American Heart Association Scientific Sessions, November 16–18, 2019 (Philadelphia, USA)
The AHA Scientific Sessions event is the annual meeting of the American Heart Association, considered the number one cardiovascular research and education meeting in the world.
ISCHEMIA1: The results of this trial in 5179 higher-risk patients with stable ischemic heart disease were much anticipated. Median follow-up was 3.3 years, with the last patient included not long before the meeting. Initial revascularization on top of optimal medical therapy did not reduce the risk for adverse cardiovascular outcomes. Revascularization did provide greater angina relief however.
ISCHEMIA-CKD2 analyzed a subset of the patients in the ISCHEMIA trial. As well as stable ischemic heart disease and moderate/severe ischemia, these 777 patients also had advanced chronic kidney disease. Patients undergoing cardiac catheterization and revascularization had the same risk of adverse clinical outcomes as patients on optimal medical therapy.
The Colchicine Cardiovascular Outcomes Trial or COLCOT study3 included 4745 participants with recent myocardial infarction. The mean time between myocardial infarction and randomization was 13 days, and patients were followed for a median of 22.6 months. Low-dose colchicine at 0.5 mg daily reduced the risk of ischemic cardiovascular events by 23% relative to placebo.
ORION-104is a trial in patients with atherosclerotic cardiovascular disease and high levels of LDL-C lipids. The study evaluated the safety and efficacy of inclisiran, a new lipid-lowering drug in the class of small interfering (si) RNAs. At 18 months’ follow-up, twice-yearly inclisiran injections safely reduced LDL-C levels relative to placebo. The drug was also safe in patients already taking statins to reduce lipid levels.
TWILIGHT-ACS5 is a subgroup analysis of the Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT) study. The 4614 patients with acute coronary syndrome (ACS) presented with unstable angina or non-ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention. Patients in the ticagrelor monotherapy group had fewer bleeding events than patients on ticagrelor plus aspirin.
A subgroup analysis of the PARAGON-HF trial6 addressed sex differences in patients with heart failure with preserved ejection fraction. The main trial found no clear benefit of sacubitril/valsartan relative to valsartal alone. However, examination of outcomes according to sex revealed a key difference: the effect of the sacubitril/valsartan combination was greater in women, who had a higher reduction in hospitalization for heart failure.
DAPA-HF7: Dapaglifozin is a sodium-glucose cotransporter 2 inhibitor used to prevent heart failure in patients with type 2 diabetes. Whether it can also be used to effectively treat heart failure was unknown. In this study of heart failure patients with reduced ejection fraction, it was better than placebo at preventing cardiovascular deaths and heart failure events. The risk reductions were substantial and consistent across subgroups, including patients without diabetes.
The GALILEO trial8 included patients with transcatheter aortic-valve replacement (TAVR) but no ongoing indication for oral anticoagulation. The study compared a rivaroxaban-based antithrombotic strategy with an antiplatelet-based strategy starting within a week after TAVR. Primary results showed more complications in the rivaroxaban group, including excess ischemic and bleeding events.
GALILEO 4D-CT: Four-dimensional computed tomography (4D-CT) has shown that prosthetic aortic valves can deteriorate. This ancillary study9 determined whether anticoagulation can reduce such deterioration after TAVR. CT imaging showed subclinical leaflet thrombosis in prosthetic valves to be lower in the rivaroxaban group than in the group on an antiplatelet-based strategy. However, caution is advised given the findings of the main GALILEO trial8.
Data from the FRANCE-TAVI registry was used to compare balloon-expandable (BE) and self-expanding (SE) transcatheter heart valves.10 Patients with SE valves had a higher risk of paravalvular regurgitation and higher mortality than those with BE valves. As valve replacement is becoming the first-line treatment for patients with aortic stenosis, a sufficiently powered randomized clinical trial is now needed.
The RECOVERY trial11 compared early surgery with conservative care for asymptomatic aortic stenosis. In this study, 145 patients with severe aortic stenosis were randomized to early surgery or to conservative care as recommended by guidelines. Patients who underwent early aortic valve surgery had a lower rate of operative or cardiovascular death during follow-up.
BETonMACE12: this trial assessed the effect of BET protein inhibition with apabetalone on cardiovascular outcomes in patients with acute coronary syndrome and diabetes. Cardiovascular outcomes were similar in patients receiving apabetalone and those on optimal medical therapy.
Author: Sally Hill