News
QUADRO – Quadruple Polypill More Effective In Lowering Blood Pressure Than Taking Three Separate Medications in Resistant Hypertension
Key Points:
- Treatment of resistant hypertension often involves at least three or more medications, but non-adherence increases as the number of pills increases.
- In the QUADRO trial, adding bisoprolol to a combination of perindopril, indapamide, and amlodipine in a single polypill significantly reduced blood pressure in patients with resistant hypertension over an 8-week period.
A Single Combined Measure Of hsCRP, LDL-C, And Lp(A) Predicts Incident CV Events Over 30 Years Among Women’s Health Study Participants
Key Points:
- While drug trials evaluate the short-term cardiovascular risk associated with elevated, blood biomarkers, little is known about the long term (20-30 year) risk conferred by these biomarkers, alone or in combination.
- This epidemiological study evaluated the association between baseline levels of hsCRP, LDL-C, and Lp(a) of ~28,000 initially healthy participants in the Women’s Health Study with incident cardiovascular events over 30 years of follow-up.
- Each of the measures were independently associated with an increased adjusted hazard of incident cardiovascular events, and each biomarker provided additive information. Women in the highest quintile of all three biomarkers had the highest risk.
- These data indicate that a single combined measure at one point in time can have predictive value beyond the traditional 10-year risk score. Since all three are potentially modifiable, these findings might have significant implications for how we prevent heart disease.
ASSURE DES: No Difference In Ischemic Events If Aspirin Is Interrupted Or Continued In Patients With DES Undergoing Non-Cardiac Surgery
Key Points:
- Anti-platelet therapy after coronary drug eluting stent (DES) placement reduces the risk of future ischemic events, but the risk of in-stent thrombosis with temporary interruption of anti-platelets decreases over time.
- Holding aspirin for non-cardiac surgery more than one year after DES placement could lower peri-operative bleeding risk, but whether this is outweighed by the ischemic risk remains uncertain.
- ASSURE DES randomized patients with prior DES undergoing non-cardiac surgery to continuation or interruption of aspirin, and found no difference in major ischemic or bleeding events, but the lower than expected event rates left the study underpowered.
Morning vs. evening dosing of blood pressure meds: No differences in outcomes or safety for either community-dwelling adults or frail nursing home residents
Key Points:
- Blood pressure follows a circadian rhythm, peaking after waking and dipping during sleep. While elevated nocturnal pressures are associated with adverse cardiovascular events, it is uncertain whether taking anti-hypertensive medication in the evening improves outcomes.
- BedMed and BedMed-Frail were pragmatic trials that randomized community-dwelling adults and nursing home residents, respectively, to their once-daily anti-hypertensives either before bed or in the morning.
- There were no differences in major cardiovascular or safety events between the two groups in either trial.
NOTION-3: Revascularization in Patients Undergoing TAVI Associated with Lower Risk of MACE vs Conservative Treatment
Key Points:
- The NOTION-3 trial found that FFR-guided revascularization with PCI in TAVI patients with coronary artery disease significantly reduced the composite endpoint of all-cause mortality, myocardial infarction, and urgent revascularization compared to conservative management.
- The reduction in the composite endpoint was mainly driven by significantly lower rates of myocardial infarction and urgent revascularization in the PCI group compared to the conservative group.
- The trial provides evidence that severe AS patients with CAD can benefit from PCI revascularization with TAVI.
TAVI Superior to Surgical Aortic Valve Replacement in Women: RHEIA Trial
Key Points:
- The RHEIA trial found that TAVI was superior to surgical aortic valve replacement (SAVR) in women with severe aortic stenosis, significantly reducing the composite endpoint of all-cause mortality, stroke, and rehospitalization for valve-related symptoms or worsening heart failure.
- The reduction in the primary endpoint was primarily driven by a significant decrease in rehospitalizations for valve- or procedure-related symptoms in the TAVI group compared to the SAVR group.
- TAVI demonstrated clear advantages over SAVR, suggesting that TAVI could be the preferred therapy for women with severe symptomatic aortic stenosis.
SWEDEGRAFT Trial: No Advantage of No-Touch vs Conventional Vein Harvesting in Coronary Artery Bypass Surgery
Key Points:
- The SWEDEGRAFT study is a prospective, binational multicenter, open-label, registry-based trial in patients undergoing first isolated non-emergent coronary artery bypass grafting (CABG), randomized 1:1 to no-touch or conventional open skeletonized vein harvesting technique, with a planned enrollment of 900 patients.
