September 20, 2017 | Juan M. Ortega-Legaspi, MD
International

The European Society of Cardiology (ESC) Annual Congress is an excellent experience, not to be missed by FITs interested in cardiovascular clinical and basic science. I was lucky enough to attend this year's session in Barcelona, Spain.

It hosted over thirty thousand delegates from over 150 countries. The ESC has expanded the scope of their meeting and grown considerably in attendance over the last few years. This is in slight contrast to the ACC and AHA meetings, which have generally seemed more focused and become smaller on their last few editions. I personally do not think that this is a particular advantage or disadvantage from the conference held at the eastern side of the pond, it is just a characteristic that some may like and some not so much. It was large enough that "fit bit" enthusiasts would find their step numbers surge significantly from going from symposium to symposium.

The conference featured all aspects of cardiovascular science; from basic science to outcomes and population research and, of course, the presentation of important clinical trials. The conference is also organized in a way that feels very global, with the involvement of cardiovascular societies from all over the world. This was highlighted even further by naming conference rooms after world capitals. The conference offered a wide range of talk formats; from the usual coordinated symposium to moderated, traditional and electronic posters, as well as interactive discussion forums with panels of experts.

As someone involved in basic and translational science, I was happy to see a large variety of basic science data presented, despite a conference that is ultimately focused more in clinical work. The main groups in cardiovascular biology and cardiac regeneration were represented, allowing for very interesting discussions.

Many late breaking clinical trials were presented, including DETO2X-SWEDEHEART, RE-DUAL, VALIDATE-SWEDEHEART, BIOFLOW V, TROPICAL-ACS, RE-DUAL PCI, CANTOS and COMPASS, among others. The two trials that seemed to be in most people's mouths were COMPASS and CANTOS. The COMPASS randomized trial showed that the combination of rivaroxaban plus aspirin compared to aspirin alone improved ischemic outcomes (cardiovascular death, stroke or myocardial infarction) in patients with stable coronary disease, with no change in intracranial or fatal bleeding, though an increase in major bleeding. This is one of those trials that is likely to quickly produce a practice change in which a carefully selected patient can benefit from this strategy.

The other study that was prominent was CANTOS. This trial was noted not much for its potential to change practices in the near future, but for its novelty in targeting a nontraditional pathway to treat atherosclerotic disease. The investigators randomized patients with a prior myocardial infarction and high C-reactive protein to canakinumab, which inhibits interleukin-1 beta, versus placebo. Patients randomized to 150mg QD of canakinumab (but not those randomized to the 50mg or 300mg doses) had a reduced rate of cardiovascular death, myocardial infarction or stroke; there was a higher incidence of fatal infection than in patients in the placebo group, but no difference in all-cause mortality. While not yet a game changer, this trial definitely opened the gates for further clinical research in the relationship between atherosclerosis and inflammation, which could soon generate an effective adjuvant treatment.

Finally, the RE-DUAL PCI trial, which randomized patients with atrial fibrillation and a recent percutaneous coronary intervention to dual therapy with dabigatran and aspirin or triple therapy (Coumadin, clopidogrel or ticagrelor, and aspirin). The incidence of major or clinically relevant bleeding event was lower in the dual therapy group (with 110mg dabigatran), with similar incidences of thromboembolic events or serious adverse events, thus opening the doors to an alternative to triple therapy.

This article was authored by Juan M. Ortega-Legaspi, MD, an advanced heart failure and transplant cardiology Fellow in Training (FIT) at the University of Pennsylvania in Philadelphia, PA.