Edoxaban Monotherapy Associated with Better Net Clinical Benefit than Edoxaban Plus Single Antiplatelet in Patients with AF and Stable CAD: EPIC-CAD

Key Points:

In patients with stable coronary artery disease and atrial fibrillation, multiple society guidelines recommend the use of monotherapy with oral anticoagulants after an early period of dual antithrombotic therapy. However, randomized trial evidence supporting this practice is limited.
In this open-label, randomized clinical trial, 1040 patients who had chronic coronary artery disease and atrial fibrillation were randomized to receiving either standard-dose edoxaban monotherapy or standard-dose edoxaban plus a single antiplatelet agent.
Edoxaban monotherapy was found to be superior to dual antithrombotic therapy for net clinical events of death, stroke, myocardial infarction, systemic embolization, unplanned urgent revascularization, or major or clinically relevant nonmajor bleeding at 12 months.

STEEER-AF: A Structured Educational Program for Clinicians Improved Adherence to Guideline Recommendation in AF

Key Points:

Adherence to guideline recommendations for AF management is suboptimal.
STEEER-AF, the first randomized trial conducted by the ESC, assigned treatment centers across Europe to a short, targeted, and structured educational program or their usual education activities. The outcome was patient level receipt of guideline-concordant care.
Exposure to the educational program was associated with a significant improvement in adherence to rhythm control, but not stroke prevention, guideline recommendations.
This trial demonstrated the feasibility and efficacy of using educational initiatives to target implementation gaps in cardiology.

Key Points:

While inflammation is critical to the pathogenesis of atherosclerosis, few available anti-inflammatory treatments have been tested in ACS.
In IVORY FINALE, low-dose interleukin 2 (IL-2) was compared to placebo in ACS. The primary endpoint was change in arterial inflammation, as measured by PET scan. Safety and tolerability were also assessed.
In the primary analysis, IL-2 resulted in a significant reduction in arterial inflammation in the index vessel on PET. Over a median of 2.6 years of follow-up, IL-2 also decreased MACE compared to placebo.