Key Points:

• Elderly frail patients with acute decompensated heart failure hospitalizations benefit from cardiac rehabilitation
• Tailored rehabilitation led to a large, significant improvement in Short Physical Performance Battery (SPPB) score which was relatively uniform across pre-specified subgroups
• Rehabilitation intervention patients saw large, significant, clinically meaningful improvements in 6-minute walk distance, quality-of-life, Fried Frailty score, and depression

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With the widespread use of second-generation drug eluting stents, it has become more apparent that the risk of stent thrombosis decreases significantly after the first thirty days. The risk of bleeding, on the other hand, increases during that same time period. It has been proposed that de-escalation of potent P2Y12 inhibitors could mitigate that risk of bleeding. Dr. Kiyuk Chang and his co-investigators sought to answer this in the TALOS-AMI trial, the results of which were presented during a late breaking clinical trial session today at the 2021 American College of Cardiology Scientific Sessions. Continue reading →

While renal denervation has been shown to improve blood pressure in patients with moderate hypertension, its effects on resistant hypertension have been more modest. During Sunday’s Late Breaking Clinical Trials session of the American College of Cardiology’s 2021 Scientific Sessions, Dr. Ajay Kirtane of Columbia University, presented the findings of the anticipated RADIANCE-HTN TRIO Trial, seeking to shine a light on the previously nebulous data. Continue reading →

KEY POINT:

• There is not enough evidence to state whether Omega-3 Fatty Acid levels are beneficial or harmful against major adverse cardiovascular events in patients with high cardiovascular risk.

Dr. Steven E. Nissen is the chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic and Professor of Medicine at the Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.  Prior to summarizing Dr. Nissen’s late breaking trial at presented May 16, Day 2 of ACC 2021 that is concurrently published in JAMA Cardiology . Continue reading →

New results were presented from the Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy (PRADA) trial at ACC 2021 on May 16 and published concurrently in Circulation .  The authors found that medications administered in addition to surgery, adjuvant breast cancer (BC) therapy with anthracylines with or without anti-human epidermal growth factor receptor 2 (HER2) therapy, and radiotherapy may not significantly attenuate the reduction in left ventricular ejection fraction (LVEF), nor improve cardiac troponins in early-stage BC patients.
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Adjuvant breast cancer therapy, while beneficial in prolonging survival, has been shown to have harmful effects on the heart, prompting some providers to prescribe neurohormonal blocking agents to attenuate the myocardial damage. The original PRADA trial showed that candesartan and metoprolol helped prevent a decline in LVEF in patients on adjuvant therapy. To date, however, smaller studies have not shown a similar benefit to neurohormonal blockade. In a late breaking clinical trial session on May 16 at the 2021 American College of Cardiology Scientific Sessions meeting, Dr. Siri Lagethon Heck of Akershush University Hospital in Oslo, Norway, presented the long-term follow up results of the PRADA trial. Continue reading →

Women fared worse than men in terms of increased bleeding risk, but comparable to men for ischemic event rates, results of a subgroup analysis of the TWILIGHT study presented May 15 at the 70th annual meeting of the American College of Cardiology (ACC) found. However, benefits of early aspirin withdrawal and continued use of ticagrelor in this high-risk PCI population was found to be comparable between sexes. Continue reading →

Rivaroxaban should be considered as adjunctive therapy to aspirin alone in patients undergoing peripheral limb revascularization, authors of the VOYAGER-PAD trial concluded today. In the Late Breaking Clinical Trials session earlier today at the 2021 American College of Cardiology Scientific Sessions, Dr. Rupert Bauersachs of Darmstadt, Germany, presented the anticipated results of the trial, which attempted to answer whether post-intervention rivaroxaban could prevent future limb ischemia and need for repeat revascularization.

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SGLT-2 inhibitors have demonstrated efficacy in various cardiometabolic conditions, including heart failure, coronary artery disease, chronic kidney disease, and diabetes. Given its favorable profile in various disease states, and the lack of effective therapies for patients hospitalized with COVID-19, it was hypothesized that dapagliflozin could provide organ protection in patients with cardiometabolic risk factors and COVID-19. During today’s Late Breaking Clinical Trials Session at the American College of Cardiology 2021 Scientific Sessions meeting, Dr. Mikhail Kosiborod of Saint Luke’s Mid Americas Hospital system presenting the findings of DARE-19, Dapagliflozin in Respiratory Failure in patients with COVID-19.