- The SWEDEGRAFT trial found no significant difference in vein graft failure or clinical outcomes between no-touch and conventional vein harvesting techniques in coronary artery bypass grafting (CABG).
- Patients undergoing no-touch harvesting experienced higher rates of leg wound complications compared to those who underwent conventional harvesting.
Transcatheter Mitral-valve Repair Lowers Hospitalization or CV Death vs Medical Therapy Alone in HF with Moderate to Severe MR: RESHAPE-HF2 Trial
Key Points:
- The Mitral Transcatheter Edge-to-Edge Repair (M-TEER) procedure with the MitraClip device has shown in the previous COAPT trial to reduce heart failure hospitalizations and mortality in patients with heart failure and severe functional mitral regurgitation (FMR).
- The RESHAPE-HF2 trial demonstrated that M-TEER, when added to standard care, significantly reduces heart failure hospitalizations compared to optimal standard of care alone in patients with FMR but did not significantly reduce mortality. M-TEER also substantially improved quality of life scores in heart failure patients as compared to optimal standard of care alone.
- RESHAPE-HF2 provides further evidence of the benefits of M-TEER in patients with reduced ejection fraction and FMR.
Continuation of Anticoagulation Non-Inferior to Interruption during TAVI: POPular PAUSE TAVI Trial.
Key Points:
- Many patients who undergo transcatheter aortic-valve implantation (TAVI) have an indication for oral anticoagulation. However, there is uncertainty over the safety and efficacy of continuing anticoagulation versus holding periprocedural anticoagulation during TAVI.
- In this international, international, open-label, randomized, noninferiority trial clinical trial, 869 patients undergoing TAVI who were also receiving long-term anticoagulants were randomized to either continuation strategy or interruption strategy of their anticoagulation.
- Continuation of anticoagulation was found to be non-inferior to interruption of anticoagulation for composite outcomes of death, stroke, myocardial infarction, major vascular complications, or major bleeding within 30 days after TAVI.
Pooled Analysis Showed Semaglutide Reduced Combined CV death or Worsening HF and Worsening HF alone but No Significant Effect on CV Death
Key Points:
- Heart failure with mildly reduced or preserved ejection fraction (hereafter referred to as HFpEF) is the most common type of heart failure and is associated with a high risk of adverse clinical events, especially in patients with overweight, obesity, or type 2 diabetes.
- Whether semaglutide reduces heart failure (HF) events in patients with HFpEF remains an unresolved and important clinical question.
- This study aimed to investigate whether semaglutide reduces the risk of adverse HF events by conducting a pooled, patient-level analysis of participants with HFpEF from the SELECT, FLOW, STEP-HFpEF, and STEP-HFpEF DM trials.
Transcatheter Edge-To-Edge Repair Is Non-Inferior To Surgery In Patients With Secondary Mitral Regurgitation: MATTERHORN Trial
Key Points:
- The MATTERHORN trial found that the transcatheter edge-to-edge repair (TEER) procedure was non-inferior to surgical mitral valve repair in reducing functional mitral regurgitation in heart failure patients with depressed left ventricular ejection fraction.
- Both TEER and surgical groups showed similar outcomes in terms of the primary composite efficacy endpoint, and both had low rates of severe MR recurrence at 1 year.
- The TEER group had significantly fewer safety events compared to the surgical group, highlighting its potential as a safer alternative for patients at high risk for surgery.
T-TEER Significantly Reduced the Severity of Secondary Tricuspid Regurgitation and Improved Quality of Life. TRI-FR Trial
Key Points:
- The TRI.FR trial found that tricuspid transcatheter edge-to-edge repair (T-TEER) together with optimal medical therapy significantly improved the clinical outcomes and reduced tricuspid regurgitation severity compared to optimal medical therapy alone.
- Patient-reported outcomes, including quality of life, were significantly better in the T-TEER group than in the control group.
- The trial underscores the importance of a multidisciplinary approach to treating tricuspid regurgitation, integrating T-TEER with guideline-directed medical management.
