ACC 2020

Despite the cancellation of the American College of Cardiology (ACC) and World Congress of Cardiology live conference slated for March 28-30 in Chicago, the event went digital with ACC.20 World Congress of Cardiology VIRTUAL. A wealth of vital science and education was presented online. Featured here is a small sample of interesting findings presented during the 3-day event.

Natural history of ischemia with no obstructive coronary disease ‘ebbs and flows’

Ischemia with no obstructive coronary artery disease (INOCA) is common, comprising approximately 20% of participants with moderate or severe ischemia screened in the recent International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial. A new analysis of people who were screened for ISCHEMIA but did not qualify for inclusion because they had less than 50% stenosis on coronary angiography finds that their symptoms and stress test results change over time in the absence of any intervention.

Vaping added to counseling leads to higher smoking quit rates versus counseling alone

Adding electronic cigarette (e-cigarette) use to smoking cessation counseling more than doubles the percentage of those who successfully quit smoking at 12 weeks when compared with counseling alone.

At 10 years, PCI equal to CABG for left main coronary artery disease

Data are limited on outcomes beyond 5 years in recipients of either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) who have left main coronary artery disease (LMCAD). Recently, a follow-up extension of the PRECOMBAT trial (Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease) examined 10-year outcomes and found no significant difference in rates of death, myocardial infarction (MI), stroke, or target vessel revascularization between patients who underwent PCI and those who underwent CABG, reported Duk-Woo Park, MD, of Asian Medical Center, Seoul, South Korea.

Enhancing cyclic guanosine monophosphate reduced heart failure hospitalization in patients with worsening disease

An investigational stimulator of guanylate cyclase, vericiguat, reduced the incidence of either cardiovascular (CV) death or heart failure hospitalization in a large randomized international phase III study of patients with worsening heart failure (HF) with reduced ejection fraction who were already receiving optimal standard of care.

Wide gender gap in authorship of cardiovascular clinical trials

Women are grossly underrepresented in leadership of cardiovascular clinical trials, making up only 9.3% of first authors and 10% of senior authors. In addition, they account for only 10.1% of trials’ leadership committee members, according to a study led by Cleveland Clinic cardiologists.

Personalized antiplatelet therapy after PCI based on genotyping barely misses primary endpoint

Genotyping-guided antiplatelet therapy following percutaneous coronary intervention (PCI) did not meet the stringent goal of halving the incidence of serious adverse cardiovascular events in the year following the procedure. However, the TAILOR-PCI trial did demonstrate a 34% reduction in such events at 1 year, in addition to a significant reduction in the number of events per patient, said Naveen L. Pereira, MD, from Mayo Clinic, Rochester, Minn.

Vascular dose of rivaroxaban added to aspirin reduces risk of ischemic events in patients with diabetes and atherosclerosis

Low-dose rivaroxaban plus aspirin reduced the risk of major cardiovascular events in patients with stable atherosclerosis, irrespective of the presence or absence of diabetes.

Equal benefit and harm from 30 days of aspirin in patients with atrial fibrillation and a recent coronary event

In patients with atrial fibrillation (AF) and a recent acute coronary syndrome (ACS) or percutaneous coronary intervention (PCI), adding apixaban to a P2Y12 inhibitor resulted in a lower rate of bleeding compared with a vitamin K antagonist (warfarin) with a reduced risk of death or rehospitalization. In both arms, the addition of aspirin resulted in an excess of bleeding without any difference in efficacy, according to a secondary analysis of the AUGUSTUS trial.

The CARAVAGGIO findings expand the range of patients with cancer-associated thrombosis who are eligible for DOAC therapy to include those with GI cancer

Twice-daily apixaban was noninferior to subcutaneous dalteparin in the prevention of recurrent venous thromboembolism (VTE) in patients with cancer.

Renal denervation offers non-drug treatment to lower blood pressure

A sham-controlled trial of catheter-based renal denervation in patients with hypertension significantly reduced ambulatory blood pressure and office blood pressure in the absence of medications.