ACC.21 Looks to Repeat Success Despite Pandemic Headwinds

The American College of Cardiology (ACC) pulled off an spectacular all-digital meeting ideally suited March, decrease than 3 weeks after canceling its in-person occasion and staunch 2 weeks after COVID-19 used to be declared a nationwide emergency.

Optimistic plans for the ACC Scientific Session 2021 (ACC.21) to be a March hybrid affair in Atlanta pivoted no longer as soon as, but twice, because the pandemic developed, with the date pushed abet 2 full months, to Would possibly per chance 15 to 17, and the structure revised to fully digital.

“Whereas this meeting is being delivered just about, I think you might uncover there get been advantages within the time to devise and additionally the classes that ACC has learned in digital training over the past One year. This has reach together to with out a doubt blueprint a good tutorial and scientific agenda,” ACC.21 chair Pamela B. Morris, MD, acknowledged in a press convention centered on the upcoming meeting.

Over the three days, there’ll be more than 200 training courses, 10 guideline-notify courses, and 11 finding out pathways that consist of core areas, but additionally particular issues, comparable to COVID-19 and the emerging cardio-obstetrics subspecialty.

The meeting will be delivered via a recent digital training program built to optimize loyal-time interplay between faculty individuals and attendees, she acknowledged. A dedicated portal on the platform will allow attendees to work on the side of regards to, as an instance, with presenters of the nearly 3000 ePosters and 420 moderated posters.

For those plagued by Zoom fatigue, the increasingly long-established Heart2Heart stage talks get additionally been transformed to podcasts, which masks issues admire gender equity in cardiology, the evolving position of evolved note mavens, and “one in every of my favorites: art work as a utility for healing,” acknowledged Morris, from the Clinical University of South Carolina, Charleston. “These courses are with out a doubt no longer to be overlooked.”

Reconnecting is an underlying theme of the meeting however the plump divider could no longer be skipped over. COVID-19 would be the level of interest of two 90-minute Intensive Classes on Saturday, Would possibly per chance 15, the first kicking off at 10: 30 AM ET, with the Bishop Keynote lecture on bringing health equity to the frontline of cardiovascular care, followed by classes learned for the length of the pandemic, easy habits medical trials, and vaccine style.

The 2d session, space for 12: 15 PM, continues the “silver linings” theme, with case shows on advances in telehealth, myocardial involvement, and thrombosis in COVID. For those attempting more, 18 abstracts are on faucet in a 2-hour Spotlight on Particular Issues session starting build at 2: 30 PM.

Requested about the pandemic’s carry out on bringing science to fruition this past One year, Morris acknowledged there’s no longer any count on it’s slowed among the progress the cardiology community had made but, admire medical note, “now we get additionally surmounted loads of those boundaries.”

“I think study has rebounded,” she acknowledged. “Factual by manner of the need of abstracts and the usual of abstracts that get been submitted this One year, I don’t think there’s any count on that we’re upright on par with earlier years.”

Indeed, 5258 abstracts from 76 countries get been submitted, with more than 3400 chosen for oral and poster presentation, including 25 late-breaking medical trials to be presented in five courses.

The late-breaking shows and discussions will be prerecorded but speakers and panelists get been invited to be recent for the length of the streaming to reply to live any questions that could additionally honest come up within the chat box, ACC.21 vice-chair Douglas Drachman, MD, Massachusetts Frequent Clinical institution, Boston, suggested theheart.org | Medscape Cardiology.

Late-Breaking Scientific Trials

The Joint ACC/JACC Late-Breaking Scientific Trials I (Saturday, Would possibly per chance 15, 9: 00 AM–10: 00 AM) kicks off with PARADISE-MI, the first head-to-head comparability of an angiotensin receptor neprilysin inhibitor (ARNI) and an angiotensin-converting-enzyme (ACE) inhibitor in patients with lowered ejection fractions (EFs) after MI but no history of heart failure (HF), finding out 200 mg sacubitril/valsartan (Entresto) vs 5 mg of ramipril, both twice-daily, in 5669 patients.

Sacubitril/valsartan used to be at the birth popular for HF with lowered EF and added a recent indication to treat some HF patients with preserved EF. Novartis, then yet again, no longer too lengthy within the past suggested investors that though numerical trends consistently appreciated the ARNI over the ACE inhibitor ramipril, the portion 3 inquire did no longer meet the first endpoint for efficacy superiority of reducing the risk for cardiovascular (CV) dying and HF events after an acute MI.

