heparin and warfarin. Currently, it is not approved for use in anticoagulation-naive patients before cardioversion.

Inclisiran Lowers 'Bad' Cholesterol for Up to 1 Year (ORION 1) trial

ORION-1 results showed that inclisiran decreases low-density lipoprotein cholesterol in patients with high cardiovascular risk and elevated LDL cholesterol for up to 1 year. It was a multicentre, placebo-controlled, double-blind, randomized phase II study conducted with an objective to find out the dose and dosing frequency for phase III trials.

ESC Congress is a place where medical professionals can stay abreast with the latest development in cardiology. Apart from this, it gives cardiologists, industry, and academia a great chance to build a network. ESC Congress 2017 was a success. Prof. Stephan Achenbach, Chair of the Congress Programme Committee said, “This has been one of the most exciting and comprehensive scientific programmes yet”.