Highlights of ESC 2024

The world’s leading cardiology experts convened in London, UK and online at the European Society of Cardiology 2024 congress (ESC 2024, 30 August – 2 September). ESC 2024 aimed to transform patient care and advance the field through ground-breaking research, pioneering technologies, and collaborative initiatives. Here is our curated list of the top 10 sessions from the European Society of Cardiology’s annual congress.

ABYSS¹ (NCT03498066)sought to explore the appropriate duration of treatment with beta-blocker drugs following myocardial infarction (MI). Investigators enrolled 3698 patients with a history of MI who were all receiving long-term beta-blocker treatment. All patients had a left ventricular ejection fraction (LVEF) ≥40%. No patients had experienced a cardiovascular event in the previous 6 months. Investigators randomized patients to either continue (n=1852) or discontinue (n=1846) their beta-blockers. After a median follow-up of three years, beta-blocker interruption was not found to be noninferior to beta-blocker continuation.

The ADMINISTER² trial (NCT05413447) explored if uptake of guideline-directed medical therapy (GDMT) could be improved by using digital consults (DCs). Investigators randomized 150 patients with heart failure and reduced ejection fraction (HFrEF) to receive usual care or participate in DCs. At a 12-week follow-up, ADMINISTER met its primary outcome of achieving a higher uptake of GDMT in the DC group.

MATTERHORN³ (NCT02371512): Current treatment recommendations for patients with heart failure (HF) and secondary mitral regurgitation include transcatheter edge-to-edge repair and mitral-valve surgery. Investigators randomized 210 patients with HF and secondary mitral regurgitation to undergo one of these two procedures. At one year, edge-to-edge repair was noninferior to mitral-valve surgery regarding death, rehospitalisation for HF, reintervention, assist device implantation and stroke.

The OCCUPI⁴ trial (NCT03625908) generated more evidence for the use of optical coherence tomography (OCT) as an effective intravascular imaging modality. Investigators randomized 1604 patients with complex coronary artery disease (CAD) to undergo OCT-guided percutaneous coronary intervention (PCI) or angiography-guided PCI. They then compared the rates of major adverse cardiac events (MACE) between the two groups at one year. Patients in the OCT-guided group had a lower rate (4.6%) of MACE than patients in the angiography-guided group (7.4%).

NOTION-3⁵ (NCT03058627)explored the benefits of PCI in patients with stable CAD and severe aortic stenosis receiving transcatheter aortic-valve implantation (TAVI). Investigators randomized 455 patients to receive either PCI (n=227) or conservative treatment (n=228). The number of patients experiencing all-cause mortality, MI, or urgent PCI at one year served as the composite primary outcome. Patients in the PCI group showed a lower risk of the composite outcome than patients in the conservative treatment group.

SHAM-PVI⁶ (NCT04272762) aimed to determine if pulmonary vein isolation (PVI) has a placebo effect in treatment of atrial fibrillation (AF). The trial randomized 126 patients with symptomatic AF to either undergo PVI (n=64) or a sham/placebo procedure (n=62). AF burden at six months served as the primary outcome measure. Participants who received PVI showed both a statistically significant and clinically important decrease in AF burden as compared to placebo.

SENIOR-RITA⁷ (ISRCTN11343602) compared two different management strategies for older adults who had experienced non-ST-segment elevation MI (NSTEMI). The management strategies were medical therapy with or without invasive treatment (defined as coronary angiography and revascularization). Investigators randomized 1518 patients aged ≥70 years of age in a 1:1 ratio to the two treatment groups. A composite of death from cardiovascular causes or nonfatal MI assessed in a time-to-event analysis comprised the primary outcome. The median follow-up was 4.1 years. Patients who received invasive therapy showed no lower risk of the primary outcome than patients who received conservative treatment.

The EARTH STEMI⁸ meta-analysis was an individual patient level data meta-analysis of seven randomized clinical trials. It compared outcomes with complete versus culprit only revascularization among 1,733 patients aged ≥75 years with STEMI and multivessel disease. A composite of death, any MI, or ischemia driven revascularization comprised the primary endpoint. Complete revascularization lowered the incidence of ischemic events up to 4 years after STEMI among these patients. However, it did not reduce all-cause mortality. Additional data are needed to elucidate whether complete revascularization is beneficial beyond 4 years.

The RHEIA trial⁹ compared outcomes with TAVI versus surgical aortic valve replacement (SAVR) in females with severe symptomatic aortic stenosis. Investigators randomized 443 women to receive transfemoral TAVI with a balloon-expandable Sapien 3 or Sapien 3 Ultra valve, or SAVR. The clinical efficacy composite endpoint comprised all-cause mortality, stroke, or rehospitalization at one year. At one year, the patients who had undergone TAVI showed better outcomes than those who had undergone SAVR. The difference between the groups was largely attributed to reduced hospitalization in the TAVI group. These findings cannot be extrapolated to other valve types.

Women’s Health Study (NCT00000479)¹⁰: Researchers followed 27,939 initially healthy U.S. women for 30 years. They measured high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) levels at baseline, and explored if these biomarkers could predict cardiovascular risk. Investigators designated a first MACE as their primary endpoint. A single combined measure of these biomarker levels proved to be predictive of incident cardiovascular events during the 30-year period.

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Author: Kelly Schoonderwoerd

References

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