was associated with a decrease in the frequency
of chest pain at follow-up. However, patients with
depression who underwent revascularization did
not have an improvement in chest pain frequency at
1-year follow-up.
Registry Updates
These were “registries” highlighted at ESC.
EORP-AF
Patients with atrial fibrillation who receive
antithrombotic management according to ESC
guidelines have better outcomes than those who
do not, according to 1-year follow up results from
the ESC’s EURObservational Research Programme
Pilot survey on Atrial Fibrillation (EORP-AF Pilot)
General Registry.6
“This is the first study to show better outcomes
using the 2012 ESC guidelines on atrial fibrillation,” said principal investigator Professor Gregory Y.H. Lip, MD, from the University of Birmingham, United Kingdom, and Aalborg University,
Denmark. “This is novel as the 2012 guidelines—
for the first time—focused on the initial identification of ‘low-risk’ patients (that is, CHA2DS2-VASc
score 0 in men, 1 in women) who did not need
any antithrombotic therapy, following which oral
anticoagulation can be offered to those with one
or more stroke risk factors. Older guidelines had
a categorical approach to stroke risk stratification
and treatment decisions were more focused on
identifying ‘high-risk’ patients to be targeted for
oral anticoagulation treatment but many patients
were suboptimally untreated.”
EORP- CICD
The EORP has another pilot registry; this one for
Chronic Ischemic Cardiovascular Disease (EORPCICD). Investigators evaluated changes in the use of
life-saving medications over the past 10 years and
found an increased rate of such prescriptions. At
discharge from hospital, 93% of patients received a
statin (up from 48%), 65% received an angiotensinconverting enzyme inhibitor (ACE I) (up from 40%),
and 80% received a beta-blocker (up from 67%).
“The increase in medications is a good sign,”
said Michel Komajda, MD, a professor at University Pierre and Marie Curie and Pitié-Salpêtrière
Hospital in Paris, France. “However, the proportion of patients who are taking all recommended
medications at the same time remains suboptimal
at 71% (ACE I/angiotensin receptor blocker, statin,
and aspirin), so there is room for improvement.”
VISION
Preoperative statins are associated with a 17%
reduction in cardiac complications (the primary
endpoint; p = 0.007) and a 43% reduction in
all-cause mortality (p = 0.004) after noncardiac
surgery, according to results from the VISION (Vascular events In noncardiac Surgery patIents cOhort
evaluatioN) Study. A total of 15,478 patients aged
ACC.org/CSWN
45 years and older undergoing noncardiac surgery
were recruited from 12 centers in eight countries.
To make “comparable” groups, they did propensity
score matching, leaving 2,845 patients (18.4%)
treated with a statin and 4,492 patients (29.0%)
who did not receive a statin.
P.J. Devereaux, MD, PhD, McMaster University,
Hamilton, Ontario, Canada, chair of the VISION
Steering Committee, said: “Among the 200 million
adults worldwide who undergo noncardiac surgery
annually, more than 10 million will suffer a cardiovascular complication in the first 30 days after
surgery. Despite the magnitude of the problem, no
intervention has been shown to be both safe and
effective in the prevention of cardiovascular complications such as heart attack, death due to cardiac
causes, and stroke.” However, the VISION results
suggest that statins have the potential to prevent
cardiovascular complications in patients undergoing
noncardiac surgery.
XANTUS
At ESC, investigators reported on major bleeding in an assessment of 6,784 patients with atrial
fibrillation treated with rivaroxaban for stroke
prevention.7 XANTUS is the first international,
prospective real-world non-vitamin K antagonist
oral anticoagulant (NOAC) study in patients with
AF. In a report simultaneously published, mean
patient age was 71.5 years, 41% were female, and
9.4% had documented severe or moderate renal
impairment (creatinine clearance <50 ml/min). The
mean CHADS2 and CHA2DS2-VASc scores were 2.0
and 3.4, respectively; 859 (12.7%) patients had a
CHA2DS2-VASc score of 0 or 1. The mean treatment
duration was 329 days. The rate of fatal bleeding
was 0.2% per year, while stroke occurred in 0.7%
patients per year, and 0.4% of patients per year
experienced an intracranial hemorrhage. Compare
that to the patients in the pivotal ROCKET AF trial
who had a mean CHADS2 score of 3.5, and the incidence of major bleeding in