Prof Juan Carlos Kaski, St George's, University of London, UK

Cardio Debate provided daily highlights from the ESC Congress 2017 recently held in Barcelona, Spain, with editor-in-chief Professor Juan Carlos Kaski from St George’s University of London, UK.

In this edition of #CardioInterviews he talks about the new ESC Guidelines on the management of acute myocardial infarction, and the results from the CANTOS trial.


Today was an important day at the ESC, here in Barcelona. There were many, many major issues discussed at the congress. One of them was the microcirculation issue – coronary microcirculation dysfunction – which was discussed in several sessions of the congress. And this is very important because we are actually changing the paradigm in the case of angina, whereby angina is not just a condition caused by coronary artery disease, obstructive coronary artery disease, but also by functional and structural abnormalities at the site of the coronary micro-vessels. And several of the speakers have highlighted the issue.

The other major topic was, of course, the new guidelines for the management of acute myocardial infarction. And this is going to be the focus of lots of reports in the next few days. They haven’t made any major changes on how we manage acute MI, but the guidelines are more didactic. I think they are going to be a lot more helpful to the practicing physicians than the previous ones.

SYNTAX II was also presented, and I will come back to that on a future report. But I think the highlight of the day was CANTOS. Paul Ridker who has been working in the field of inflammation and coronary artery disease for many years, and was promoter of c-reactive protein as a marker of cardiovascular risk, conducted this very large study in over 10,000 patients who had a previous MI, whose cholesterol was not very high because they were receiving high intensity statin treatment, but the CRP remained elevated.

So those patients were entered into a randomized study with the use of the compound canakinumab, which is an interleukin-1 beta blocker, and the results were very interesting because this anti-inflammatory intervention, without affecting lipids, reduced the primary and secondary end point, which included cardiovascular death and major cardiovascular events.

And the other important finding of the study was that there was a 50% reduction in incidents of cancer. Which means that tacking inflammation is likely to affect not only coronary circulation but also other conditions which are treated by tackling inflammation. So very important study.

Of course it’s too early to say that this will change clinical practice, but at least we are seeing for the first time that the management of inflammation can improve cardiovascular outcomes.