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Non-Invasive Imaging Cuts Needless Angiography Rate

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Non-Invasive Imaging Cuts Needless Angiography Rate TUESDAY 30 AUGUST Arrangements now in place for the Pope’s historic visit ESC representatives met yesterday should arrive by 11:00. The Highlights Session will start at welcome His Holiness who will with Italian and Vatican security entrances will be closed shortly 09:45. There are no other changes to then deliver a short address. This services to ensure the Papal visit afterwards and remain closed Wednesday morning’s programme. will be televised on large screens proves an enjoyable, historic until the end of the Pope’s visit (by • After the Congress Highlights along the walkway. experience, while maintaining the 13:15). There will be no restrictions Session ends at 11:45, ESC staff will • ESC will be providing a bus security of the Pope and all ESC on leaving Fiera Roma after 11:00. guide delegates to the ‘Passarella’ service to the airport from the Review videos, participants. • To reach the congress, ESC hotel on Level 1, the upper walkway that main parking area outside Fiera • On Wednesday 31 August there shuttles will continue as scheduled, extends the length of the Congress Roma near the train station. This slides, abstracts, will be airport-style security at the with arrival time at approximately site. service will be free of charge and reports and main entrance, with designated 08:00. Services from ESC • The Pope is due to arrive at 12:15 run between 11:00 and 15:00. If you fast-lanes for delegates with only transportation points have been in his Popemobile and will be wish to return to the city, please interviews hand luggage. Those with suitcases extended and will now run every 15 driven slowly along the Passarella, take a taxi or train. Free access should leave them at the Cloakroom minutes from 06:45 to 10:00. giving delegates every opportunity • We thank you once again for your after clearing security. • The ESC Clinical Practice to see him and take photos. patience and co-operation and offer • Buses will drop off delegates at Guidelines Highlights session will • ESC President, Professor Fausto our best wishes for the remainder of the main entrance only. Delegates start at 08:30 and the Congress Pinto, will say a few words to ESC Congress. www.escardio.org/365 Want more insights on sessions? Non-invasive imaging cuts Watch the interviews needless angiography rate with the speakers! HOT LINE SESSION RESULTS www.escardio.org/ESCTV Patients with suspected CHD whose care Don’t Miss was guided by cardiovascular magnetic • 08:30 - 10:00 / 11:00 - 12:30 Forum (The Hub) resonance (CMR) had significantly less Heart Team Sessions unnecessary angiography than those whose • 08:30 - 18:00 care was led by guidelines. The study, which Join us in the Poster Area to view the poster and was described in a Hot Line presentation attend Rapid Fire Abstract sessions in the Agora yesterday, did find, however, that CMR • 10:00 - 11:00 Copenhagen (Village 5) was not superior to myocardial perfusion General Assembly scintigraphy (MPS). The Clinical Evaluation of Magnetic • 10:10 - 10:50 / 13:00 - 13:40 / 15:40 - 16:20 Resonance Imaging in Coronary Heart Meet the Guidlelines Task Force & Meet the Trialists sessions at coffee break in The Hub Disease 2 (CE-MARC 2) trial results, also published in JAMA, could have implications • 11:00 - 12:30 Michelangelo (The Hub) for referral rates for invasive coronary ECG & Cardiac Imaging Quizz angiography and potentially for costs. • 16:30 - 18:00 Forum (The Hub) Principal investigator John Greenwood ESC Cardiology Quiz from the University of Leeds, UK said: John Greenwood: ‘Rates of invasive angiography are considered too high among patients ‘Rates of invasive angiography are with suspected coronary heart disease.’ considered too high among patients with suspected CHD. Our findings now show that example, reported that approximately 60% testing (n=481). The primary endpoint was ESC BOOK FAMILY both CMR and MPS significantly reduced of elective cardiac catheterisations found no unnecessary angiography as defined by the Promoting Excellence in Cardiology rates of unnecessary angiography compared obstructive CHD. absence of significant stenosis measured by to guideline-directed care, with no penalty The CE-MARC 2 trial thus aimed to FFR or quantitative CA. 10 Books covering in terms of major adverse cardiovascular compare CMR, guidelines (which were Those assigned to the NICE group with the whole discipline of events. This suggests that functional those of the UK’s National Institute for a low likelihood of CHD (10-29%) were cardiovascular medicine imaging should be adopted on a wider basis, Health and Care Excellence, NICE) or MPS allocated to cardiac computed tomography even in high-risk patient subgroups.’ in reducing unnecessary angiography in (CCT); those with an intermediate likelihood Visit us on the ESC Stand! Early diagnostic pathways in patients with suspected CHD. The study also considered (30%-60%) to MPS; and those with a high suspected CHD commonly use invasive if a CMR approach reduced patient risk and likelihood directly to CA. CA - and this despite wide availability and made financial savings. Results showed that 22% of study subjects FREE JOURNALS recommendations for non-invasive imaging Between November 2012 and March had coronary angioplasty within 12 months. ANNUAL ONLINE in international guidelines. 2015, 1202 symptomatic patients from six In the NICE guidelines group 43% had AND PRINT In explaining the background to the study, UK hospitals with suspected CHD were invasive CA, 18% CMR and 16% MPS. ESC JOURNALS Greenwood said that evidence from large recruited. They were randomly assigned A CMR-guided strategy did significantly populations presenting with chest pain has to care management according to the reduce unnecessary angiography when confirmed that most will not have significant NICE guidelines (n=240), to care based compared with the NICE guided care. Discover your ESC Membership bene ts obstructive CHD. One large US study, for on the results of CMR (n=481), or MPS Continued on page 2 ESC Stand, ESC Plaza www.escardio.org 2 HOT LINE SESSION RESULTS Two studies of apheresis: A combination concept one in refractory angina, for ‘dramatic’ lower risk LONG-TERM exposure to the combination of SBP group had an 86.1% lower risk (OR 0.139). even modestly lowered LDL cholesterol and ‘Because their effects are multiplicative one in raised cholesterol systolic blood pressure (SBP) has the potential to and cumulative, long-term exposure to the deliver synergistic effects that dramatically reduce combination of modestly lower LDL and SBP has ONE STUDY in a Hot Line session yesterday a person’s lifetime risk of CVD, according to a the potential to dramatically reduce the lifetime suggested a new indication for apheresis among study in yesterday’s Hot Line. risk of cardiovascular events, even among persons patients with refractory angina, while a second ‘The results demonstrate for the first time that with apparently normal cholesterol and blood raised the possibility that apheresis could be LDL cholesterol and systolic blood pressure have pressure levels,’ said Ference. replaced by a PCSK9 inhibitor in patients with independent, multiplicative and cumulative causal The prevention of CVD, he added, can familial hypercholesterolaemia. effects on the risk of CVD,’ said study presenter be substantially improved and simplified by Apheresis, which is both expensive and time Brian Ference from Wayne State University designing prevention programmes which focus on consuming and can only be performed in specialist School of Medicine, Detroit. ‘Our study confirms promoting long-term exposure to the combination centres, is generally regarded as a last-resort for that CVD events are largely preventable.’ of lower LDL levels and lower SBP beginning patients with persistently elevated LDL. A new Previous studies have suggested that people in early adulthood. Instead of using more study now suggests that it may also have a role with ideal risk factor profiles have very low pharmacotherapy, he said, it would be important to to play in removing lipoprotein a (Lpa) in patients lifetime risks of CVD, but the causal effects of introduce lifestyle changes that included increased with refractory angina. combined lowering of LDL and SBP are unknown. activity to lower blood pressure and cholesterol. It is known that around 15% of patients In this study investigators used genetic and with angina do not respond to available cardiovascular risk factor data from 102,773 therapies, explained Tina Khan, one of the study subjects of 14 prospective cohort or case-control investigators from Imperial College, London. studies. Genetic LDL and BP scores were used as ‘Refractory angina is a challenging condition,’ she instruments to ‘naturally randomise’ the subjects said, ‘which continues in spite of optimal medical Tina Khan: A ‘desperate need’ for new therapeutic to lower LDL, lower SBP, both or neither, using a therapy and revascularisation and imposes much options in refractory angina. 2x2 factorial randomisation design. burden on patients. There’s a desperate need for Results showed that a total of 14,368 major new therapeutic options.’ therapies match up to apheresis.’ vascular events (a composite of major vascular Lpa has been established as an independent In the second apheresis study, ODYSSEY event, CHD death, MI stroke or coronary cardiovascular risk factor in a multitude of ESCAPE, which was published simultaneously revascularisations) occurred during up to 32 years studies, but cannot be effectively lowered with in the European Heart Journal, investigators set of follow-up. In comparison to the reference conventional lipid lowering agents. ‘We believe out to investigate whether alirocumab, a fully group (where neither were lowered), subjects that Lpa contributes to angina by causing human monoclonal antibody that inhibits PCSK9- in the lower LDL group had 54.2% lower risk endothelial dysfunction through plasma viscosity, mediated hepatic catabolism of the LDL receptor, of the primary outcome (OR 0.454), subjects in and in addition adheres to the intima more might reduce the need for apheresis.
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