Science News from ESC 2020

European Society of Cardiology Congress 2020 | Virtual conference

Selected science from Sat., August 29, 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. 

EMPEROR-Reduced in NEJM
ClinicalTrials.gov NCT03057977

EMPEROR-Reduced

Milton Packer, MD, EMPEROR-Reduced principal investigator, summarizes the trial results in this brief video and explains the study design and its comparison to DAPA-HF, and why the trial was designed with only three endpoints.

EMPEROR-Reduced trial data (PDF)
EMPEROR Reduced trial results - Milton Packer, MD

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. 

EXPLORER-HCM published in JACC
ClinicalTrials.gov NCT03470545

EXPLORER-HCM

Daniel Jacoby, MD, one of the investigators for EXPLORER-HCM, summarizes the results of this Phase III double blind multi-center trial, and how mavacamten may change treatment for HCM patients.
EXPLORER HCM trial data (PDF)
EXPLORER-HCM trial results - Daniel Jacoby, MD

Also published by AHA on Saturday

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 published in NEJM
ClinicalTrials.gov NCT01288352

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.

EAST AFNET 4 trial data (PDF)
EAST-AFNET 4 trial results - Paulus Kirchhof, MD

Selected Science from Sun., Aug. 30, 2020

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.
ATPCI published in The Lancet
ATPCI trial data (PDF)

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.
POPULAR TAVI Published in NEJM
POPULAR TAVI trial data (PDF)

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.
PARALLAX Published in JACC Heart Failure
PARALLAX trial data (PDF)

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.  

DAPA-CKD Discussion

Manesh Patel, MD, Chief, Division of Cardiology, Duke School of Medicine, comments on the results of DAPA-CKD, which found dapagliflozin improved outcomes in patients with chronic kidney disease with and without diabetes.

DAPA CKD trial data (PDF)
ClinicalTrials.gov NCT03036150
DAPA-CKD Discussion - Manesh Patel, MD

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

Selected Science from Mon., Aug. 31, 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.

LoDoCo2 Results

Arend Mosterd, MD, PhD, is the study author of LoDoCo2, a Hot Line trial that studied colchicine's anti-inflammatory effects on patients with chronic coronary disease. He explains the study's design and results on its composite endpoints in this brief video.

LoDoCo2 trial data (PDF)
LoDoCo2 on ANZCTR: ACTRN12614000093684
LoDoCo2 published on NEJM
LoDoCo2 Trial Results - Arend Mosterd, MD, PhD

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.
BPLTTC trial data (PDF)

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.

HOME PE trial data (PDF)
ClinicalTrials.gov NCT02811237

Selected science from Tue., Sept. 1, 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.

IMPACT-AFib

Investigator Sean Pokorney, MD, MBA of the Duke Clinical Research Institute, summarizes the results of IMPACT-Afib and why underuse of anticoagulation in stroke prevention was the target of the trial.

IMPACT-AFib Trial Data (PDF)
Impact-Afib.org
ClinicalTrials.gov NCT0325937
IMPACT-Afib Trial Results - Sean Pokorney, MD, MBA

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.

BRACE CORONA Trial data (PDF)
ClinicalTrials.gov NCT04364893

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).

REALITY results

Investigator Tabassome Simon, MD, PhD summarizes the results of the REALITY, a non-inferiority trial comparing liberal versus restrictive transfusion for post-MI patients with anemia.

REALITY Trial Data (PDF)
ClinicalTrials.gov NCT02648113
REALITY Trial Results - Tabassome Simon, MD, PhD

Also published by AHA on Tuesday