The results of the VICTORIA trial were presented at the American College of Cardiology 2020 Meeting and simultaneously published in the New England Journal of Medicine. The trial demonstrated that vericiguat, an oral guanylate cyclase stimulator, decreased the occurrence of death from cardiovascular cause or hospitalization for heart failure in patients admitted with high-risk heart failure.
The results of a pooled analysis of the ORION-10 and ORION-11 trials were recently presented at the American College of Cardiology 2020 Conference. The combined results published in the New England Journal of Medicine, demonstrated that inclisiran, a drug that inhibits hepatic synthesis of proprotein convertase subtilisin–kexin type 9, reduced low-density lipoprotein (LDL) cholesterol by 50% over 510 days.
A trial led by Dr. Holger Thiele showed that there was no difference in outcomes by 30 days when comparing the use of self-expandable and balloon-expandable valves in transcatheter aortic valve implantation (TAVI). The findings of this study published in the European Heart Journal suggest that both can be safely used in the majority of the population.
A post-hoc analysis of the Drug-Eluting Stents Versus Bare-Metal Stents in Saphenous Vein Graft Angioplasty (DIVA) trial was recently published in Circulation: Cardiovascular Interventions. The study led by Dr. Faisal Latif showed that in patients undergoing percutaneous coronary intervention (PCI) of a de novo saphenous vein graft lesion, there was no difference in target vessel failure at 12 months between the stent-only and balloon-stent group. However, stent thrombosis and target vessel myocardial infarction (MI) rates were lower in the stent-only group over a longer duration of follow up.
A randomized controlled trial led by Dr. Seung-Yul Lee published in Circulation: Cardiovascular Intervention showed that in patients who required percutaneous coronary intervention, the use of optical coherence tomography (OCT) to help guide bioresorbable vascular scaffold (BVS) implantation did not reduce the incidence of nonoptimal deployment as compared to angiography guided BVS implantation.
A study led by Dr. Michinari Hieda published in Circulation showed that left ventricular myocardial stiffness is greater in patients with left ventricular hypertrophy and elevated cardiac biomarkers as compared to healthy controls. This may represent the transitional state from a normal healthy heart to heart failure with preserved ejection fraction (HFpEF).
Statins, especially high-intensity statins, could reduce the risk of a composite of death, stroke, acute coronary syndrome, or major bleeding as compared to a placebo in patients with acute ischemic stroke and atrial fibrillation. The observational study that was published in the Journal of the American Heart Association highlights the need for a further randomized control trial to further explore this observation.
In patients with stable coronary artery disease, a decrease in circulating progenitor cell count during exercise is associated with worse disease prognosis compared to the presence of stress-induced myocardial ischemia. The study led by Dr. Kasra Moazzami that was published in JAMA Cardiology highlights the need to identify whether strategies to improve circulating progenitor cell count response during exercise will lead to a better prognosis.
A study led by Dr. Navakaranbir Bajaj published in Circulation showed that coronary microvascular dysfunction, but not estimated glomerular filtration rate was associated with abnormal cardiac mechanics and an increased risk of cardiovascular events. The findings of this study suggest that coronary microvascular dysfunction may play a role in determining how chronic kidney disease can lead to abnormal cardiac function in patients without ischemic heart disease.
A study led by Dr. Kathleen Sturgeon published in the European Heart Journal showed that in patients diagnosed with cancer, the majority of cardiovascular deaths in the United States occur in patients diagnosed with breast, prostate or bladder cancer. Additionally, the investigators demonstrated that patients with cancer are at a higher risk of dying from cardiovascular disease as compared to the general population.
The results of the COMPLETE Optical Coherence Tomography Substudy were presented by Dr. Natalia Pinilla-Echeverri at the American Heart Association 2019 meeting. The substudy found that in patients with an ST-elevation myocardial infarction and multivessel coronary artery disease, half of the patients had a non-culprit lesion with vulnerable plaque morphology.
The COMPLETE trial previously demonstrated that routine angiography guided staged a percutaneous coronary intervention (PCI) of non-culprit lesions reduced the composite endpoint of cardiovascular death or myocardial infarction by 26%. However, whether the benefit of routine PCI of non-culprit lesions is, as a result, the non-culprit lesions having characteristics that were consistent with a vulnerable plaque is not known. Optical coherence tomography (OCT) is a form of intracoronary imaging that is able to identify vulnerable plaques. OCT is able to recognize thin cap fibroadenoma (TCFA), an indicator of a vulnerable plaque that is at risk of rupturing. The investigators wanted to identify the prevalence of TCFA in obstructive compared to non-obstructive non-culprit lesions.
