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Editorial – ESC Munich 2018

JEROEN J. BAX, FESC
Leiden University Medical Center, The Netherlands

From the 25th to 29th of August 2018, the European Society of Cardiology host-
ed the annual ESC congress in Munich again. This year, a total of 33 000 health care professionals
attended the 4.5-day event, one the most successful cardiology meetings ever. The attendees came
from more than 150 countries and enjoyed al- most 600 sessions running in parallel in 30 rooms.
Importantly, more than 10 000 scientific abstracts were submitted and 4 461 were selected for oral
or poster pre- sentation. Among the top 10 abstract-submitting countries were Germany, the United
Kingdom, France, Italy, Japan, the United States, and China. These facts un- derscore the
transition of a European congress into a worldwide, global meeting!

More than 1 500 faculty members from over 80 different countries had active roles at the ESC
congress 2018 in Munich. Importantly, a further increase to 25% of all faculty was noted in the
number of women involved in the program.

The opening ceremony on the 26th of August highlighted the progress that has been made over the
last decades in cardiovascular medicine. Eugene Braunwald elegantly summarized the enormous
progress in lipid-lowering therapy, which was only possible through the intensive collaboration
between physicians, research- ers, and the pharmaceutical industry. Another highlight was Barbra
Streisand’s welcome address to our delegates. The ESC gold medals were awarded to Ottavio Alfieri,
Evgeny Shlyakhto, and Marc Pfeffer for their enormous contributions to academic medicine and
science. A significant number of travel grants were giv- en to young researchers and clinicians to
spend time in a center of excellence in Europe.

The facilities of the congress center in Munich were excellent, and 9 villages covered all the
important topics in the entire spectrum of cardiology: electro- physiology, heart failure, valvular
heart disease, coronary artery disease, coronary intervention, hypertension, prevention, basic
science, and cardiac imaging. Excellent state-of-the-art overviews were provided by luminary
speakers from all over the world. In the oral abstract presentations, a new interactive app was
intro- duced enabling the audience during the sessions to submit their questions, which could then
be addressed in the subsequent discussion.

More discussions took place in the popular “hubs” (open areas in the congress center, where the
audience is seated around the speaker and interactive discus- sions take place), a concept
introduced several years ago by Keith Fox.

A specific forum for new developments in digital health was created, where tech- nology meets
cardiology and where attendees could learn about the increasing possibilities and opportunities in this field, including telemedicine, telemonitoring, mobile apps, and many more applications.

Much attention was paid to the area where the poster presentations took place: open, spacious areas
with colorful lighting and soft music, inviting participants to enter into lively discussions.

An overwhelming exhibition area was created, where delegates could learn about the latest
developments in the pharmaceutical and medical device industry, as well the rapidly evolving
possibilities in (noninvasive and invasive) imaging technology.

The spotlight of the ESC congress 2018 was “heart valve disease” and many ses- sions were dedicated
to the diagnosis and treatment of valvular heart disease (specifically aortic stenosis and mitral
regurgitation, but also endocarditis and rheumatic heart disease). With the increasing interest in
transcatheter heart valve therapy, a significant part of the program involved the innovations in
this field, with a focus on expanding indications for transcatheter aortic valve replacement and
MitraClip. A highlight was the Andreas Gruentzig Lecture given by Martin Leon on the past, present,
and future of transcatheter heart valve therapy.

Innovations in cardiology were discussed extensively in the “ innovation corner,” and a special
moment was the first Paul Hugenholtz Lecture, given by Francesco Maisano.

Furthermore, four new guidelines were presented at this year’s congress on highly relevant clinical
topics, including myocardial revascularization, hypertension, syn- cope, as well as pregnancy and
heart disease. In addition, the fourth edition of the universal definition of myocardial infarction
was released.

Finally, the most important, exciting new science was presented in the traditional Hotline
sessions, with specific sessions on the latest new trials in pharmacother- apy, coronary
interventions, electrophysiology and devices, heart failure, heart valves, and imaging. Several of
these trials will have an impact on the practice of cardiology. Here is a short summary of some of
the leading trials:

  • The GLOBAL LEADERS trial (16 000 patients) failed to show any benefit of 23 months of ticagrelor
    after 1 month of DAPT following PCI over standard treat- ment to prevent adverse outcome during
    2-year follow-up.
  • The ATTR-ACT trial (almost 450 patients, follow-up 30 months) illustrated the benefit (event-free
    survival) of tafamidis in patients with transthyretin amyloid cardiomyopathy.
  • The CAMELLIA-TIMI 61 trial (12 000 patients, follow-up 3.3 years) demonstrated the cardiovascular
    safety of lorcaserin in obese patients.
  • The MARINER trial (more than 12 000 patients, follow-up 45 days after hos- pitalization) did not
    show any benefit of rivaroxaban in preventing (venous) thromboembolic events after hospitalization.
  • The COMMANDER HF trial (more than 5 000 patients) did not show any benefit of rivaroxaban in
    patients hospitalized with heart failure during 21 months of follow-up.
  • The SCOT-HEART trial showed that CT coronary angiography is an alternative to standard care in
    patients with chest pain and low-intermediate pre-test likeli- hood of coronary artery disease.
  • The ARRIVE study (>12 500 patients, follow-up 60 months) did not show any benefit of aspirin in
    patients with intermediate risk (based on traditional risk factors), but a trend towards lower
    prevalence of infarction in patients taking aspirin was noted.

Finally, much was also done for the physicians who could not attend the 2018 ESC congress in
person: every day, the highlights were broadcast from the ESC TV stu- dio and all sessions were
recorded and can be reviewed at any time during the coming year in our ESC congress 365 program.

In the current issue of Dialogues in Cardiovascular Medicine, various experts in different fields
of cardiology share their experiences at the 2018 ESC congress. They provide summaries of the
different subspecialties in cardiology. Specifically, Martin Cowie reports on advances in (digital)
technology, whereas Michel Komajda and others address novelties in prevention and treatment, and
Filippo Crea sum- marizes the new ESC guidelines, the different ESC registries, and new important
clinical trials presented at the 2018 ESC congress. In addition, Kim Fox and Roberto Ferrari
provide an excellent comprehensive overview of studies in heart disease published in the major
journals during the last year.

We hope you will appreciate these highlights of the 2018 ESC congress in the current issue of
Dialogues in Cardiovascular Medicine!