The American College of Cardiology (ACC) 2022 Scientific Session was a hybrid event which took place from April 2 to 4, 2022, in Washington, USA and online. Here is the curated list of the top highlights of the ACC 2022 sessions.
SODIUM-HF trial1: This international trial (NCT02012179) followed 806 adult patients with chronic heart failure (CHF) receiving optimally tolerated guideline-directed medical treatment, stratified to either usual care or to a low sodium diet interventions. The primary endpoint was cardiovascular (CV)-related admissions to hospital, emergency room (ER) visits or all-cause death within 12 months. These composite events occurred in 17% of usual-care patients and in 15% of the low-sodium group; these outcomes were not considered statistically significant.
VALOR-HCM2: The VALOR-HCM trial (NCT04349072) results showed mavacamten significantly decreased septal reduction therapy (SRT) procedures vs placebo in patients with symptomatic obstructive hypertrophic cardiomyopathy (OHCM), who were considered eligible for SRT. Only 17.9% of patients on mavacamten decided to undergo SRT, while 76.8% of patients assigned to placebo underwent SRT (p=<0.0001). These results may indicate that for severe, symptomatic OHCM, mavacamten may be an effective alternative therapy to SRT.
POISE-33: The POISE-3 trial (NCT03505723) followed 9535 patients undergoing noncardiac surgery, at risk of major bleeding or vascular events post-surgery, randomized to tranexamic acid (TXA) or to placebo. Primary efficacy outcomes confirmed TXA reduced composite bleeding events by 24% vs placebo (p<0.0001). However, TXA’s noninferiority to placebo was not established (TXA [14.2%] vs placebo [13.9%] regarding the primary safety outcome of composite cardiovascular (CV) outcomes events.
APOLLO4: The phase 1 APOLLO study (NCT04606602) of a short interfering RNA (siRNA), SLN360, enrolled 32 participants with elevated plasma lipoprotein A [Lp(a)] and no known CV disease [CVD]. Results indicated a single subcutaneous (SC) injection of SLN360 versus placebo was well tolerated, with a dose-dependent reduction of Lp(a) observed in up to 98% of participants, which persisted for 150+ days after administration. These findings may merit further efficacy and safety analyses of SLN360.
PROTECT TAVR5: This PROTECT TAVR study examined the safety and efficacy of same-day discharge (SDD) after transcatheter aortic valve replacement (TAVR) during the COVID-19 pandemic. Over 2000 patients underwent elective transfemoral TAVR between March 2020 and August 2021; 124 were selected for SDD. The primary endpoint, comprising CV death, stroke, myocardial infarction (MI), all-cause readmission, major vascular complications, and new permanent pacemaker (PPM) implantation, occurred in 5.7% of patients, suggesting SDD post-TAVR may be feasible in selective patients, even post-pandemic.
SCORED6: Secondary analyses of the SCORED trial (NCT03315143) data confirmed sotagliflozin significantly reduced major CV adverse events (MACE) vs placebo in patients with type 2 diabetes and chronic kidney disease, plus major CV risk factors. Among patients with one major CV risk factor (or ≥2 minor CV risk factors), sotagliflozin exhibited a 26% relative risk reduction in total MACE, while demonstrating significant relative risk reduction vs placebo for total CV deaths, hospitalizations for heart failure (HF), and urgent HF visits. Meaningful MACE benefit appeared within 3 months of sotagliflozin initiation.
ADAPT-TAVR7: The ADAPT-TAVR study (NCT03284827) investigated edoxaban versus dual antiplatelet therapy (DAPT) in 229 patients who had undergone successful TAVR, without indication for anticoagulation (AC) post-procedure. Primary endpoint results trended towards lower incidence of leaflet thrombosis on computed tomography (CT) at 6 months post-procedure in the edoxaban group vs the DAPT group (p=0.076). Although not statistically significant, study results may warrant further research.
