Nia Cason

The American College of Cardiology and the American Heart Association have updated treatment recommendations for the primary prevention of cardiovascular disease. The report was presented earlier this month at the American College of Cardiology annual meeting in New Orleans.Â In this slideshow, we highlight the take-home messages.

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The American College of Cardiology and the American Heart Association have updated treatment recommendations for the primary prevention of cardiovascular disease. Among the recommendations:  Stop recommending aspirin to prevent CVD.

Aspirin Does Little to Prevent Cardiovascular Disease

NEW ORLEANSâDeath, stroke and re-hospitalizations were reduced by 46 percent in low-risk patients with severe aortic stenosis who opted for a minimally invasive procedure to repair their damaged aortic valve, instead of removing it via open heart surgery.

The procedure, called transcatheter aortic valve replacement (TAVR), was performed using a SAPIEN 3 valve which was inserted with a catheter next to the damaged valve. The findings were reported this week at the American College of Cardiology’s annual meeting in New Orleans.

Martin Leon, M.D., of Columbia University Irving Medical Center, described the procedure which he suggested would be suitable for patients who are at high risk of surgery-associated complications, but now, low risk patients who are more often considered for valve replacement.

The study, called PARTNER 3, was a prospective, randomized, controlled, multi-center trial of 1,000 patients with severe aortic stenosis and a low-risk for surgical complications.

A second randomized, prospective study with 1,468 low-risk patients with severe, symptomatic aortic stenosis was also presented in the same session by Michael Reardon, M.D., who found that at one year, TAVR patients had significantly lower all-cause mortality or stroke (0.8% vs. 2.6%) and rehospitalization rates than SAVR patients. TAVR was superior than surgery for major stroke (0.8% vs. 2.4%), but all-cause mortality alone was not significant (2.4% vs. 3%). Quality of life was also significantly better in TAVR patients.

Dr. Leon recommends that the choice of TAVR versus surgery for severe aortic stenosis be made independent of the surgical risk profile. The longer-term durability of catheter valve replacements is unknown, but patients in the PARTNER 3 trial will be followed for 10 years to this aim.

Leon, M. “Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients: Results of the PARTNER 3 Trial,” the American College of Cardiology annual meeting. 9:45 a.m., March 17, 2019. Abstract number: 19-LB-19835-ACC

Michael Reardon, M.D. “Self-Expanding Transcatheter or Surgical Aortic Valve Replacement in Patients at Low Risk of Surgical Mortality,” ACC annual meeting. 9:45 a.m., March 17, 2019. Abstract number: 19-LB-19883-ACC

PARTNER 3 was funded by Edwards Lifesciences. The second study cited here was funded by Medtronic.

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Death, stroke and re-hospitalizations were reduced by 46 percent in low-risk patients with severe aortic stenosis who opted for a minimally invasive procedure over open heart surgery to repair the aortic valve.

Aortic Stenosis Low-Risk Patients Benefit from Minimally Invasive Surgery

NEW ORLEANSâAtrial fibrillation patients at risk for acute coronary syndrome, stroke and blood clots have a lower risk of bleeding and hospitalization with an antithrombotic regimen that includes apixaban without aspirin, according to researchers who presented findings this week at the American College of Cardiology’s annual meeting held in New Orleans.

Complex cases of both atrial fibrillation (Afib) and acute coronary syndrome and/or percutaneous coronary intervention require combined anti-coagulant treatment to reduce stroke risk and antiplatelet therapy to prevent clotting and recurrent coronary ischemic events, but this combination increases the risk of bleeding.

In this study of 4,600 patients, researchers led by Renato Lopes, M.D., Ph.D., of Duke University in North Carolina, set out to determine the optimal antithrombotic treatment for complex cases of Afib. They compared apixaban with vitamin K antagonists and aspirin with placebo in patients with Afib who develop acute coronary syndrome and/or undergo percutaneous coronary intervention while taking a platelet inhibitor.
	Patients who received a platelet inhibitor were given either 2.5 mg or 5 mg apixaban tablets twice per day; or, the vitamin K antagonist warfarin once daily and aspirin (81 mg) or an aspirin placebo.

After six months, major or clinically relevant nonmajor bleeding was lower in patients who received apixaban (10.5%) compared to those who received warfarin (14.7%), with a 31% reduction in risk of bleeding associated with apixaban. Major bleeding was also significantly lower in patients receiving the placebo (9%) as compared to aspirin (16.1%), with a 47% reduction in risk of bleeding associated with no aspirin.

The apixaban group had a lower incidence of death or hospitalization. There was an overall similar incidence of ischemic events in all groups. The lowest rates of bleedingâwith no increase in deaths or hospitalizationsâwere seen in patients who received the two-drug regimen and no aspirin.

Renato Lopes, M.D., MHS, Ph.D., Duke University Health System, North Carolina. “An Open-label, 2 x 2 Factorial, Randomized Trial to Evaluate the Safety of Apixaban versus Vitamin K Antagonist and Aspirin versus Placebo in Patients with Atrial Fibrillation and Acute Coronary Syndrome and/or Percutaneous Coronary Intervention: Primary Results of the AUGUSTUS Trial,” AAC.19. Abstract number: 19-LB-19653-ACC. Sunday, March 17, 12:15–1:15 p.m.

The authors disclosed a number of conflicts of interest.

Atrial fibrillation patients at risk for acute coronary syndrome, stroke and blood clots have better outcomes with an antithrombotic regimen of apixaban without aspirin, researchers report.

Nia Cason

Articles

Aspirin Does Little to Prevent Cardiovascular Disease

Aortic Stenosis Low-Risk Patients Benefit from Minimally Invasive Surgery

Optimal Treatment for Complex Afib Cases Excludes Aspirin