Second up is ADAPTABLE, which appears to be to total a aesthetic proof hole over whether 81 mg or 325 mg daily is the optimum dose of the ubiquitously prescribed aspirin for secondary prevention in excessive-risk patients with established atherosclerotic CV illness.

The open-designate, randomized inquire will peek at efficacy and vital bleeding over roughly 4 years in 15,000 patients within PCORnet, the Nationwide Patient-Centered Scientific Analysis Network, a partnership of medical study, health thought study, and affected person-powered networks created to streamline affected person-reported outcomes study.

“This inquire is no longer going to greatest give main medical knowledge for us, virtually speaking, whether we must restful prescribe decrease- or higher-dose aspirin, then yet again it will additionally additionally operate a template for future pragmatic medical trial create within the loyal world,” Drachman acknowledged for the length of the click convention.

Up next is the 4812-affected person Canadian LAAOS III, the greatest trial to bag the efficacy of left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation (AF) already undergoing cardiac surgery. The vital consequence’s the first incidence of stroke or systemic arterial embolism over a median follow-up of 4 years.

Percutaneous closure of the left atrial appendage (LAA) has been shown to diminish stroke in AF patients at excessive-risk of bleeding on systemic anticoagulation. However these devices could additionally honest additionally be costly and studies have not incorporated patients who additionally get valvular heart illness, a community that actually contains more than half of of patients undergoing cardiac surgery who additionally get AF, he vital.

At the same time, surgical LAA closure studies get been tiny and get had very mixed results. “There is no longer a plump-scale rigorous evaluation available within the market for these patients undergoing surgery, so I think this goes to be interesting to peep,” Drachman acknowledged.

The session closes with ATLANTIS, which appears to be to shed some gentle on the position of anticoagulation treatment in patients after transcatheter aortic valve replacement (TAVR or TAVI). POPular TAVI, presented at ACC.20, showed aspirin alone used to be the most long-established antithrombotic treatment over aspirin plus clopidogrel (Plavix) in patients no longer on oral anticoagulants, however the optimum anticoagulation routine remains unsettled.

The French open-designate, 1510-affected person ATLANTIS trial examined whether the new oral anticoagulant apixaban (Eliquis) is superior in combating CV events after TAVR, in comparison with antiplatelet treatment in patients with out an illustration for anticoagulation and in comparison with weight loss program Okay antagonists in those receiving anticoagulants.

An ATLANTIS 4D CT substudy of valve thrombosis is additionally slated for Saturday’s Featured Scientific Analysis 1 session at 12: 15 to 1: 45 PM.

Sunday LBCTs

Drachman highlighted a series of numerous late-breaking studies, including the worldwide DARE-19 trial finding out the diabetes and HF drug dapagliflozin (Farxiga) given with local normal-of-care treatment for 30 days in hospitalized COVID-19 patients with CV, metabolic, or renal risk factors.

Even though sodium-glucose cotransporter-2 inhibitors get been white sizzling of late, top-line results reported ideally suited month show dapagliflozin did no longer blueprint statistical significance for the first endpoints of reducing organ dysfunction and all-trigger mortality and for improving restoration. Facts will be presented within the Joint ACC/JAMA Late-Breaking Scientific Trials II (Sunday, Would possibly per chance 16, 8: 00 AM–9: 30 AM).

Two trials, FLOWER-MI and RADIANCE-HTN TRIO, get been singled out within the Joint ACC/N Engl J Med Late-Breaking Scientific Trials III (Sunday, Would possibly per chance 16, 10: 45 AM–12: 00 PM). FLOWER-MI examines whether fractional float reserve (FFR) is more healthy than angiography to e book total multivessel revascularization in ST-elevation MI patients with as a minimal 50% stenosis in as a minimal one nonculprit lesion requiring percutaneous coronary intervention (PCI). Most modern studies get shown the prevalence of FFR guided PCI for nonculprit lesions, in comparison with perpetrator lesion treatment-greatest, but this is the first time FFR-and angiography-guided PCI get been in comparison in STEMI patients.

RADIANCE-HTN TRIO already tipped its hand, with top-line results reported late ideally suited One year showing that the trial met its vital efficacy endpoint of higher reduction in sunlight hours blood tension over 2 months with the Paradise endovascular ultrasound renal denervation machine, in comparison with a sham direction of, in 136 patients with resistant hypertension, importantly, after being given a single tablet containing a calcium-channel blocker, angiotensin II receptor blocker, and diuretic.