ABYSS – Beta Blocker Interruption in Post-Myocardial Infarction Patients
Key Points:
- In the ABYSS trial, 3700 patients who had a left ventricular ejection fraction ≥ 40% and were > 6 months post myocardial infarction were randomized to receive beta blocker continuation vs. beta blocker interruption
- The authors found higher rates of the primary endpoint, the composite of death, MI, stroke and cardiovascular hospitalization, among patients who had interruption of their beta blocker, especially if those individuals had a history of hypertension
- Beta blocker interruption had no impact on quality of life and not surprisingly, resulted in higher blood pressures and heart rates
Vitrusiran Reduces Risk of Death and CV Events in Patients with ATTR-CM
Key Points:
- ATTR amyloid cardiomyopathy, resulting from accumulation of TTR amyloid protein in the heart, leads to progressive heart failure, complicated by arrhythmias, with a significant increase in worsened quality of life, hospitalization, and death
- This study tested the efficacy and safety of vutrisiran, a novel subcutaneously (SQ) administered RNAi therapeutic, dosed quarterly, to treat ATTR amyloid cardiomyopathy
- Vutrisiran demonstrated statistically significant improvement over standard therapy (tafamadis, SGLT2i inhibitors, and diuretics) on both primary and secondary outcomes, including mortality, disease progression, and quality of life
- The authors argue these results support vutrisiran as a reasonable new standard-of-care for ATTR amyloid cardiomyopathy patients, either as first-line for new diagnosis, or alternative vs add-on therapy in treated patients with progressive disease
IVUS-Guided DES Reduced MACE at 1 year Compared to Angiography-Guided PCI: IVUS-ACS Trial
Key Points:
- The IVUS-ACS trial assessed whether the use of intravascular ultrasound guidance, as compared with angiography guidance, improves the outcomes of percutaneous coronary intervention with contemporary drug-eluting stents in patients presenting with an acute coronary syndrome.
- The study showed that IVUS-guided implantation of contemporary DES resulted in a lower 1-year rate of the composite outcome of cardiac death, target vessel myocardial infarction, or clinically driven revascularization compared with angiography guidance alone.
IVUS -DBC: IVUS-guided drug-coated balloon angioplasty improves primary patency
Key Points:
- One-year success rates of angioplasty in peripheral artery disease (PAD) patients were significantly higher when guided by intravascular ultrasound (IVUS) alongside angiography.
- IVUS, offering precise vessel measurements and visualization, demonstrated its effectiveness in achieving longer-lasting benefits from the procedure.
- At 12 months, primary patency was achieved in 83.8% of patients who received IVUS and 70.1% of those receiving angiography alone, with IVUS group showing significant superiority.
A technology assisted Web App allowed >90% of consumers to correctly self-select for statin use and achieve clinically important LDL-C reduction
Key Points:
- Nonprescription statin access may help statin-eligible patients receive appropriate treatment.
- This prospective, actual-use study employed a Web App for participants to self-qualify for guideline-appropriate moderate intensity statin initiation use, and found that this technology had high accuracy in making clinician-concordant statin determinations and led to a significant reduction in participant LDL.
PROACT: Enalapril Does Not Mitigate Anthracycline Toxicity in Breast Cancer and NHL
Key Points:
- Anthracycline toxicity is an important cause of cardiomyopathy; it is unclear whether prophylactic treatment with ACE inhibitors could mitigate this risk.
- In PROACT, enalapril was compared to standard of care in individuals undergoing anthracycline treatment for breast cancer or NHL. The primary endpoint was myocardial injury (defined as cTnT≥14 ng/L).
- Enalapril did not result in a significant reduction in anthracycline toxicity as measured by myocardial injury, LVEF, or GLS a month after chemotherapy completion.
Topical TXA Does Not Reduce Peri-Operative Seizures but Increases Risk of Transfusion in Cardiac Surgery Compared to Intravenous TXA
Key Points:
- IV TXA is used to prevent peri-operative bleeding in cardiac surgery, but it carries a risk of seizure. It is hypothesized that topical TXA may reduce this risk of seizure.
- In DEPOSITION, topical and IV TXA were compared in individuals undergoing cardiac surgery. The primary endpoint was seizure. Authors also investigated differences in RBC transfusions between arms.
- Topical TXA did not result in a significant difference in peri-operative seizures, but it did increase RBC transfusion requirement relative to IV TXA.
IMPROVE-HCM: Cardiac Mitotrope -Ninerafaxstat- Improves Functional Capacity in Symptomatic Non-Obstructive HCM
Key Points:
- Despite the high symptomatic burden, very few effective treatments exits for symptomatic, non-obstructive HCM.
- In IMPROVE-HCM, a novel cardiac mitotrope (ninerafaxstat) was compared to placebo in non-obstructive HCM. The primary efficacy endpoint was change in KCCQ score from baseline. Safety and tolerability were also assessed.
- In the primary intention-to-treat analysis, ninerafaxstat did not improve symptoms; however, when restricting the population to patients with baseline limitation by KCCQ (or NYHA III), treatment resulted in a significant improvement in HF symptoms. Ninerafaxstat also improved exercise capacity on CPET in the total sample.
