Новости из Парижа с ESC Congress 2011

[Pyankov Vasily]

ARISTOTLE: Efficacy and safety of Apixaban compared to Warfarin for prevention of stroke and systemic embolism in 18,202 patients with atrial fibrillation: primary results of the ARISTOTLE trial

Background: Vitamin K antagonists are highly effective in preventing stroke in patients with atrial fibrillation but have several limitations. Apixaban is a novel oral direct factor Xa inhibitor that has been shown to reduce the risk of stroke in a similar population in comparison with aspirin.

Methods: In this randomized, double-blind trial, we compared apixaban (at a dose of 5 mg twice daily) with warfarin (target international normalized ratio, 2.0 to 3.0) in 18,201 patients with atrial fibrillation and at least one additional risk factor for stroke. The primary outcome was ischemic or hemorrhagic stroke or systemic embolism. The trial was designed to test for noninferiority, with key secondary objectives of testing for superiority with respect to the primary outcome and to the rates of major bleeding and death from any cause.

Results: The median duration of follow-up was 1.8 years. The rate of the primary outcome was 1.27% per year in the apixaban group, as compared with 1.60% per year in the warfarin group (hazard ratio with apixaban, 0.79; 95% confidence interval [CI], 0.66 to 0.95; P<0.001 for noninferiority; P = 0.01 for superiority). The rate of major bleeding was 2.13% per year in the apixaban group, as compared with 3.09% per year in the warfarin group (hazard ratio, 0.69; 95% CI, 0.60 to 0.80; P<0.001), and the rates of death from any cause were 3.52% and 3.94%, respectively (hazard ratio, 0.89; 95% CI, 0.80 to 0.99; P = 0.047). The rate of hemorrhagic stroke was 0.24% per year in the apixaban group, as compared with 0.47% per year in the warfarin group (hazard ratio, 0.51; 95% CI, 0.35 to 0.75; P<0.001), and the rate of ischemic or uncertain type of stroke was 0.97% per year in the apixaban group and 1.05% per year in the warfarin group (hazard ratio, 0.92; 95% CI, 0.74 to 1.13; P = .42).

Conclusions: In patients with atrial fibrillation, apixaban was superior to warfarin in preventing stroke or systemic embolism, caused less bleeding, and resulted in lower mortality.

P.S. Большой привет нашим людям в Париже.

[Pyankov Vasily]

The Bern-Rotterdam cohort study included more than 12,000 patients treated between 2002 and 2009 at the Bern University Hospital in Switzerland and the Thoraxcenter at Erasmus Medical Centre in Rotterdam, The Netherlands. The objective was to compare the incidence of stent thrombosis between newer generation DES eluting everolimus, and early generation DES eluting srolimus or paclitaxel, with particular focus on stent thrombosis occurring between one and four years (VLST).

Results showed that the rate of stent thrombosis up to four years was lower among patients treated with everolimus-eluting stents (1.4%) than with sirolimus-eluting stents (2.9%, p<0.0001) and paclitaxel-eluting stents (4.4%, p<0.0001). The reduction in stent thrombosis was most prominent between one and four years, resulting in a 67% risk reduction in VLST for the comparison of everolimus-eluting with sirolimus-eluting stents, and a 76 % risk reduction for the comparison of everolimus-eluting with paclitaxel-eluting stents.

http://www.escardio.org/about/press/pre ... s-DES.aspx

[Andrey Bushmelev]

Hot topics in echocardiography: the position of the European Association of Echocardiography

EAE recommendations about the use of echo in Emergency Department

Finally, Prof Andreas Hagendorf from Leipzig reported on an unpublished document about use of echo in the emergency department. The main points underlined by Prof Hagendorf have been the need for high quality machines and for highly experienced operators to obtain the right information to take the proper decision in order to calculate patient management. The role of the new technologies has been emphasized.
http://www.escardio.org/congresses/esc- ... adano.aspx

Это в предверии 6-го съезда РАСУДМ

[Pyankov Vasily]

Презентация S.Yusuf: Polypill for primary prevention.

http://assets.escardio.org/webcasts/def ... C2011/3750

[Sergey Chevychelov]

Panel Endorses Xarelto for Stroke Prevention

ADELPHI, Md. -- An FDA advisory committee has voted 9-2, with one abstention, to recommend that the FDA approve the direct oral factor Xa inhibitor rivaroxaban (Xarelto) to prevent stroke in patients with atrial fibrillation.