Renal denervation for hypertension has been making one thing of a comeback, with the 2018 RADIANCE-HTN SOLO reporting higher ambulatory blood tension adjust with the Paradise machine than with a sham direction of within the absence of antihypertensive brokers. The utility has been granted breakthrough utility designation from the US Meals and Drug Administration for the treatment of hypertensive patients who are unable to sufficiently reply to or are intolerant of antihypertensive treatment.

Monday LBCTs

Within the Late-Breaking Scientific Trials IV session (Monday, Would possibly per chance 17, 8 AM–9: 30 AM), Drachman called out a secondary analysis from GALATIC-HF taking a peek on the affect of EF on the therapeutic carry out of omecamtiv mecarbil. In ideally suited One year’s vital analysis, the selective cardiac myosin activator produced a modest but vital reduction in HF events or CV dying in 8232 patients with HF and an EF of 35% or much less.

Rounding out the checklist is the Canadian CAPITAL CHILL inquire of average vs silent therapeutic hypothermia in out-of-sanatorium cardiac arrest, to be presented within the ideally suited Late-Breaking Scientific Trials V session (Monday, Would possibly per chance 17, 10: 45 AM–12: 00 PM).

The double-blind trial sought to bag out whether neurologic outcomes at 6 months are improved by focusing on a core temperature of 31 ˚C vs 34 ˚C after the return of spontaneous circulation in comatose survivors of out-of-sanatorium cardiac arrest.

“For me, I think this could additionally with out a doubt commerce note and has private relevance from trip with cardiac arrest survivors that I’ve known and delight in terribly deeply,” Drachman suggested theheart.org | Medscape Cardiology. “I think that there’s loads of change here as successfully.”

Requested what numerous trials get the capability to commerce note, Drachman acknowledged FLOWER-MI holds particular interest on fable of it appears to be at easy adjust patients with STEMI with more than one lesions on the level of care.

“Now we get received loads of clarity from so much of numerous prior medical trials, but this could abet to reply to the count on in a quite numerous manner of announcing: are you able to eyeball it, are you able to peek on the angiogram and train whether or no longer that numerous, nonculprit lesion must restful be treated within the same hospitalization or must restful you with out a doubt be using a tension wire,” he acknowledged. “For me as an interventionalist, this is incessantly main on fable of while you happen to enact up doing an intervention on a affected person it will additionally very successfully be the nighttime and the affected person could additionally honest be more or much less stable, but you might per chance additionally get got already exposed them to the risk of a direction of, must restful then you trot on and carry out another side of the direction of to count on with a tension wire a ideally suited narrowing? I think that is important; that’ll abet me bag decisions on a day-to-day foundation.”

Drachman additionally cited RADIANCE-HTN TRIO on fable of it employs an endovascular methodology to manipulate blood tension in patients with hypertension, particularly those proof towards more than one capsules.

All the plan in which via the click convention, Morris, a preventive cardiologist, keep her money on the ADAPTABLE inquire of aspirin dosing, reiterating that the recent trial create could additionally expose future study, and on Sunday’s 8: 45 AM late-breaking post hoc analysis from the STRENGTH trial that looks to take hang of up where the controversy over omega-3 fatty acid preparations left off ultimately One year’s American Heart Association meeting.

An absence of earnings on CV occasion charges reported with Epanova, a excessive-dose combination of eicosapentaenoic acid (EPA) and docosahexaenoic acid, resulted in a contentious debate over easy reconcile STRENGTH with the findings from REDUCE-IT, which showed a 25% relative risk reduction in vital CV events with the EPA product, icosapent ethyl (Vascepa).

STRENGTH investigator Steven Nissen, MD, Cleveland Sanatorium, and REDUCE-IT investigator and session panelist Deepak Bhatt, MD, Brigham and Ladies folks’s Clinical institution, Boston, will portion the digital stage at ACC.21, but Morris acknowledged the “ravishing data” is both researchers know one another very successfully and “will with out a doubt be focusing on no political concerns, staunch the omega-3 fatty ranges within the bloodstream and what does that indicate in either trial.”

“Here is no longer designed to be a debate, level counterpoint,” she added.

For that, as all cardiologists and journalists know, there would be the wild and woolly #CardioTwitter sphere.

Follow Patrice Wendling on Twitter: @pwendl. Follow ACC.21 protection from theheart.org | Medscape Cardiology on Twitter and Fb.