Science News from ACC 2019
Saturday, March 16
Apple Heart Study
Marco Perez, MD summarizes the results of the Apple Heart Study, which tested whether a smart watch application could effectively detect rhythm abnormalities. Jump to the Apple Heart science.
PARTNER 3 Trial
Martin Leon, MD and Michael Mack, MD provide an overview of the results of PARTNER 3 which were presented at ACC 2019 in New Orleans. Jump to PARTNER 3 science.
Self-Expanding Transcatheter or Surgical AVR in Severe AS
Michael Reardon, MD, breaks down the results of this trial comparing self-expanding transcatheters with surgical AVR in patients with severe aortic stenosis with low risk of mortality. Jump to Dr. Reardon's science.
CODIAC QoL: Depression screening after ACS
Principal investigator Ian M. Kronish, MD, MPH, of Columbia University explains whether screening patients for depression post-ACS had an impact on outcomes. Jump to CODIAC QoL science.
Apple Heart Study: Assessment of Wristwatch-Based Photoplethysmography to Identify Cardiac Arrhythmias
Mintu Turakhia and Marco Perez | Stanford University, Stanford, CA
- RESULTS: First-of-its-kind study uses smartwatch app technology to help ID arrhythmias such as atrial fibrillation.
- Apple Heart Study Abstract (opens in new window)
- clinicaltrials.gov NCT03335800 (opens in new window)
- New! Further details on Apple Heart trial
PARTNER 3: The Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis (P3)
Martin Leon | The PARTNER 3 Trial Investigators, Columbia University Medical Center, New York, NY
- RESULTS: Better outcomes for TAVR compared to surgery in low-risk patients with severe, symptomatic AS.
- PARTNER 3 Abstract (opens in new window)
- New! Further details on PARTNER 3
- Published in NEJM (opens in new window): Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients
Self-Expanding Transcatheter or Surgical Aortic Valve Replacement in Patients at Low Risk of Surgical Mortality
Michael J. Reardon | Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- RESULTS: TAVR with self-expanding supra-annular valve was non-inferior to surgical valve replacement for the primary composite endpoint in low-risk patients with severe AS.(opens in new window)
- Reardon's Abstract (opens in new window)
- New! Further details on Self-expanding TAVR vs SAVR trial
- Published in NEJM (opens in new window): Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients
PANACHE: A Trial to Study Neladenoson Bialanate Over 20 Weeks in Patients With Chronic Heart Failure With Preserved Ejection Fraction
Sanjiv Jayendra Shah | Northwestern University, Chicago, IL
- RESULTS: Results were neutral: Neladenoson bialanate, a partial A1-receptor agonist in HFpEF patients, was safe at 20 weeks but no dose-response relationship was demonstrated for any of the endpoints (primary endpoint - improvement in 6 minute walking test).
- PANACHE Abstract (opens in new window)
- clinicaltrials.gov NCT03098979 (opens in new window)
CODIACS-QoL: Comparison of Depression Identification After Acute Coronary Syndrome: Quality of Life and Cost Outcomes
Ian Matthew Kronish | Columbia University Medical Center, New York, NY
- RESULTS: In post-ACS patients with no prior history of depression, there was no significant difference in QALY’s or depression-free days for depression identification after acute coronary syndrome in the three groups studied.
- CODIACS-QoL Abstract (opens in new window)
- clinicaltrials.gov NCT01993017 (opens in new window)
- New! Further details on CODIACS-QoL
- Video: Interview with Ian Kronish, MD, MPH (opens in new window)
Hopeful Heart: Blended Collaborative Care for Heart Failure and Co-Morbid Depression
Bruce Rollman | University of Pittsburgh School of Medicine, Pittsburgh, PA
- RESULTS: '"Blended" (treatment of both depression and HF) collaborative care improved health-related QOL more than usual care at 12 months after HF hospitalization.
- Hopeful Heart Abstract (opens in new window)
- clinicaltrials.gov NCT02044211 (opens in new window)
- Hopeful Heart study website (opens in new window)
PIONEER-HF: Results of the Open-Label Extension
Adam DeVore | Duke Clinical Research Institute, Durham, NC
- RESULTS: Transitioning from enalapril to sacubitril/valsartan (S/V) after discharge in stable HFrEFpatients hospitalized with acute decompensated heart failure (ADHF) significantly reduced NT-proBNP levels.
