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AFIRE and DAPA Trials Impact Atrial Fibrillation and CHF
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AFIRE and DAPA Trials Impact Atrial Fibrillation and CHF
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Upload Date:
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Language: EN.
Segment:0 .
>> Practice Impact Extra podcasts are derived from Hurst's The Heart Board Review and other online resources available only through accesscardiology.com. >> In Paris, this August and September of 2019, lots of great trials presented. So it's always hard to pick out the trials that would, I think be most impacting. Yet, there are trials that I think do meet those -- my criteria for practice impacting now. [ Music ] Hi, Dr. Bernie here, and, again, welcome to Practice Impact Extra.
I want to present briefly, three trials from the European Society Cardiology that I believe warrant your review. Let's talk about the AFIRE Trial. This trial addresses the important question, what do you do with patients with atrial fibrillation who have chronic stable coronary artery disease and are one-year out? Now, this was a Japanese study on 2,200 patients. And therefore, it really is a limited population that's being assessed. And I think that's very important.
So all these 2,200 patients, they had atrial fibrillation, had chronic stable coronary artery disease. And they were randomized either to 15 milligrams of Rivaroxaban, or Rivaroxaban and aspirin. So what were the principle findings? There was no significant benefit to adding aspirin to Rivaroxaban in preventing ischemic events. And the bleeding complication rate was significantly increased. So, what's my take on this study?
I thought the evidence of this trial supports anticoagulation without any platelet is safe in the long-term management of atrial fibrillation in stable coronary artery disease. I mean that's what that data indicates. I do believe, however, the study really only provides a good start. I believe the result is really limited. The trial was terminated prematurely because of outcomes. And I really feel that we really need to have more data in trials.
And these trials are ongoing to really address the issue concerning the addition of aspirin and Rivaroxaban for patients with atrial fibrillation and chronic coronary artery disease. Another trial, the DAPA, the DAPA Heart Failure Trial was quite impacting and really is a new approach in treating patients was congestive heart failure. Dapagliflozin, a sodium-glucose co-transporter, you know the SGLT2, was evaluated in patients with congestive heart failure and a reduced ejection fraction and they compared that the groups with standard care plus placebo.
Of this group, only 42% of the patients had diabetes. So, what were the results at a year and half at 18 months? There was a significant reduction in cardiovascular deaths and hospitalizations for heart failure in patients treated with Dapagliflozin. The fascinating fact was there was no outcome difference in heart failure whether the patients had diabetes or did not have diabetes. And this was actually reconfirmed data from the fine AF trial.
So what's the take home message here? The DAPA Trial with Dapagliflozin may signal now a new approach in the treatment of patients with reduced ejection fraction and heart failure. Big question, hopefully there's some answer to this question, bypass surgery, coronary artery stenting, which one is really superior? Well, I'll tell you what we know from some trials that were -- or a particular trial, the SYNTAX Trial, which was a five-year trial, and it looked at the option for treatment of ischemic heart disease.
And this study showed that comparing PCI and coronary artery bypass grafting, CABG, it did not show any real different survival benefit with either therapy at five years. Well, at the European Society meetings in Paris in 2019, the ten-year extended SYNTAX randomized study was presented. And this, again, they saw that all cause mortality curves remain similar for the PCI and the CABG group even at ten years.
So really, no difference and the all cause mortality comparing five to ten years. However, within this ten-year extended trial, they randomized and analyzed patients with three-vessel coronary artery disease and left main who either underwent PCI or CABG, the PCI being with a drug-alluding stent. So, what did the ten-year follow-up demonstrate and indicate? Well, in people with three-vessel coronary artery disease, they had a particularly high mortality when assigned to the PCI group, as compared to the CABG group.
That's three-vessel coronary artery disease, higher mortality PCI group compared to CABG. But, if you looked at left main, again, they were no worse off when either procedure was considered and done. So, what's the take home message here? Well, I really think that you need to take a look at the ten-year SYNTAX follow-up study, particularly in your present evaluation of patients with ischemic heart disease and three-vessel coronary artery disease.
Now there are two additional new trials that are ongoing, but I'm afraid it's going to take several years before we can see any additional outcome on basis of those trials. So, do review this study of the ten-year SYNTAX follow up study. I think that's pretty valuable. So, once again, thanks for joining me and see you next time on Practice Impact Extra. >> We hope you enjoyed this Podcast from McGraw-Hill. Subscribers to AccessCardiology have instant access to over 25,000 pages of rich medical content, receive medical updates from trusted experts and have access to other special features.
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