MD Conference Express ESC 2012 - (Page 23)
was substantially less variation in the stroke rate, ranging from approximately 5% in China and Southeast Asia to 3% in India. Most of the difference in stroke rates could be explained by differences in VKA use. Figure 1. 1-Year Mortality for Patients with AF by Region.
Crude Mortality 25 Adjusted Mortality*
modalities for diagnosis, risk stratification, and treatment of patients presenting with AF is crucial in reducing the morbidity and mortality of this condition. Figure 3. Global CHADS2-Specific Stroke Rate (1-Year).
Proportion of Patients with Stroke at 1 Year, without RHD Proportion of Patients with Stroke at 1 Year, with RHD but No Valve Surgery
18 16
20
14
Percent (%)
15
Global Average
Percent (%)
12 10 8 6
10
5
4 2
0
North South Western Eastern America America Europe Europe
Middle East
Africa
India
China
Southeast Asia
0
0
1
*Adjusted for age, sex, heart failure, coronary artery disease, hypertension, diabetes, rheumatic heart disease, and reason for emergency department presentation.
2 CHADS2 Score
3
>3
Reproduced with permission from J. Healey, MD.
Reproduced with permission from J. Healey, MD.
Figure 2. Regional Variation in 1-Year Mortality According to AF as a Primary or Secondary Diagnosis.
Primary Diagnosis of AF 30 25 20 15 10 5 0
Global Average
TRA 2°P-TIMI 50 Results
Written by Lori Alexander
Other Primary Diagnosis
For patients with a history of myocardial infarction (MI) who are stable, the addition of vorapaxar to the standard of care reduced the long-term risk of cardiovascular (CV) death or ischemic events and increased the risk of moderate or severe bleeding. These findings are among the first to show a benefit of adding intense antiplatelet treatment to standard therapies for long-term secondary prevention in patients with a history of MI. Vorapaxar inhibits platelet activation by antagonizing thrombin-mediated activation of the protease activated receptor-1 (PAR-1) expressed on platelets. The efficacy and safety of the drug were evaluated for secondary prevention in a broad group of patients with prior MI, prior stroke, or peripheral artery disease in the Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events-Thrombolysis in Myocardial Infarction 50 [TRA 2°P-TIMI 50] trial. Benjamin M. Scirica, MD, Brigham and Women’s Hospital, Boston, Massachusetts, USA, presented the primary results in the subgroup of patients who were randomized with a qualifying MI (type 1 MI within the previous 2 weeks to 12 months), with publication timed to coincide with the presentation at the European Society of Cardiology Congress 2012 [Scirica BM et al. Lancet 2012].
Percent (%)
North South Western Eastern America America Europe Europe
Middle East
Africa
India
China
Southeast Asia
Reproduced with permission from J. Healey, MD.
About one third of the patients from India in the registry had documented rheumatic heart disease (RHD). Overall, 1788 patients had RHD, and when the data for this population were analyzed, the risk of stroke was higher for patients with a history of RHD (adjusted rates, 4.3% vs 2.5%). Globally, the CHADS2 score had a greater influence on risk of stroke than the presence of RHD (Figure 3). The authors concluded that the 1-year RELY AF registry results underscore the large unmet medical needs and large opportunities for improvement in outcomes for patients with AF. Consistent global application of currently available
Official Peer-Reviewed Highlights from the European Society of Cardiology Congress 2012
23
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Table of Contents for the Digital Edition of MD Conference Express ESC 2012
MD Conference Express ESC 2012
Contents
ESC 2012 Clinical Practice Guidelines
TAVI: 10 Years After the First Case
PARAMOUNT Trial Results
TRILOGY ACS Outcomes
Results from the ALTITUDE Trial
Results of the WOEST Trial
Results from the Aldo-DHF Trial
FAME 2 Results
Results from the IABP-SHOCK II Trial
STEMI Mortality Decreases in France While Some Key Risk Factors Increase
Results from the PURE Study
PURE: Treatment and Control of Hypertension
Genetic Determinants of Variability in Dabigatran Exposure
The RE-LY AF Registry
TRA 2°P-TIMI 50 Results
Rivaroxaban of Benefit in STEMI: ATLAS ACS 2-TIMI 51
Ivabradine Effect on Recurrent Hospitalization for HF
CLARIFY: Similar 1-Year Outcomes for Men and Women with Stable CAD
HPS2-THRIVE Study Results
PRoFESS Study Results
Outcomes from the CARDia Trial
Hypertension
Atrial Fibrillation
Heart Failure
MD Conference Express ESC 2012
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