Novedades en el manejo de la enfermedad cardiovascular en los principales congresos del año 2016 29/11/2016 18:00h Casa del Corazón, Madrid http://cvvt.secardiologia.es Perspectiva del cardiólogo clínico Dr. Domingo Marzal Martín. Complejo Hospitalario de Mérida (Badajoz)

1. Madrid, noviembre 2016
Domingo Marzal Martín
CardioVascular Virtual Topics:
excelencia en el manejo de la cardiopatía isquémica
Novedades en el manejo de la enfermedad cardiovascular
en los principales congresos 2016
Perspectiva del cardiólogo clínico

2. • CE-MARC 2
• CONSERVE
• NACIAM
• ALBATROSS
• EARLY-BAMI
• PRAGUE-18
• ANTARCTIC
• STEMI Spain
• EUCLID
• PIONEER AF-PCI
• SWEDEHEART
• DAPT score
• PEGASUS subgroups

3. Greenwood JP; et al. JAMA 2016;316:1051-60

4. Greenwood JP; et al. JAMA 2016;316:1051-60

5. CONSERVE

6. Primary Endpoint
Death, non-fatal MI, UA, stroke,
revascularization and CV hospitalization
0
1
2
3
4
5
4.6% 4.6%
Direct ICA Selective ICA
MACErates(%)
P=0.99
Per-Patient Direct ICA Selective ICA P value
ICA 1.02 0.22 <0.001
Revascularization 0.17 0.10 <0.001
Cardiovascular costs (USD) 6740 3338 <0.001
CONSERVE

7. P=0.02
NACIAM trial

8. NACIAM trial
safety endpoints

9. Primaryendpoint
Days Since Randomization
HR 0.97 (0.73-1.28)
P=0.81
Standard Therapy
MRA regimen
Beygui F, et al. J Am Coll Cardiol. 2016;67:1917-27

10. Days Since Randomization
HR 0.65 (0.30-1.38)
P=0.26
Standard Therapy
MRA regimen
Death
All patients
Days Since Randomization
HR 0.20 (0.06-0.69)
P=0.0044
Standard Therapy
MRA regimen
Death
Patients with STEMI
Beygui F, et al. J Am Coll Cardiol. 2016;67:1917-27

11. study design

12. primary endpoint

13. adverse cardiac events at 30 days

14. safety endpoint

15. PRAGUE-18
Primary end-point (7 days) Key secondary end-point (30 days)

16. ANTARCTIC Design

17. ANTARCTIC Results

18. Cequier A, et al. Rev Esp Cardiol. 2016 (in press)

19. Cequier A, et al. Rev Esp Cardiol. 2016 (in press)

20. Cequier A, et al. Rev Esp Cardiol. 2016 (in press)

27. clinically significant bleeding events

28. CV death, MI or stroke

29. Introduction of ticagrelor
N=45,073
Sahlén A, et al. Eur Heart J. 2016 (online first)
SWEDEHEART registry

30. Sahlén A, et al. Eur Heart J. 2016 (online first)
Association between use of ticagrelor vs clopidogrel and outcomes

31. Yeh RW, et al. JAMA 2016;315:1735-49
DAPT score

32. Yeh RW, et al. JAMA 2016;315:1735-49
Lowscore(<2)
Major CV events
Moderate or severe bleeding
Highscore(≥2)
Major CV events
Moderate or severe bleeding

33. Steg PG, et al. Eur Heart J. 2012;33:2569-619
Roffi M, et al. Eur Heart J. 2016;37:267-315

34. 57%
Bueno H, et al. Heart 2016;0:1–7. doi:10.1136/heartjnl-2016-309509
EPICOR

35. Bonaca MP, et al. N Engl J Med. 2015;372:1791-800
Primary endpoint

36. Bleeding
Bonaca MP, et al. N Engl J Med. 2015;372:1791-800

37. Bonaca MP, et al. N Engl J Med. 2015;372:1791-800
Analysis of Net Clinical Benefit

38. Bhatt D, et al. J Am Coll Cardiol. 2016;67:2732-40
Diabetic Patients from the PEGASUS-TIMI 54 Trial
Days from Randomization
CVDeath/MI/stroke(%)
11.6%
10.1%
7.8%
6.7%
P interaction=0.99
Ticagrelor in Non-Diabetic Patients
HR 0.84 (0.74-0.96)
ARR 1.1%; P=0.01
Ticagrelor in Diabetic Patients
HR 0.84 (0.72-0.99)
ARR 1.5%; P=0.03
Ticagrelor (doses pooled)
Placebo

39. PAD Patients from the PEGASUS-TIMI 54 Trial
25%
20%
15%
10%
5%
0%
0
CVDeath/MI/stroke(%)
Ticagrelor in PAD patients
HR 0.75 (0.55-1.01)
ARR 4.1%; NNT 25
Ticagrelor in Non-PAD patients
HR 0.86 (0.77-0.96)
ARR 1.0%; NNT 100
90 180 270 360 450 540 630 720 810 900 990 1080
Placebo
Ticagrelor
19.3%
15.2%
8.4%
7.4%
Days from randomization
P interaction=0.41
Bonaca M, et al, JACC 2016;67(13_S):2266

40. Bansilal S, et al. J Am Coll Cardiol. 2016;67:2146 (abstract ACC 2016)
Multivessel disease & stenting

41. gracias por vuestra atención
domingo.marzal@secardiologia.es
@domingomarzal