- DeVore's Abstract (opens in new window)
- clinicaltrials.gov NCT02554890 (opens in new window)
HoT-PE: Home Treatment of Patients with Low-Risk Pulmonary Embolism with the Oral Factor Xa Inhibitor Rivaroxaban: Prospective Management Trial
Stavros V. Konstantinides and Irene Schmidtmann | HoT-PE Investigators, Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany
- RESULTS: Home treatment with rivaroxaban, an oral factor Xa inhibitor, of acute low-risk pulmonary embolism patients (discharged within 48 hours of presentation) resulted in 3 (0.6%) recurrent VTE events, all nonfatal, at 3 months.
- HoT-PE Abstract (opens in new window)
- HoT-PE on EU Clinical Trials Register (opens in new window)
Sunday, March 17
2019 CVD Primary Prevention Guideline: A Deep Dive
Donna Arnett, MSPH, PhD and Erin Michos, MD, MHS provide an in-depth look at the 2019 Guideline on the Primary Prevention of Cardiovascular Disease.
2019 CVD Primary Prevention Guideline: Top Take Home Messages
Donna Arnett, MSPH, PhD and Erin Michos, MD discuss their top take home messages for the new 2019 Guideline on the Primary Prevention of Cardiovascular Disease.
AUGUSTUS Trial
Renato Lopes, MD, MHS, PhD, summarizes the results of the AUGUSTUS trial, which compared treatment outcomes for patients with AF and ACS and/or PCI, and also taking a P2Y12 inhibitor. Jump to AUGUSTUS science.
COAPT: Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation
Federico M. Asch | MedStar Health Research Institute, Hyattsville, MD
- RESULTS: Echocardiography helped in diagnosing secondary mitral regurgitation in HF patients, and informed surgeons of appropriate candidates for transcatheter mitral valve repair (TMVR) and of long-term outcomes.
- COAPT Abstract (opens in new window)
- clinicaltrials.gov NCT01626079 (opens in new window)
Quality of Life After Transcatheter Mitral-Valve Repair in Patients with Heart Failure and Secondary Mitral Regurgitation
Suzanne Arnold | Saint Luke's Mid America Heart Institute, Kansas City, MO
- RESULTS: In COAPT patients with secondary mitral regurgitation (SMR) and HF, transcatheter mitral valve repair (TMVR) with MitraClip demonstrated improved and sustained changes in QOL.
- Arnold's Abstract (opens in new window)
- clinicaltrials.gov NCT01626079 (opens in new window)
STS/ACC Transcatheter Valve Therapy Registry (TVT Registry) (TVTR)
Raj R. Makkar | Cedars Sinai Heart Institute, Los Angeles, CA
- RESULTS: Transcatheter aortic valve replacement (TAVR) with a balloon-expandable Sapien3 valve in bicuspid aortic stenosis resulted in rates of death similar to the normal tricuspid aortic valve, but a greater risk for stroke.
- STS/ACC TVTR Abstract (opens in new window)
- clinicaltrials.gov NCT01737528 (opens in new window)
AUGUSTUS: A Study of Apixaban in Patients With Atrial Fibrillation, Not Caused by a Heart Valve Problem, Who Are at Risk for Thrombosis (Blood Clots) Due to Having Had a Recent Coronary Event, Such as a Heart Attack or a Procedure to Open the Vessels of the Heart
Renato D. Lopes | Duke Clinical Research Institute, Durham, NC
- RESULTS: In patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or PCI and also taking a P2Y12 inhibitor, there was less bleeding and hospitalizations with apixaban without aspirin. Ischemic events differences were not significant for arms that included either or both vitamin K antagonist (VKA) and aspirin.
- AUGUSTUS Abstract (opens in new window)
- Clinicaltrials.gov NCT02415400 (opens in new window)
- New! Further details on AUGUSTUS
- Published in NEJM (opens in new window): Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation
WRAP-IT: World-wide Randomized Antibiotic Envelope Infection Prevention Trial
Khaldoun G. Tarakji | Cleveland Clinic, Cleveland, OH
- RESULTS: An absorbable antibiotic-eluting envelope (TYRX) reduced risk of major cardiovascular implantable electronic device (CIED)-related infections through 12-months post-procedure.
- WRAP-IT Abstract (opens in new window)
- Clinicaltrials.gov NCT02277990 (opens in new window)
- Published in NEJM (opens in new window): Antibacterial Envelope to Prevent Cardiac Implantable Device Infection
POET: Partial Oral Treatment of Left-Sided Infectious Endocarditis Long Term Follow-Up
Henning Bundgaard | The Heart Center, The National University Hospital, Rigshospitalet, Copenahagen, Denmark
- RESULTS: Long-term outcomes (average 3.5 years) for this Danish study found that switching from IV antibiotic treatment after 10 days to oral treatment for left-sided endocarditis caused by certain bacteria resulted in improved long-term survival and less complications.
