Science News for Scientific Sessions 2019
#AHA19 Helpful Links
AHA Conferences App:
- AHA News - consumer audience
Late Breaking Science I – Outside the Box: New Approaches to CVD Risk Reduction
Innovative Strategies for Reducing Cardiovascular Risk
Joseph A. Hill, MD, PhD and Aruna Das Pradhan, MD, MPH discuss the trials presented in the first late breaking science session during Scientific Sessions 2019: DAPA-HF, ORION-10, COLCOT, BETonMACE.
DAPA-HF: The Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure Trial: Results in Nondiabetic Patients
John J V McMurray | BHF Cardiovascular Research Centre, Glasgow, United Kingdom
Results: In HFrEF patients both with and without T2DM, dapagliflozin + standard therapy reduced the risk of worsening HF events and CV death and improved symptoms.
See our special in-depth DAPA-HF page for slides, videos and commentary from this study.
Safety and Efficacy of Inclisiran in Patients With ASCVD and Elevated LDL Cholesterol - Results From the Phase 3 ORION-10 Trial
R. Scott Wright | Mayo Clinic, Rochester, MN
Results: Twice-yearly inclisiran safely reduced LDL-C in ASCVD patients with continued high LDL-C while on maximum tolerated statin dose.
See our special in-depth ORION-10 page for slides, videos and commentary of this study.
The COLchicine Cardiovascular Outcomes Trial (COLCOT)
Jean-Claude Tardif | Montreal Heart Institute, Montreal, QC, Canada
Results: Colchicine compared to placebo reduced the risk of ischemic CV events in patients with a recent MI.
See our special in-depth COLCOT page for slides, videos and commentary of this study.
Effect of BET Protein Inhibition With Apabetalone on Cardiovascular Outcomes in Patients With Acute Coronary Syndrome and Diabetes - Results of the BETonMACE Trial
Kausik K Ray, Imperial College of London, London, United Kingdom
Results: In patients with ACS, DM, and low HDL-C, apabetalone, a selective BET protein inhibitor, did not significantly improve CV outcomes. CV outcomes trend was favorable.
See our special in-depth BETonMACE page for slides, videos and commentary of this study.
Late Breaking Science II – Results for the Ischemia Trials: To Intervene or Not to Intervene
The ISCHEMIA Trials
Elliott Antman, MD, Alice Jacobs, MD, and John Spertus, MD, MPH discuss the significance of the results of the three highly anticipated ISCHEMIA trials which were presented during Scientific Sessions 2019.
ISCHEMIA - International Study of Comparative Health Effectiveness With Medical and Invasive Approaches: Primary Report of Clinical Outcomes
Judith S Hochman | NYU School of Medicine, New York, NY; ISCHEMIA Research Group
Results: In SIHD patients with moderate-severe ischemia, initial revascularization + OMT compared to OMT alone did not reduce the risk for adverse CV outcomes.
See our special in-depth ISCHEMIA page for slides, videos and commentary of this study.
International Study of Comparative Health Effectiveness With Medical and Invasive Approaches- Chronic Kidney Disease (ISCHEMIA-CKD): Primary Results of Clinical Outcomes
Sripal Bangalore| New York University School of Medicine, New York, NY; ISCHEMIA-CKD Research Group
Results: In SIHD patients with moderate-severe ischemia and CKD, the risk of adverse clinical outcomes with an initial invasive strategy was not reduced compared to an initial conservative OMT strategy.
See our special in-depth ISCHEMIA-CKD page for slides, videos and commentary of this study.
Late Breaking Science III — Controversies in Contemporary Management of AS
Global Comparison of a Rivaroxaban-Based Antithrombotic Strategy versus an Antiplatelet-Based Strategy After Transcatheter Aortic Valve Replacement to Optimize Clinical Outcomes (GALILEO) Trial: Primary Results
George Dangas | Mount Sinai Hospital, New York, NY
Results: More complications were seen with rivaroxaban-based vs antiplatelet-based antithrombotic therapy after TAVR in patients without an established indication for anticoagulation. Study suggests routine anticoagulation with rivaroxaban after TAVR not needed in the absence of another specific indication. Future trials needed.
See our special in-depth GALILEO page for slides, videos and commentary of this study.
Randomized Clinical Trial Comparing a Rivaroxaban-Based Strategy With an Antiplatelet-Based Strategy for the Prevention of Subclinical Leaflet Thrombosis in Transcatheter Aortic Valves (GALILEO-4D)
Ole De Backer | Rigshospitalet University Hospital, Copenhagen, Denmark
Results: CT imaging finds decrease in subclinical leaflet thrombosis in TAVR valves with rivaroxaban-based strategy compared to antiplatelet-based strategy. Perspective needed in light of GALILEO findings.
Balloon-Expandable versus Self-Expandable TAVR on Paravalvular Regurgitation and 2-Year Mortality: A Propensity-Matched Comparison From the FRANCE-TAVI Registry
Eric Van Belle | Institute Coeur Poumon - CHU Lille, Lille, France
Results: Registry comparison identifies need for trial to compare latest generation of self- and balloon-expandable valves for para valvular regurgitation and mortality after TAVR.