In the COMPLETE trial, patients with a STEMI and multivessel disease who underwent successful PCI of the culprit lesion were randomized to either routine staged PCI of all suitable non-culprit lesions with the goal of complete revascularization regardless of whether there were clinical symptoms or evidence of ischemia or culprit-lesion revascularization only. Patients were deemed to have multivessel disease if they had angiographically significant non-culprit vessel disease of a vessel that was at least 2.5mm in diameter. A lesion was considered angiographically significant if it had at least 70% stenosis of the vessel diameter or 50-69% stenosis with a fractional flow reserve of less than 0.8. In this substudy, STEMI patients with stenosis of at least one non-culprit vessel with more than 70% stenosis that was suitable for OCT were identified. After randomization, multivessel OCT imaging was performed on vessels with non-culprit lesions that underwent PCI, additional vessels with or without target non-culprit lesions for PCI, and STEMI vessels with segments more than 50mm that were unstented.
A total of 93 patients and 425 lesions were included in this substudy. The baseline characteristics in the main study were similar to this imaging study. The average age was 61.3, 82.8% were male, 12.9% had diabetes, 64% had 1 residual diseased vessel and 36% had two or more residual diseased vessels. The non-culprit lesions were classified according to whether they had significant stenosis and whether they had a TCFA. Of the lesions with greater than 70% obstruction, 58 (38.7%) had a TCFA and 92 did not. Of the lesions with less than 70% obstruction, 74 (23.2%) had a TCFA and 201 did not. When assessing the prevalence of TCFAs per patient, the investigators found that half of the patients with TCFA had an obstructive non-culprit lesion that contained vulnerable plaque.
In an interview with Dr. Arzu Kalayci, Dr. Pinilla-Echeverri discussed the implications of the study. She said, “this is very important in the STEMI population because we believe the STEMI population has higher rates of future cardiovascular events. IT may all be related to the inflammatory response that is behind [this]. This is telling us that these patients had a definitely higher risk because they had vulnerable plaques far from the culprit segment. This is reassuring that acute coronary syndrome implies a diffuse pathophysiology with vulnerable plaque not only in the culprit segment but in places far away from the culprit lesion. These results support the findings in the COMPLETE trial.” However, this study does have its limitations. The substudy was observational and is affected by confounding and bias. The substudy was not powered to link clinical evens to morphology. Regardless, the findings of this study could potentially explain the benefit of routine PCI of obstructive non-culprit lesions in patients with STEMI and multivessel disease.
The results of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches – Chronic Kidney Disease were presented by Dr. Sripal Bangalore at the American Heart Association 2019 meeting. Dr. Bangalore and his team showed that in patients with moderate ischemia and end-stage renal disease, an initial invasive strategy with catheterization and possibly percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) did not lead to an improvement in clinical outcomes.
Dr. John McMurray presented the results of the DAPA-HF trial at the American Heart Association 2019 Meeting. The study, which was published in the New England Journal of Medicine, showed that dapagliflozin, an SGLT-2 inhibitor, can potentially be used to treat heart failure with reduced ejection fraction (HFrEF) in patients with and without type 2 diabetes.
During the American Heart Association 2019 meeting, Dr. Kosh Ray presented the results of the BETonMACE trial. Dr. Ray and his teams showed apabetalone, a BET protein inhibitor was safe and well-tolerated and could potentially be used to reduce the risk of major adverse cardiovascular events (MACE).
The results of a phase 1 trial that evaluated the safety of RUC-4, a novel subcutaneous GPIIb/IIIa inhibitor, were presented by Dr. Dean Kereiakes at the American Heart Association 2019 meeting. The study showed that in healthy volunteers and subjects on aspirin with stable coronary artery disease (CAD), RUC-4 provided rapid and high-grade platelet inhibition that resolved within 2 hours.
The results of the GALILEO trial were presented by Dr. George Dangas at the American Heart Association 2019 meeting. The trial, which was stopped early, showed that in patients with a successful transcatheter aortic valve replacement (TAVR), a rivaroxaban-based strategy was associated with excessive ischemic and bleeding events.
The results of the ISCHEMIA trial were presented by Dr. Judith Hochman at the American Heart Association 2019 meeting. The study demonstrated that in stable patients, there was no difference in cardiac event rates in patients who underwent invasive procedures as compared to those who were managed conservatively.
The results of the COLCOT trial were presented by Dr. Jean-Claude Tardif at the American Heart Association 2019 conference and published in the New England Journal of Medicine. The study showed that in patients with a recent myocardial infarction, colchicine led to a significantly lower risk of ischemic cardiovascular events than placebo.