- POET Abstract (opens in new window)
- clinicaltrials.gov NCT01375257 (opens in new window)
- Published in NEJM (opens in new window): Long-Term Outcomes of Partial Oral Treatment of Endocarditis
MOMENTUM 3: Multi-Center Study of MagLev Technology in Patients Undergoing MCS Therapy With HeartMate 3™ Final Analysis
Mandeep R. Mehra for the MOMENTUM 3 Investigators | Brigham and Women's Hospital Heart and Vascular Center, Boston, MA
- RESULTS: With the magnetically levitated LVAD device used in advanced HF, compared to axial-flow device, there was better disabling stroke-free survival and less need to replace the pump.
- MOMENTUM 3 Abstract (opens in new window)
- clinicaltrials.gov NCT02892955 (opens in new window)
- Published in NEJM (opens in new window): A Fully Magnetically Levitated Left Ventricular Assist Device — Final Report
CardioMEMS HF System Post Approval Study
David Mark Shavelle | University of Southern California, Los Angeles, CA
- RESULTS: Use of the wireless CardioMEMS heart failure sensor to monitor pulmonary artery pressure and signal worsening HF, reduced HF hospitalizations with almost no device complications or sensor failure.
- CardioMEMS-PAS Abstract (opens in new window)
- clinicaltrials.gov NCT02279888 (opens in new window)
REVERSAL: Reversal of the Anti-platelet Effects of Ticagrelor
Deepak L. Bhatt | Brigham and Women's Hospital, Boston, MA
- RESULTS: Phase 1 trial of an antibody-based ticagrelor reversal agent finds PB2452 provided immediate and sustained antiplatelet reversal effects.
- REVERSAL Abstract (opens in new window)
- clinicaltrials.gov NCT02383771 (opens in new window)
- Published in NEJM (opens in new window): Antibody-Based Ticagrelor Reversal Agent in Healthy Volunteers
DEFINE PCI: Physiologic Assessment of Coronary Stenosis Following PCI
Allen Jeremias | Cardiovascular Research Foundation, New York, NY
- RESULTS: Epicardial residual ischemia after successful angiographic PCI occurred in 24% of patients in this study, and did not correlate with the vessel diameter.
- DEFINE PCI Abstract (opens in new window)
- clinicaltrials.gov NCT03084367 (opens in new window)
Impact of FFRCT on 1-Year Outcomes in Patients Evaluated: Lessons from the ADVANCE Registry
Manesh R. Patel | Duke University Medical Center, Durham, NC
- RESULTS: Use of the ADVANCE FFR registry found less revascularization and a trend toward lower adverse events with a negative fractional flow reserve (FFR) compared to those with abnormal FFRs at 1 year.
- Patel's Abstract (opens in new window)
- clinicaltrials.gov NCT02499679 (opens in new window)
MRUSMI: Microvascular Reperfusion Utilizing Sonothrombolysis in Acute Myocardial Infarction
Wilson Mathias | Heart Institute (InCor) - University of Sao Paulo, Sao Paulo, Brazil
- RESULTS: PCI for acute STEMI using sonothrombolysis (diagnostic ultrasound [DUS])-induced cavitation of microbubbles increased rate of early epicardial recanalization and improved systolic function.
- MRUSMI Abstract (opens in new window)
- clinicaltrials.gov NCT02170103 (opens in new window)
GLASSY: GLOBAL LEADERS Adjudication Sub-Study
Marco Valgimigli | GLASSY Investigators, University of Bern, Bern, Switzerland
- RESULTS: After PIC, non-inferiority was demonstrated for ticagrelor monotherapy beyond 1 month for all-cause death, non-fatal MI or stroke, and urgent target vessel revscularization (compared to 12 months of DAPT followed by aspirin alone).
- GLASSY Abstract (opens in new window)
- clinicaltrials.gov NCT03231059 (opens in new window)
Also published Sunday
Circulation – Practice Variation in Anticoagulation Prescription and Outcomes after Device-Detected Atrial Fibrillation: Insights from the Veterans Health Administration
Alexander C. Perino, et al.
Circulation (Editorial) – Device-Detected Atrial Fibrillation: Evidencing the Knowledge Gap
Bart A. Mulder, et al.
Circulation – Effects of canagliflozin on heart failure outcomes associated with preserved and reduced ejection fraction in type 2 diabetes: results from the CANVAS Program
Gemma A Figtree, et al.