Van Belle's Abstract
Van Belle's Presentation Slides (PDF)
Discussant Slides (PDF) for Van Belle
Published in Circulation: Balloon-Expandable versus Self-Expanding Transcatheter Aortic Valve Replacement: A Propensity-Matched Comparison from The France-TAVI Registr
Recovery: Early Surgery versus Conventional Management for Asymptomatic Severe Aortic Stenosis
Duk-Hyun Kang | Asan Medical Center, Seoul, Republic of Korea
Results: Composite and all-cause death were lower with early surgery versus conventional treatment for asymptomatic, severe AS.
See our special in-depth RECOVERY page for slides, stats and background of this study.
More science from Friday and Saturday
AHA News article: AHA tackles youth vaping crisis with massive new initiative – Learn about the $20 million End the Lies Youth Vaping and Nicotine Research Initiative to drive scientific discovery to help end teen vaping
- Sessions Daily News Article: Saturday, Nov. 16
- AHA News Release: Vaping industry faces a triple threat - science, advocacy and community action
- Website: Quitlying.org
AHA News article: E-cigarettes match traditional smoking in some heart risks
AHA News article: Flu shot may aid heart bypass recovery
Late Breaking Science IV – State of the Art Interventional Management for ACS Patients
State of the Art interventional Management for ACS Patients
J. Dawn Abbott, MD, provides an overview of the science presented during a late-breaking session that examined new and trending interventions for acute coronary syndrome. Dr. Abbott looks at COACT, OCT COMPLETE, and PCI with different kinds of heart pumps.
NHLBI-funded Research at Scientific Sessions 2019: COLCOT, ISCHEMIA, FUEL
Donald M. Lloyd-Jones, MD and David C. Goff, Jr, MD, Director, Division of Cardiovascular Sciences, NHLBI, NIH discuss implementation of a new NHLBI strategic plan for cardiovascular science and some of the NHLBI-funded research presented during Scientific Sessions 2019.
TWILIGHT-ACS: Ticagrelor with Aspirin or Alone in High-Risk Patients after Coronary Intervention for Acute Coronary Syndrome
Usman Baber | Icahn School of Medicine at Mount Sinai, New York, NY
Results: Subgroup analysis of ticagrelor alone versus ticagrelor + aspirin in NSTE-ACS after PCI found less clinically relevant bleeding; similar rates of death, MI, and stroke.
Colchicine in Percutaneous Coronary Intervention
Binita Shah | VA NY Harbor Healthcare System, NYU School of Medicine, New York, NY
Results: Pre-PCI colchicine reduced post PCI inflammation but not the risk of PCI-related myocardial injury.
See our special in-depth Colchicine-PCI page for slides, videos and commentary of this study
OCT COMPLETE: Non-culprit Lesion Plaque Morphology in Patients with ST-segment Elevation Myocardial Infarction: Substudy from the Complete Trial using Optical Coherence Tomography
Natalia Pinilla Echeverri | McMaster University, Hamilton, ON, Canada
Results: Obstructive non-culprit lesions with complex vulnerable plaque morphology found in almost half of STEMI and multi-vessel disease patients.
COACT: One Year Outcomes of Coronary Angiography After Cardiac Arrest
Mortality and Bleeding Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock Undergoing Percutaneous Coronary Intervention With Impella™ vs Intra-Aortic Balloon Pump
Sanket Dhruva | UCSF School of Medicine, San Francisco, CA
Results: Observational analysis of cardiogenic shock and high-risk PCI patients found the Impella® ventricular assist device was associated with more death, bleeding, stroke and higher costs than intra-aortic balloon pumps.
Comparative Effectiveness and Costs of Impella versus Intra-aortic Balloon Pump in the United States
Amit P Amin | Washington University School of Medicine, Saint Louis, MO
Results: Released after presentation
Amin's Presentation Slides (PDF)
Discussant Slides (PDF) for Amin
Published in Circulation: The Evolving Landscape of Impella™ Use in the United States Among Patients Undergoing Percutaneous Coronary Intervention with Mechanical Circulatory Support
The session featured AHA President Bob Harrington, MD, AHA CEO Nancy Brown and Muratz Sönmez, World Economic Forum managing board member. Read session highlights.
The 2019 recipients of the AHA Distinguished Scientists Award are recognized for their years of scientific excellence to the cardiovascular community.
Late Breaking Science V – Challenges in Heart Failure Management
Challenges in Heart Failure Management
Clyde Yancy, MD, Ileana Piña, MD, and Lynne Warner Stevenson, MD discuss some of the challenges posed by the results of the late breaking heart failure science presented during Scientific Sessions 2019.
FUEL - Results From the Pediatric Heart Network’s Fontan Udenafil Exercise Longitudinal Trial
David J Goldberg, Children's Hospital of Philadelphia, Philadelphia, PA
Results: Exercise performance measures, but not oxygen consumption at peak exercise, improved with udenafil treatment after Fontan. More study needed.
