ESC Congress Highlights 2023

Highlights of the first day of the 2023 ESC Congress: 

1- SGLT2 inhibitors are recommended as class I in HF mrEF and HFpEF (dapagliflozin and empagliflozin) 

2- there is no change in the strategies of antithrombotic treatment in patients with ACS :

Aspirin + P2Y12 inhibtirs for 12 months flooded by aspirin alone for life long (class I). 

3- Surgery is recommended for early Prosthetic valve endocarditis (less than 6 months) with new valve replacement and complete debridement (class IC)

4- ACS management in cancer patients:

Invasive strategy if the life expectancy >6 months 

Conservative management if poor prognosis 

Antithrombotic therapy according to platelet count

5- SGLT2 inhibitors are recommended as first line treatment ( class I) in type 2 diabetic patients with established ASCVD (to reduce CV risk independent of glucose control , in type2 diabetic patients with HF(to reduce HF hospitalizations ), and in type 2 diabetic patients with CKD (to reduce CV risk and kidney failure risk).

6- Colchicine is the first anti-inflammatory agent (0.5 mg once daily) approved by US FDA and health Canada to reduced the risk of atherothrombotic events in patients with established ASCVD.

7-Colchicine does not significantly reduce perioperative Afib or myocardial injury after non-cardiac surgery (MINS) in patients undergoing major non-cardiac thoracic surgery.

8- Semaglutide (which belongs to a class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists) improves heart failure-related symptoms and physical function and results in greater weight loss compared with placebo in patients with HFpEF and obesity (STEP-HFpEF trial)

9- NOACs are finally approved for the treatment of LV thrombus as a complication of ACS( class IIa).

10- DOAC Score: A Novel Bleeding Risk Prediction Tool for Patients With Atrial Fibrillation on Direct-Acting Oral Anticoagulants

11- complete revascularization should be done either during the index procedure or within 45 days in patients with STEMI. 

ESC Guidelines for the management of CVD in patients with DM :

1-SCORE2-Diabetes : In patients with T2DM without symptomatic ASCVD or severe TOD, it is recommended to estimate 10-year CVD risk via SCORE2-Diabetes

2-SGLT2i & GLP-1 : cornerstone 

3-Finerenone class 1A : Finerenone is recommended in addition to an ACE-I or ARB in patients with T2DM and eGFR >60 mL/min/1.73 m2 with a UACR ≥30 mg/mmol (≥300 mg/ g), or eGFR 25–60 mL/min/1.73 m2 and UACR ≥3 mg/mmol (≥30 mg/g) to reduce CV events and kidney failure.

4- Aspirin class IIb A as 1ry prevention : In adults with T2DM without a history of symptomatic ASCVD or revascularization, ASA (75–100 mg o.d.) may be considered to prevent the first severe vascular event, in the absence of clear contraindications.

5-EPA class IIb B : High-dose icosapent ethyl (2 g b.i.d.) may be considered in combination with a statin in patients with hypertriglyceridaemia

6-Statin in T1DM : Statins should be considered for LDL-C lowering in adults older than 40 years with T1DM without a

history of CVD to reduce CV risk

Statins should be considered for use in adults younger than 40 years with T1DM and other risk factors of CVD or microvascular end-organ damage or 10-year CVD risk ≥10% to reduce CVD risk

7-No omeprazole or esomeprazole with clopidogrel

8- Pioglitazone and saxagliptin not recommended in diabetic heart failure patients or at risk of HF : Pioglitazone is associated with an increased risk of incident HF in patients with diabetes and is not recommended for glucose-lowering treatment in patients at risk of HF (or with previous HF).

The DPP-4 inhibitor saxagliptin is associated with an increased risk of HF hospitalization in patients with diabetes and is not recommended for glucose-lowering treatment in patients at risk of HF (or with previous HF )