The American College of Cardiology (ACC) 2021 scientific sessions took place virtually this year from 15-17 May. Here is our curated list of the top 10 highlights of these sessions.
TALOS-AMI trial1: This trial followed 2697 patients who had experienced myocardial infarction (MI), undergone percutaneous coronary intervention (PCI), and completed 1 month of dual antiplatelet therapy (DAPT) with aspirin and ticagrelor (NCT02018055). Participants were randomized to either continue this protocol (n=1348) or to switch from ticagrelor to clopidogrel (while continuing to also take aspirin) (n=1349). The primary outcome was a composite of major adverse cardiac events (MACE) (cardiovascular death, MI, and stroke) and bleeding academic research consortium bleeding (BARC) events at 1 year. Fewer MACE and bleeding events occurred in the clopidogrel group than in the ticagrelor group. TALOS-AMI was conducted exclusively in South Korea; therefore, it remains unknown if results are generalizable to all ethnic groups.
ISCHEMIA trial2: A pre-planned sub-study of the ISCHEMIA trial (NCT01471522) showed that in patients with chronic coronary disease, better long-term outcomes may be achieved using an invasive approach over a conservative approach, if anatomic complete revascularization is achievable.
GALACTIC HF trial3: A pre-planned sub-analysis of the GALACTIC HF trial (NCT02929329) divided the trial’s 8256 participants with heart failure (HF) and reduced ejection fraction (HFrEF) into quartiles based on baseline left ventricular ejection fractions (LVEF); namely, LVEFs of ≤22%, 23-28%, 29-32%, and ≥33%. LVEF was the strongest modifier of the effect of omecamtiv mecarbil (a cardiac myosin activator) on the primary composite outcome of HF events and cardiovascular deaths. Participants with the lowest LVEF (≤22%) showed the most benefit from omecamtiv mecarbil. Safety and tolerability profiles were comparable across quartiles.
SOLOIST-WHF and SCORED trials4: A pre-planned meta-analysis of pooled data from the SOLOIST-WHF (NCT03521934) and the SCORED (NCT03315143) trials found that sotagliflozin reduced the primary composite outcome of cardiovascular death and the total number of either hospitalizations or urgent outpatient visits for HF across the entire range of LVEF. The range of LVEF analyzed included participants with HFrEF (LVEF <40%), HF with mid-range ejection fraction (40-<50%), HF with preserved ejection fraction (HFpEF) (≥50%), as well as participants with no history of HF and an ejection fraction of ≥50%.
PIROUETTE trial5: This phase 2 trial (NCT02932566) evaluated the safety and efficacy of pirfenidone in 94 patients with HFpEF. At one year, there was a marked decrease in extracellular volume as measured by cardiac MRI in patients who had taken pirfenidone as compared with placebo. Future prospective studies are being planned to evaluate if pirfenidone can significantly reduce a composite of annual rate of hospitalization for HF or all-cause mortality in patients with HFpEF.
TWILIGHT trial6: A gender-based analysis of the results from the main TWILIGHT study (NCT02270242) showed that the clinical benefits of withdrawal of aspirin therapy following 3 months of DAPT (with Ticagrelor and aspirin) were generally the same in men and women. Switching to an antiplatelet therapy using only ticagrelor reduced bleeding events, with no corresponding increase in ischemic events among patients deemed to be at high risk for bleeding or ischemic events following PCI.
HOST-EXAM study7: Clopidogrel monotherapy was superior to aspirin monotherapy in patients who had experienced an event-free 6-12 months following PCI using a drug-eluting stent over a 2-year follow-up period. Clopidogrel was associated with both fewer thrombotic and bleeding endpoints. HOST-EXAM (NCT02044250) was conducted exclusively in South Korea; therefore, it remains unknown if results are generalizable to all ethnic groups.
TRISCEND study8: This early feasibility study assessed the performance and safety of the Edwards EVOQUE tricuspid valve replacement system. In patients with significant tricuspid regurgitation (TR) who received the EVOQUE system, results at 30-days showed a reduction of TR and improvement of symptoms. The majority of patients experienced no major adverse events. Researchers have now initiated TRISCEND 2 (NCT04482062); a prospective, multi-centre, randomized controlled pivotal clinical trial which will evaluate the safety and efficacy of the EVOQUE System with optimal medical therapy (OMT) compared to OMT alone in the treatment of patients with TR. (NCT04221490)
FLOWER-MI trial9: Fractional flow reserve (FFR)-guided revascularization showed no benefit over angiography-guided revascularization in patients with ST-elevated MI (STEMI) and multi-vessel disease at reducing the composite primary outcome of death from any cause, non-fatal MI, or hospitalization requiring urgent revascularization. (NCT02943954)
RADIANCE-HTN trial10: Thermal ablation of renal sympathetic nerves with ultrasound was more effective at reducing blood pressure than a once daily, fixed-dose, single-pill combination of a calcium channel blocker, an angiotensin receptor blocker, and a thiazide diuretic after 2 months. If these benefits are maintained in the long-term, renal denervation may become an alternative to managing essential hypertension. (NCT02649426)
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Author: Kelly Schoonderwoerd
- Presented by Dr. Kiyuk Chang at the ACC 2021 Scientific Session, 15-17 May 2021.
- Presented by Dr. Gregg Stone at the ACC 2021 Scientific Session, 15-17 May 2021.
- Teerlink J et al. JACC 17 May 2021.
- Presented by Dr. Deepak Bhatt at the ACC 2021 Scientific Session, 15-17 May 2021.
- Presented by Dr. Chris Miller at the ACC 2021 Scientific Session, 15-17 May 2021.
- Vogel B et al. JAMA 15 May 2021.
- Presented by Dr. Hyo-Soo Kim at the ACC 2021 Scientific Session, 15-17 May 2021.
- Presented by Dr. Susheel Kodali at the ACC 2021 Scientific Session, 15-17 May 2021.
- Puymirat et al. NEJM 16 May 2021.
- Azizi M et al. The Lancet 16 May 2021.