Effect of Treatment According to Age in the Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure Trial (DAPA-HF)
Felipe Martinez |Insto Damic, Cordoba, Argentina
Results: Dapagliflozin + standard therapy reduced the risk of worsening HF events and CV death, and improved symptoms across age groups for patients with HFrEF.
Martinez's Presentation Slides (PDF)
Discussant Slides (PDF) for Martinez
Published in Circulation: Efficacy and Safety of Dapagliflozin in Heart Failure With Reduced Ejection Fraction According to Age: Insights From DAPA-HF
Effect of treatment measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) in the Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure
Mikhail Kosiborod | St. Luke's Health System, Kansas City, MO
Results: HFrEF patients reported improved symptoms, function, and HF-QOL with dapagliflozin compared to placebo across the range of health status outcomes.
McMurray's KCCQ Abstract
McMurray's KCCQ Presentation Slides (PDF)
Discussant Slides (PDF) for McMurray's KCCQ
Published in Circulation: Effects of Dapagliflozin on Symptoms, Function and Quality of Life in Patients with Heart Failure and Reduced Ejection Fraction: Results from the DAPA-HF Trial
PARAGON-HF: LBCT: Effects of Sacubitril/Valsartan in Women Compared to Men With Heart Failure and Preserved Ejection Fraction
John J McMurray | University of Glasgow, Glasgow, United Kingdom
Results: A comparison of the therapeutic effects of sacubitril/valsartan, compared to enalapril or valsartan alone across the spectrum of EF in HF showed therapeutic benefits vary by LVEF. Primary composite event rates decreased as LVEF increased.
McMurray's PARAGON-HF Abstract
McMurray's PARAGON-HF Presentation Slides (PDF)
Discussant Slides (PDF) for McMurray's PARAGON-HF
Published in Circulation: Effects of Sacubitril-Valsartan, versus Valsartan, in Women Compared to Men with Heart Failure and Preserved Ejection Fraction: Insights from PARAGON-HF
PARAGON-HF Secondary Analysis: Effect of Sacubitril/Valsartan Across the Spectrum of Ejection Fraction in Heart Failure
Scott D Solomon, Brigham and Women's Hospital, Boston, MA
Results: A comparison of the effects of sacubitril/valsartan, compared to renin angiotensin system inhibition across the spectrum of EF in HF showed composite primary events decreased as LVEF increased.
Late Breaking Science VI – New Frontiers in Lipid Therapy
New Frontiers in Lipid Therapy
Jennifer Robinson, MD, MPH, Alan Brown, MD, and Samia Mora, MD discuss the clinical implications of the results of the late breaking lipid therapy trials presented during Scientific Sessions 2109.
EVAPORATE: Effect of Icosapent Ethyl on Progression of Coronary Atherosclerosis in Patients With Elevated Triglycerides (200-499mg/dl) on Statin Therapy
Matthew J Budoff | Lundquist Institute and UCLA School of Medicine, Torrance, CA
Results: Icosapent ethyl added to statin therapy in patients with elevated triglycerides significantly slowed coronary atherosclerosis progression.
Safety and Efficacy of Inclisiran in Patients With Heterozygous Familial Hypercholesterolemia - Results From the Phase 3 ORION-9 Trial
Frederick J Raal | Johannesburg Hospital, Johannesburg, South Africa
Results: In patients with heterozygous familial hypercholesterolemia and on maximally tolerated statin dose, twice-yearly inclisiran safely reduced LDL-C approximately 50%.
See our special in-depth ORION-9 page for slides, videos and commentary of this study
RNA Interference Targeting Apolipoprotein C-III Results in Deep and Prolonged Reductions in Plasma Triglycerides
Christie M Ballantyne | Baylor College of Medicine, Houston, TX
Results: In healthy patients and those with severe hypertriglyceridemia and familial chylomicronemia syndrome, ARO-APOC3, a RNAi-based therapy, successfully reduced hepatocyte expression of APOC3, a component of triglyceride-rich lipoproteins, and plasma triglycerides.
RNA Interference Targeting Hepatic Angiopoietin-Like Protein 3 Results in Prolonged Reductions in Plasma Triglycerides and LDL-C in Human Subjects
Gerald F Watts | University of Western Australia, Royal Perth Hospital, Perth, Australia
Results: In this phase 1 study for patients with dyslipidemia, targeting ANGPTL3 with the RNAi drug, ARO-ANG3, resulted in a reduction in ANGPTL3 and mean triglyceride and LDL-C.
Benefit of a Target LDL Cholesterol Less Than 70 mg/dl After an Ischemic Stroke of Atherosclerotic Origin, the Treat Stroke to Target Trial Results
Pierre Amarenco | Paris University, Paris, France
Results: Following an atherosclerotic ischemic stroke, reducing LDL-C to <70 mg/dL compared to 100±10 mg/dL resulted in lower risk for more CV events.
See our special in-depth Treat Stroke to Target page for slides, videos and commentary of this study