NEW HF GUIDELINES8: The 2022 American Heart Association (AHA)/ACC/Heart Failure Society of America (HFSA) HF Guideline replaces the 2013 American College of Cardiology Foundation (ACCF)/AHA Guideline and 2017 ACC/AHA/HFSA HF Guideline. The 2022 HF Guideline incorporates advancements in the management of HF, discussing new therapies, updated evidence for existing treatments, augmented terminologies/classifications, and an amended focus on patient-centered care. Modifications have made the Guideline more ‘user friendly’ and include “cost-value appraisals” for the use/rationalization of certain treatments.
FAME 3 Sub-analysis9: This non-inferiority trial (NCT2100722) studied the impact on quality of life (QoL) for 1500 patients with coronary artery disease (CAD) assigned to coronary artery bypass grafting (CABG) or to fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) with zotarolimus drug-eluting stents (DES). Primary endpoint outcomes comparing the European Quality of Life-5 Dimensions (EQ-5D) summary index revealed no difference between the groups at 12 months (p=0.95), while the EQ-5D trajectory over 12 months differed (p=0.001). QoL trended better with PCI than with CABG over time.
SuperWIN10: The SuperWIN study results (NCT03895580) suggested that in-person nutritional interventions significantly improved adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, as compared with online education. DASH scores differed significantly between the groups in the first 3 months. By 6 months, the variance was no longer significant.
FLAVOUR11: Trial findings (NCT02673424) revealed that FFR-guided PCI was noninferior to intravascular ultrasound (IVUS)-guided PCI for patients with intermediate coronary stenosis. Significantly fewer patients evaluated by FFR underwent PCI as compared to patients evaluated by ultrasound. Investigators found no statistically significant difference in adverse events or in QoL between the groups.
CHAP12: This phase 4 study (NCT02299414) found that active treatment of chronic hypertension (CHTN) in pregnancy (defined as targeting a blood pressure of <140/90 mmHg) significantly reduced the incidence of adverse pregnancy outcomes as compared to usual care, without increasing risk for low birth weight, compared to usual care for pregnant women with mild CHTN.
TRANSLATE-TIMI 7013: Due to overall disappointing results in this Phase 2 study (NCT04516291) combined with hepatic safety concerns, the clinical development program for vupanorsen has been discontinued.
CLASP TR14: The 1-year trial (NCT03745313) results found ‘edge-to-edge’ transcatheter valve repair with the PASCAL system continued to significantly reduce tricuspid regurgitation (TR) and improve QoL in patients with symptomatic, severe TR. These one-year outcomes validate the safety and performance of the investigational device seen at 30 days and 6 months.
PARTITA15: The PARTITA trial (NCT01547208) showed that catheter ventricular tachycardia (VT) ablation after first appropriate implantable cardioverter defibrillator (ICD) shock significantly reduced the risk of all-cause death or hospitalization for HF. Results suggest optimal timing and efficacy of VT ablation may be after the first ICD shock.
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Author: Saskia van Tetering
- Ezekowitz JA et al. The Lancet 2 April 2022.
- Presented by Dr. Milind Y. Desai at the American College of Cardiology Annual Scientific Session (ACC 2022), Washington, DC, 2 April 2022.
- Devereaux PJ et al. N Engl J Med. 2 April 2022.
- Nissen SE et al. JAMA 3 April 2022.
- Barker M et al.J Am Coll Cardiol Intv. 2022 Mar, 15 (6) 590–598
- Presented by Deepak L. Bhatt at the American College of Cardiology Annual Scientific Session (ACC 2022), Washington, DC, 2 April 2022.
- Park DW et al. Circulation 4 April 2022.
- Heidenreich PA et al. J Am Coll Cardiol 1 April 2022.
- Fearon WF et al. Circulation 2 April 2022.
- Presented by Dr. Dylan Steen at the American College of Cardiology (ACC) 2022 Scientific Session, Washington, DC, 3 April 2022.
- Presented by Dr. Bon-Kwon Koo at the American College of Cardiology Annual Scientific Session (ACC 2022), Washington, DC, 4 April 2022.
- Tita AT et al. N Eng J Med 2 April 2022.
- Bergmark BA et al. Circulation 4 April 2022.
- Presented by Dr. Adam Greenbaum at the American College of Cardiology Annual Scientific Session (ACC 2022), Washington, DC, 4 April 2022.
- Della Bella P et al. Circulation 3 April 2022.