Shelley Wood

August 26, 2013

AMSTERDAM, THE NETHERLANDS — There are some unusual topics among the hot lines for this year's European Society of Cardiology (ESC) 2013 Congress : two large diabetes drug trials, a noncardiac surgery study, deaths in more than six decades' worth of Tour de France cyclists. That's no accident, says the chair of the congress program committee, Dr Keith Fox (University of Edinburgh, Scotland), who said he set out to put together a program that considered the heart as part of the whole.

"The whole theme of this year's meeting is the heart interacting with the systemic organs, so I've gone out to bridge some of the barriers we've seen before, because obviously our patients see the impact of disease beyond a single organ. . . . This is about getting outside the silo and saying let's get expertise across the organ system."

That's not to say that this year's late-breakers won't include some of cardiology's hot topics. New oral anticoagulants, for example, will dominate the stage in the opening hot-line session Sunday morning: edoxaban (Lixiana, Daiichi Sankyo) in venous thromboembolism in the Edoxaban Hokusai-VTE study; otamixaban in non-ST-segment-elevation ACS in the TAO study; and dabigatran (Pradaxa, Boehringer Ingelheim) in the setting of mechanical heart valves in RE-ALIGN . This last was halted in late 2012, for futility, according to the company, as reported by heartwire , but additional information came out from the FDA after it announced that dabigatran users in the trial were more likely to experience strokes, MI, and thromboses forming on the mechanical heart valves than were users of warfarin.

Dr Keith Fox

A second hot-line session later in the day on Sunday focuses on devices and interventions. Speaking with heartwire , Fox highlighted the PRAMI trial, testing the use of "preventive angioplasty" in nonculprit lesions during AMI stenting. Other trials singled out by Fox included ACCOAST , looking at prasugrel (Effient, Lilly/Daiichi-Sanyo) preloading vs no preloading for PCI in ACS patients, and LINC , a study of "Lucas," a chest-compression system. The latter, said Fox, "may well create some interest," since--perhaps as a comment on the times--devices like this one would theoretically permit bystanders to perform hands-free CPR.

Hot-line session 3 on Monday morning includes the two diabetes trials focused on gliptins. One of these is SAVOR-TIMI 53 , with saxagliptin (Komboglyze, Onglyza, AstraZeneca/Bristol-Myers Squibb), which (it was revealed in June) has failed to show a reduction in CV events compared with placebo on top of usual care in patients with type 2 diabetes and established CVD or multiple risk factors. The other is EXAMINE , with alogliptin (Nesina, Takeda Pharmaceuticals), seeking similar benefits, this time in type 2 diabetes patients with ACS. Another negative trial, ASSURE, is also in the line-up for this "risk factors and diabetes" hot line. Back in June, Resverlogix announced that its phase 2b trial evaluating RVX-208, an apoA-1 inducing agent, in high-risk cardiovascular patients with low HDL had failed to meet its primary end point of a -0.6% change in percent atheroma volume by intravascular ultrasound (IVUS).

The final hot-line session, Tuesday morning, covers heart failure and ACS. Highlights here, said Fox, include AQUARIUS looking at the effects of aliskiren (Tekturna, Novartis) on atherosclerosis progression, and BIC-8 , a randomized trial testing the ability of cardiac troponin and copeptin for "instant early rule-out" in suspected ACS. A third presentation Fox admits is a bit "out in left field": an analysis looking at 65 years' worth of mortality data from the Tour de France. This study reflects the growing interest in high-performance endurance sports and their effects on the heart, Fox noted, and is not focused on the cardiovascular effects of performance-enhancing drugs.

Updates and Hot Lines in the Journals

In addition to the hot lines, there will also be three clinical-trial and registry-update sessions, one each on the Monday, Tuesday, and Wednesday of the congress. Featured here are some of the big drug and device trials from meetings past, including RELAX-AHF , PARTNER , Symplicity HTN-1 , CHAMPION , RAFT , and ORIGIN .

All of the hot-line and update sessions include discussants, and in a new initiative this year, all of the accepted poster abstracts will also have discussants, Fox noted.

Asked how many of the hot lines or "updates" will also be simultaneously published, Fox said he was sworn to secrecy by the journal editors but acknowledged there will be "some" simultaneous publications, "but I can't say when or where."

Several new guideline documents will be released for the first time at ESC 2013 (diabetes and stable coronary artery disease) while other guideline documents (arterial hypertension, cardiac pacing) released at recent subspecialty meetings will also have dedicated sessions.

All told, there are 21 hot-line presentations distributed across the four sessions--that's up from 18 in three sessions at last year's ESC meeting. There are an additional 18 trials and registries in the "updates" sessions. In all, Fox said, the the ESC received more than 10 500 abstracts from 150 countries, packing all of the content into more than 400 sessions over the four-and-a-half day meeting. According to Fox, preregistration has already passed the total registration from last year's meeting in Munich.

New This Year

Asked what he was especially proud of in this year's program, Fox pointed to the "hub"--a circular auditorium in the center of the congress that will be home to a number of special sessions. One, a "rapid-fire" session where investigators are given five minutes to present their data, then retreat to large plasma screens on the periphery of the hub where audience members can take more time with the individual presenter on a one-on-one basis, with the presentation available on the screens. Another will be the interactive "ask-a-legend" sessions. These feature some of the biggest names in cardiology and, according to Fox, are designed to inspire early-career cardiologists "to say, 'I could do that.' " Questions for the "legends" can be submitted in advance or during the sessions themselves.

The venue for this year's congress is Amsterdam RAI, 6 km south of city center--an eight-minute, €33 journey by cab, or a 15-minute trip on tram number 4 (or 11, during conference days). An ESC-subsidized five-day transport pass is available to attendees.

Finally, in what might prove to be the most innovative aspect of this year's ESC, Fox says he and his colleagues convinced Amsterdam's mayor "to lay down a dedicated cycle path" for the meeting. The 5-km route from downtown will take about 20 minutes by bike; the ESC has arranged a special rate with Yellow Bike, with three bike-pickup locations around the city.

Asked whether he himself plans to commute to the ESC congress by bike, Fox replied: "I will indeed."


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