Top 10 Highlights of AHA 2020 Congress

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The American Heart Association (AHA) 2020 congress took place virtually this year, from November 13 to 17, 2020. Here is our curated list of the top scientific sessions from AHA 2020.

SOLOIST-WHF trial¹: Sotagliflozin superior to placebo in preventing deaths and hospitalizations in patients with type 2 diabetes and worsening heart failure. This multicenter, double-blind trial followed 1222 patients for a median of nine months. The primary end point was the total number of deaths from cardiovascular causes and hospitalizations and urgent visits for heart failure. (ClinicalTrials.gov identifier: NCT03521934)

SCORED trial²: Sotagliflozin superior to placebo in preventing deaths and hospitalizations in patients with type 2 diabetes and chronic kidney disease. This multicenter, double-blind trial followed 10,584 patients with type 2 diabetes and chronic kidney disease for a median of 16 months. The primary endpoint was the composite of the total number of deaths from cardiovascular causes and hospitalizations and urgent visits for heart failure. Adverse events were more common in the sotagliflozin group. (ClinicalTrials.gov identifier: NCT03315143)

GALACTIC HF trial³: Omecamtiv mecarbil superior to placebo in preventing deaths and heart failure in patients with chronic heart failure and reduced ejection fraction. This multicenter, double-blind trial followed 8256 patients with chronic heart failure and reduced ejection fraction for a median of 21.8 months. The primary outcome was a composite of a first heart-failure event or death from a cardiovascular event. (ClinicalTrials.gov identifier: NCT02929329)

TIPS-3 trial⁴: Combined treatment with a polypill plus aspirin led to a lower incidence of cardiovascular events than did placebo among participants without cardiovascular disease with an elevated INTERHEART Risk Score. This randomized placebo controlled trial followed 5713 participants for a median of 4.6 years. The polypill (Polycap) contains 25mg hydrochlorothiazide, 100mg atenolol, 10mg ramipril and 40mg simvastatin. (ClinicalTrials.gov identifier: NCT01646437)

RIVER trial⁵: Rivaroxaban noninferior to warfarin in patients with atrial fibrillation and a bioprosthetic valve. This phase 2 randomized trial followed 1005 patients enrolled at 49 sites in Brazil. The mean time to the primary outcome of death, major cardiovascular events, or major bleeding at 12 months was comparable between groups.
(ClinicalTrials.gov identifier: NCT02303795)

RHAPSODY trial⁶: Rilonacept hastens resolution of recurrent pericarditis and lowers future risk. Rilonacept is an interleukin1α and interleukin-1β cytokine trap. This phase 3 trial randomized 61 participants to receive either rilonacept or placebo, weekly over 12 weeks. First recurrence of pericarditis constituted the primary endpoint.
(ClinicalTrials.gov identifier: NCT03737110)

EARLY-AF trial⁷: Atrial fibrillation recurrence significantly lowered using catheter cryoballoon ablation. 303 patients with symptomatic, paroxysmal, untreated atrial fibrillation were randomized to either undergo catheter ablation or to receive antiarrhythmic drugs. The primary end point was the first documented recurrence of any atrial tachyarrhythmia over a follow-up period of 12 months. (ClinicalTrials.gov identifier: NCT02825979)

Evinacumab significantly reduced LDL cholesterol level in patients with refractory hypercholesterolemia⁸. This phase 2 trial investigated the safety and efficacy of varying doses of Evinacumab administered over a 16 week period. The human monoclonal antibody was administered either subcutaneously or intravenously. Both groups receiving Evinacumab at the maximum doses showed >50% reduction of LDL cholesterol levels. (ClinicalTrials.gov identifier: NCT03175367)

PCI performed in non-ischemic lesions associated with greater risk of major adverse cardiac events (MACE)⁹: A retrospective, multicenter population-based cohort study conducted in Canada followed 9106 patients who underwent fractional flow reserve (FFR) studies. Among the patients with a nonischemic FFR (i.e. >.80), those receiving PCI had a higher rate of MACE at 5 years as compared to those with no PCI. Conversely, in the ischemic group (FFR ≤.80), those who underwent PCI had a significantly lower rate of MACE at 5 years. These findings reinforce the importance of following established guidelines, which identify a FFR threshold of ≤.80 to perform PCI. Stenting should be avoided if this threshold is not present.

The SEARCH-AF trial¹⁰monitored rates of post-operative atrial fibrillation (AFib) in post-discharge cardiac surgical patients for 30 days. Previous observational studies have been conducted only during the hospitalization phase. This trial randomized 336 patients to receive either non-invasive continuous cardiac monitoring, or usual care, following cardiac surgery. The group who underwent monitoring revealed an AFib rate that was 10 times higher than the group receiving usual care. The researchers conclude that this strategy could be routinely implemented to help identify patients who could benefit from further intervention (e.g. anticoagulant therapy). (ClinicalTrials.gov identifier: NCT02793895)

RAPID CTCA trial¹¹ fails to show improved outcomes from cardiac CT angiography in patients with chest pain. This randomized trial of 1749 adults with acute chest pain compared early cardiac computed tomography (CT) angiography to usual care alone. At one year, cardiac CT angiography did not reduce the incidence of death or subsequent myocardial infarction. Furthermore, the group receiving CT angiography stayed in hospital longer, and incurred greater health care costs. (ClinicalTrials.gov identifier: 02284191)

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Author: Kelly Schoonderwoerd