The ACC.20/WCC Virtual Experience

For the first time in its 69-year history, the American College of Cardiology (ACC) had to cancel its annual congress, which was scheduled to take place on 28-30 March 2020 in Chicago, together with the World Congress of Cardiology (WCC). However, these societies rose to the challenge by converting the congress into an entirely virtual and free meeting: ACC.20/WCC Virtual.

At least 38,000 people from 157 countries attended the virtual congress, a number far in excess of the 16,000 people who were expected to attend the congress in person in Chicago.

VOYAGER PAD: Evidence-based therapy in a challenging setting

Patients with peripheral artery disease (PAD) are at particularly high risk of major adverse limb and cardiovascular (CV) events after peripheral revascularization. These events are associated with a poor prognosis and can have a significant impact on a patient's quality of life and ability to function. Furthermore, there is a lack of evidence on optimal antithrombotic therapy in patients with symptomatic PAD undergoing peripheral revascularization. No previous antithrombotic strategy has demonstrated efficacy for reducing major CV and limb events in this setting. The VOYAGER PAD study aimed to address the unmet need for evidence-based antithrombotic therapy in this setting and was one of the highlights of the ACC.20/WCC virtual congress.

Professor Marc Bonaca from Brigham and Women's Hospital, Boston, MA, USA, presented the overall results of the study in a session attended by over 4000 people, which investigated the efficacy and safety of dual pathway inhibition (DPI) with rivaroxaban 2.5 mg twice daily (bid) plus aspirin versus aspirin in patients with symptomatic PAD undergoing peripheral revascularization.

The VOYAGER PAD study met its primary efficacy endpoint (the composite of acute limb ischaemia, major vascular amputation, myocardial infarction, ischaemic stroke or CV death), with no significant increase in the primary safety outcome of Thrombolysis in Myocardial Infarction (TIMI) major bleeding. Specifically, the risk of the primary efficacy endpoint was significantly reduced by 15% compared with aspirin. The number needed to treat (NNT) decreased over time, from 65 at 6 months to 39 at 3 years, which demonstrated that the benefit of DPI versus aspirin accrued over time. In fact, for every 10,000 patients treated for a year, DPI was expected to prevent approximately 181 primary efficacy outcome events at the cost of 29 primary safety outcome events versus aspirin. Although the secondary safety outcome of International Society on Thrombosis and Haemostasis (ISTH) major bleeding was significantly increased, there was no increase in the risk of fatal or intracranial bleeding with DPI versus aspirin.