Monday, March 18
CREOLE Study
Dike Ojji, MBBS, PhD provides an overview of the results of the CREOLE study, which compared three 2-drug therapy combinations to lower BP in sub-Saharan Africans. Jump to CREOLE science.
Alcohol AF Study
Alexandr Voskoboinik, MD provides an overview of the results of ALCOHOL AF, which tracked the effects of alcohol abstinence in moderate drinkers with atrial fibrillation. Jump to Alcohol AF science.
CLEAR Wisdom: Evaluation of Long-Term Efficacy of Bempedoic Acid (ETC-1002) in Patients With Hyperlipidemia at High Cardiovascular Risk
Anne C. Goldberg | Esperion Therapeutics, Inc., Ann Arbor, MI
- RESULTS: LDL-C was significantly reduced at 12 weeks by bempedoic acid vs placebo in high- CV risk patients with hypercholesterolemia and on maximally tolerated statin doses. Safety was comparable to placebo.
- CLEAR WISDOM Abstract (opens in new window)
- clinicaltrials.gov NCT02991118 (opens in new window)
CREOLE: Comparison of Three Combination Therapies in Lowering Blood Pressure in Black Africans
Dike Ojji | Creole Study Investigators, University of Abuja, Abuja, Nigeria
- RESULTS: For black sub-Saharan African patients, blood pressure was lowered better with amlodipine (a long-acting calcium channel blocker) + either hydrochlorothiazide or perindopril than with perindopril + hydrochlorothiazide (no amlodipine).
- CREOLE Abstract (opens in new window)
- clinicaltrials.gov NCT02742467 (opens in new window)
- New! Further details on CREOLE
INFINITY: Intensive Versus Standard Blood Pressure Lowering to Prevent Functional Decline in Older People
William B. White | University of Connecticut School of Medicine, Farmington, CT
- RESULTS: Using ambulatory BP-guided therapy in patients >75 years (mean 81) of age with HTN, 24-hour BP was lower and white matter volume increased less with intensive compared to standard BP control. No significant improvement in mobility or cognitive function was measured.
- INFINITY Abstract (opens in new window)
- clinicaltrials.gov NCT01650402 (opens in new window)
Effect of Dapagliflozin on Heart Failure and Mortality in Type 2 Diabetes Mellitus Based on Ejection Fraction
Eri T. Kato | TIMI Study Group, Boston, MA
- RESULTS: In patients with T2DM dapagliflozin, a sodium glucose co-transporter 2 inhibitor (SGLT2i), there was less HF hospitalizations seen in those with and without HFrEF, but reduced CV death and all-cause mortality was seen only in those with HFrEF.
- Kato's Abstract (opens in new window)
- clinicaltrials.gov NCT01730534 (opens in new window)
Reduction in Total Ischemic Events with Icosapent Ethyl in REDUCE-IT
Deepak L. Bhatt | for the REDUCE-IT Investigators, Brigham and Women's Hospital, Boston, MA
- RESULTS: Icosapent ethyl vs placebo demonstrated reductions in first, recurrent, and total ischemic event in high CV risk patients (elevated triglycerides, CVD, diabetes) who are also on statins.
- Bhatt's Abstract (opens in new window)
- clinicaltrials.gov NCT01492361 (opens in new window)
- Further details on REDUCE-IT
SAFARI-STEMI: Femoral Versus Radial Access for Primary PCI
Michel R. Le May | University of Ottawa Heart Institute, Ottawa, Canada
- RESULTS: Survival was similar for either radial or femoral access for PCI.
- SAFARI-STEMI Abstract (opens in new window)
- clinicaltrials.gov NCT01398254 (opens in new window)
Coronary Angiography after Cardiac Arrest
Jorrit Lemkes | Amsterdam University Medical Centre, Amsterdam, The Netherlands
- RESULTS: Immediate angiography did not improve 90-day survival more than delaying angiography for successfully resuscitated out-of-hospital cardiac arrest patients without STEMI.
- Lemkes' Abstract (opens in new window)
- clinicaltrials.gov NCT01239914 (opens in new window)
TREAT: Ticagrelor in Patients With ST Elevation Myocardial Infarction Treated With Pharmacological Thrombolysis
Otavio Berwanger | Research Institute - HCor, Sao Paulo, Brazil
- RESULTS: In patients <75 years of age with STEMI treated with fibrinolytic therapy, ticagrelor compared to clopidogrel, did not significantly reduce CV events (CV Death, MI, stroke) at 12 months.
