Practice Update: Cardiology

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The year’s top research, all in one issue Welcome to our special issue, PracticeUpdate Cardiology: Best of 2016 – bringing you a collection of the best research of 2016 from the world’s top cardiology congresses. You’ll find the best in here plus key clinical commentary on why these studies are practice-changing. Our PracticeUpdate Cardiology advisory and editorial board members share their views on the best cardiology story of the year (see left) as well as commenting on the studies to make an impact from the American College of Cardiology, European Society of Cardiology and the American Heart Association. The Elsevier Australia editorial team has specially selected these highlights of 2016 including DAPT, PARTNER-2, EMPA-REG OUTCOME, DANISH, FUTURE, EUCLID and PRECISION. To discover more please visit practiceupdate.com On behalf of the Elsevier Australia PracticeUpdate Cardiology team, I thank you for your continued support and readership. We’ve had some big changes this year with a new name and improved content which we hope helps you in your clinical practice providing the best patient outcomes. I wish you well for 2017 – and to the breakthroughs next year will bring. Happy summer reading! Anne Neilson Managing editor, PracticeUpdate Cardiology (Australian Edition) While it is disappointing not to find a reduction in cardiovascular events with CPAP, our results showed that treatment of obstructive sleep apnoea in patients with cardiovascular disease is nevertheless worthwhile. They weremuch less sleepy and depressed, and their productivity and quality of life was enhanced. Doug McEvoy MD, Flinders University, on results of the SAVE study at ESC 2016. The study carries important implications for both guidelines and regulatory policy, because it provides strong evidence that muscle-related statin intolerance is a real and reproducible phenomenon. Steven Nissen MD, MACC, Cleveland Clinic, on the challenging clinical problem of muscle symptoms in statin-treated patients at ACC 2016. While ticagrelor was nomore effective in reducing risk than clopidogrel, we learned valuable information about this population, specifically, that patients with a history of lower extremity revascularisation are at higher risk of acute limb events and cardiovascular events. Schuyler Jones MD, Duke University School of Medicine, while presenting results of the EUCLID trial at AHA 2016.

Optimal duration of DAPT By Joerg Herrmann MD Mayo Graduate School of Medicine, Rochester, Minnesota. A pproximately 1 million percutaneous cor- onary interventions (PCIs) are performed annually in the United States. Accordingly, any recommendation that pertains to the care of these patients is of great magnitude and so is then the “2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Pa- tients With Coronary Artery Disease” ( J Am Coll Cardiol 2016;68:1082–1115). This update comes 5 years after the last ACC/AHA guidelines on myocardial revascularisation and 2 years after the corresponding ESC guidelines. Most importantly, the recommendations for the minimum duration of DAPT are now in sync across these major societies: a minimum of 1 month after bare-metal stenting and 6 months after newer-generation drug-eluting stenting in patients with stable coronary artery disease and 12 months after an acute coronary syndrome regardless of revascularisation strategy. Interestingly, to extend DAPT beyond the recom- mended minimum timeframe is given a class IIb rating in the ACC/AHA guideline. Accordingly, there is a universal mandate for DAPT early af- ter stenting, but long-term DAPT is an individual decision. Even though patient groups at increased ischemic/stent thrombosis risk on the one hand and at higher bleeding risk on the other hand can be listed, this does not provide much-needed concrete guidance for daily practice. This gap was addressed by the development of a pre- diction rule relative to which patient would derive a net benefit from prolonged DAPT based on the DAPT trial data and subsequent validation using the PROTECT trial data ( JAMA 2016;315:1735– 1749). Despite the fact that the “DAPT score” may not be applicable to all comers outside the DAPT trial criteria, and, in fact, performed only modestly in the validation cohort, it is still the best tool avail- able currently and a major advance. Thus, significant steps were taken in 2016 to pro- vide more concrete guidance on the optimal dura- tion of DAPT, which is one of the most common inquiries in daily practice. For this reason, these two articles should be remembered as top stories for the year 2016. Dr Herrmann is Associate Professor of Medicine at

DECEMBER 2016