Science News from ESC 2020
EMPEROR-Reduced
Empagliflozin in heart failure with a reduced ejection fraction, with and without diabetes
Milton Packer | Baylor College of Medicine, Dallas, TX
RESULTS: Empagliflozin reduced the risk of CV death or hospitalization in patients with HFrEF whether or not they have diabetes. When combined with results from DAPA-HF, findings support the addition of SGLT2 inhibitors to recommended treatments for HFrEF.
EXPLORER-HCM
Efficacy and safety of mavacamten in adults with symptomatic obstructive hypertrophic cardiomyopathy
Iacopo Oilivotto | Careggi University Hospital, Florence, Italy
RESULTS: Mavacamten, a first-in-class cardiac myosin inhibitor, improved heart function and symptoms in patients with obstructive hypertrophic cardiomyopathy. Every aspect of objective performance and subjective well-being improved on treatment, with high statistical significance, vs. placebo.
Also published by AHA on Saturday
Colchicine in Patients with Acute Coronary Syndrome: The Australian COPS Randomized Clinical Trial
David C. Tong, et al.
Circulation, August 29, 2020
Initial Invasive versus Conservative Management of Stable Ischemic Heart Disease Patients with a History of Heart Failure or Left Ventricular Dysfunction: Insights from the ISCHEMIA Trial
Renado D. Lopes, et al
Circulation, August 29, 2020
EAST-AFNET 4
Effects of early rhythm control therapy in patients with atrial fibrillation
Paulus Kirchhof | University Heart and Vascular Center UKE, Hamburg, Germany
RESULTS: Early rhythm control therapy, when compared to usual care, was beneficial for patients newly diagnosed with atrial fibrillation (AF) and overall safety was comparable.
EAST-AFNET 4
Principal Investigator, Paulus Kirchhof, MD summarizes the results of EAST-AFTNET 4, which suggest that early rhythm control therapy for all patients with atrial fibrillation might improve outcomes compared to the current approach of delaying treatment until patients are symptomatic.
ATPCI
Trimetazidine in Angina Patients with Recent Successful Percutaneous Coronary Intervention: a Randomized, Double-Blind, Placebo-Controlled Trial
Roberto Ferrari | University of Ferrara, Ferrara, Italy
RESULTS: Among patients with chronic or acute coronary syndromes who had a recent successful PCI, trimetazidine after PCI did not improve outcomes.
POPULAR TAVI
Aspirin With or Without Clopidogrel after Transcatheter Aortic Valve Implantation
Jorn Brouwer | St. Antonius Hospital, Nieuwegein, The Netherlands
RESULTS: After TAVI, aspirin alone was superior to aspirin plus clopidogrel with respect to bleeding and thromboembolic events in patients not on oral anticoagulation and who had not had coronary stenting.
PARALLAX
Sacubitril/Valsartan versus Individualized RAAS Blockade in Patients with HFpEF
Burkert Pieske | Deutsches Herzzentrum Berlin, Berlin, Germany
RESULTS: In this trial of therapies for patients with HFpEF, sacubitril/valsartan significantly lowered NT-proBNP, but did not meaningfully improve functional capacity compared to optimal medical therapy.
DAPA-CKD
Dapagliflozin in Patients with Chronic Kidney Disease
Hiddo Heerspink | University of Groningen, Groningen, The Netherlands
RESULTS: In chronic kidney disease patients with or without T2DM, dapagliflozin reduced the risk of kidney failure, death from CV causes, HF hospitalization, and all-cause mortality.
Also published by AHA on Sunday
Renal and Cardiovascular Effects of SGLT2 Inhibition in Combination with Loop Diuretics in Patients with Type 2 Diabetes and Chronic Heart Failure: The RECEDE-CHF Trial
Natalie A. Mordi, Ify R. Mordi, Jagdeep S. Singh, Rory J. McCrimmon, Allan D. Struthers, and Chim C. Lang
Circulation, August 30, 2020
LoDoCo2
Colchicine in Patients With Chronic Coronary Disease
Mark Nidorf | GenesisCare, Perth, Australia
RESULTS: In patients with chronic coronary disease, colchicine significantly lowers the risk of major CV events. The reduction, almost one third, was observed rapidly after starting therapy, maintained over time, and is consistent in magnitude with the CANTOS and COLCOT trial findings.
BPLTTC
Blood Pressure Lowering for Prevention of Cardiovascular Events across Different Levels of Blood Pressure
Kazem Rahimi | University of Oxford, Oxford, UK
RESULTS: Blood pressure medication can benefit anyone with an elevated risk of having a heart attack or stroke, not only those with prior CVD or current hypertension.
HOME-PE
Hospitalisation or Outpatient Management of PE Patients - HESTIA vs. Simplified PESI
Pierre-Marie Roy | CHU Angers, Angers, France
RESULTS: Both the Hestia method and sPESI score are useful to identify patients with acute PE whose care can occur safely at home. For more than a third of such patients selected with the two triaging strategies, the rate of complications with home care was low.
Also published by AHA on Monday
Colchicine Attenuates Inflammation Beyond the Inflammasome in Chronic Coronary Artery Disease: A LoDoCo2 Proteomic Substudy
Tjerk S.J. Opstal
Circulation, August 31, 2020
The Effect of Adding Ticagrelor to Standard Aspirin on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting (POPular CABG): A Randomized, Double-Blind, Placebo-Controlled Trial
Laura M. Willemsen, et al
Circulation, August 31, 2020
Antiplatelet Agents Added to Aspirin: No Benefit for SVG Patency After CABG
Steven Goldman
Circulation, August 31, 2020
IMPACT-AFib
Implementation of Stroke Prevention in Atrial Fibrillation
Sean Pokorney | Duke University, Durham, NC
RESULTS: When patients with atrial fibrillation and their healthcare providers received a single mailing describing oral anticoagulant medication benefits, medication use did not increase over one year. More research is needed to assess whether multiple education interventions would have been beneficial.
BRACE CORONA
Continuing vs. Suspending ACE Inhibitors and ARBs in COVID-19
Renato Lopes | Duke University, Durham, NC
RESULTS: Patients taking angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) to control blood pressure or treat heart failure should continue taking those medications even if hospitalized with COVID-19.
REALITY
A Trial of Transfusion Strategies for Myocardial Infarction and Anemia
Philippe Gabriel Steg | Bichat–Claude Bernard Hospital, Paris, France
RESULTS: For patients hospitalized with MI and anemia, a restrictive blood transfusion approach had comparable safety to a liberal approach in preventing 30-day cardiac events while lowering risks of transfusion side effects (infection and acute lung injury).
Also published by AHA on Tuesday
Comparison Between Ticagrelor and Clopidogrel in Elderly Patients with an Acute Coronary Syndrome: Insights from the SWEDEHEART Registry
Karolina Szummer, et al.
Circulation, September 1, 2020
Ticagrelor or Clopidogrel in Elderly Patients with Myocardial Infarction: When the Choice Makes the Difference
Piera Capranzano and Dominick J. Angiolillo
Circulation, September 1, 2020