- TREAT Abstract (opens in new window)
- clinicaltrials.gov NCT02298088 (opens in new window)
STOPDAPT-2: ShorT and OPtimal Duration of Dual AntiPlatelet Therapy-2 Study
Hirotoshi Watanabe | STOPDAPT-2 investigators, Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto
- RESULTS: Reducing dual antiplatelet therapy (DAPT) to 1 month (stopping aspirin and continuing clopidogrel, a P2Y12 inhibitor) after implantation of a drug-eluting stent resulted in fewer adverse events by 1 year.
- STOPDAPT-2 Abstract (opens in new window)
- clinicaltrials.gov NCT02619760 (opens in new window)
SMART-CHOICE: Comparison Between P2Y12 Antagonist Monotherapy and Dual Antiplatelet Therapy After DES
Joo-Yong Hahn | Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- RESULTS: P2Y12 inhibitor monotherapy (clopidogrel) was not inferior to DAPT (clopidogrel+aspirin) for major adverse cardiac or cerebrovascular events at 12 months in patients receiving DES implantation.
- SMART-CHOICE Abstract (opens in new window)
- clinicaltrials.gov NCT02079194 (opens in new window)
Alcohol AF: Impact of Alcohol Abstinence in Moderate Drinkers with Atrial Fibrillation: Results from the Alcohol-AF Randomized Controlled Trial
Aleksandr Voskoboinik | Baker Heart & Diabetes Institute, Melbourne, Australia
- RESULTS: Moderate alcohol drinkers ( ≥10 standard drinks/week) with AF who abstained had less recurrent AF, longer AF-free survival and a lower AF burden, as well as lower weight and systolic BP compared to those who continued moderate drinking.
- Alcohol AF Abstract (opens in new window)
- Trial on Australia New Zealand Clinical Trial Registry (opens in new window)
- New! Further details on Alcohol AF
Impact of ADCY9 on Response to Anacetrapib Among 20,000 Participants in the HPS3/TIMI55-REVEAL Trial
Jemma Caroline Hopewell, HPS3/TIMI55 REVEAL Collaborative Group, University of Oxford, Oxford, United Kingdom
- RESULTS: Released after presentation
- Hopewell's Abstract (opens in new window)
- clinicaltrials.gov NCT01252953 (opens in new window)
ODYSSEY OUTCOMES: Lipoprotein(a) Lowering by Alirocumab Contributes to Total Events Reduction Independent of Low-Density Lipoprotein Cholesterol in the ODYSSEY OUTCOMES Trial
Vera Bittner | University of Alabama at Birmingham, Birmingham, AL
- RESULTS: Lipoprotein (a) (Lp(a)) was reduced when alirocumab, a PCSK9 inhibitor, was given to patients with ACS on statins who still have elevated lipoproteins; this was associated with a reduction in total nonfatal CV events. Higher baseline Lp(a) levels had more total event reductions.
- Bittner's Abstract (opens in new window)
- clinicaltrials.gov NCT01663402 (opens in new window)
Dapagliflozin and Outcomes in Patients with Peripheral Artery Disease: Insights from DECLARE - TIMI 58
Marc P. Bonaca | Brigham and Women'S Hospital, Boston, MA
- RESULTS: Patients with T2DM and PAD who were treated with dapagliflozin vs placebo had more absolute risk reductions for CVD and hospitalization for HF, and renal disease progression, compared to those without PAD.
- Bonaca's Abstract (opens in new window)
- clinicaltrials.gov NCT01730534 (opens in new window)
Acute Aortic Dissection: Lessons Learned from 9000 Patients
Kim Eagle | University of Michigan, Ann Arbor, MI
- RESULTS: A 25-year comparison of 3 groups of acute aortic dissection (AAD) patients shows improved survival and a more aggressive surgical approach for type A AAD; for type B AAD, an increased use of stent graft therapy (TEVAR) in place of surgery, no change in hospital survival, but better 5-year survival.
- Eagle's Abstract (opens in new window)
- clinicaltrials.gov NCT01552720 (opens in new window)
Also published Monday
Circulation: Dapagliflozin and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Prior Myocardial Infarction - a Sub-analysis From DECLARE TIMI-58 Trial
Remo H. M. Furtado, et al.
Circulation: Effect of Dapagliflozin on Heart Failure and Mortality in Type 2 Diabetes Mellitus
Eri T. Kato, et al.
Circulation (Editorial): The Serendipitous Story of SGLT2 Inhibitors in Heart Failure: New Insights from DECLARE-TIMI 58
Subodh Verma and John J.V. McMurray
Circulation: Representation of Patients with Cardiovascular Disease in Pivotal Cancer Clinical Trials
Janice Bonsu, et al.