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Transcatheter tricuspid valve replacement has become a feasible alternative to surgery in patients deemed to be at high risk of adverse events, and in the past decade, various devices have been designed to meet this clinical need. In his Focused Clinical Research session on the opening day of the American College of Cardiology 2021 Scientific Sessions, Dr. Susheel Kodali, director of the Structural Heart & Valve Center at New York-Presbyterian/ Columbia University Medical Center presented the 30-day results from the implantation of the EVOQUE valve, as part of the TRISCEND study. Continue reading →

The WATCHMAN left atrial appendage occluder device has been widely accepted as an alternative to oral anticoagulation for stroke prevention in patients with underlying atrial fibrillation. However, the indications for WATCHMAN implantation laid forth by the Centers for Medicare & Medicaid Services in the United States differ from the original trials supporting its use. Real-world practice, therefore, highlights significant differences in the characteristics of patients receiving the therapy from those originally studied.  In a Focused Clinical Research Session at the 2021 American College of Cardiology meeting, Dr. Matthew Price, Director of the Cardiac Cath Lab at Scripps Green Hospital and Assistant Professor at the Scripps Translational Science Institute, La Jolla, California, presented the results of his study from the NCDR LAAO Registry (NCT02699957), assessing one- year real-world outcomes for patients undergoing WATCHMAN implantation.

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Subclinical valve thrombosis after transcatheter aortic valve intervention (TAVI) has emerged as a challenge to the standardization of antithrombotic therapy after valve implantation. Results of the randomized ATLANTIS trial, presented also today, May 15, as a Late Breaking Clinical Trial at ACC 2021, showed no superiority of apixaban over standard of care after transcatheter aortic valve intervention, irrespective of the baseline need for anticoagulants. In his Focused Clinical Research Session, Gilles Montalescot, MD, PhD, Professor of Cardiology at the Pitié-Salpêtrière Hospital, Paris, presented the 4D-CT substudy results to assess the incidence and implications of CT-proven valve thrombosis. Continue reading →

The administration of apixaban monotherapy after transcatheter aortic valve replacement is not superior to the standard of the care antithrombotic treatment, results of the randomized, phase IIIb, prospective, open label, ATLANTIS trial, Anti-Thrombotic Strategy After Trans-Aortic Valve Implantation for Aortic Stenosis (NCT02664649), show. These findings hold true regardless of a patient’s baseline requirement for anticoagulation. Continue reading →

KEY POINTS

• Sacubitril/valsartan did not provide a lower rate of cardiovascular death, heart failure hospitalization, or outpatient development of heart failure when compared to active treatment with ramipril in patients after high-risk myocardial infarction.
• When examining total adjudicated events and investigator reported primary endpoints, there was a trend toward clinical benefit in patients randomized to sacubitril/valsartan.

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KEY POINTS:

• There was no significant difference in primary composite endpoint of all-cause mortality, hospitalization for myocardial infarction, or hospitalization for stroke in patients with coronary artery disease taking 81 mg versus 325 mg of aspirin every day.
• There was no significant difference in the safety endpoint of hospitalization for major bleeding with blood product transfusion in patients with coronary artery disease taking 81 mg versus 325 mg of aspirin every day.
• Conducting pragmatic study in a real world, patient-centric approach will likely continue to emerge as an appealing, cost effective trial design in the field of cardiology.

Cardiovascular disease is costly and a major cause of death worldwide. Aspirin has been the mainstay of treatment in secondary prevention of coronary artery disease for over thirty years. More recently, several analyses have suggested varying doses aspirin (81 mg vs 325 mg) as well as the use of other, newer antiplatelet agents for the treatment of coronary artery disease. Continue reading →

EXPLORER-HCM presented at the American College of Cardiology 2021 meeting by John A. Spertus, MD, MPH, and simultaneously published in The Lancet, demonstrated that the use of mavacamten, a first-in-class cardiac myosin inhibitor, was associated with a highly significant improvement in patients’ health status. 1 out of 5 patients treated with mavacamten tended to experience a significant improvement in health status. Continue reading →

Patients with atrial fibrillation undergoing cardiac surgery should have concomitant atrial appendage occlusion, according to a new study presented at the American College of Cardiology 2021 Scientific Sessions.

“We have shown that left atrial appendage occlusion is not only a viable option but should be standard of care for patients with atrial fibrillation undergoing cardiac surgery,” says Dr. Richard Whitlock, primary investigator of the LAAOS III trial, a cardiovascular surgeon and professor of surgery at McMaster University. The results of LAAOS III were concurrently published in the New England Journal of Medicine . Continue reading →