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ACC Scientific Session Returns Live, Virtually to New Orleans

The Crescent City’s next big bash in the wake of Mardi Gras is a homecoming of sorts for one of cardiology’s premier educational events as it circles back, in spirit, to a more innocent prepandemic age. New Orleans last hosted the annual gathering in 2019, when masks were apolitical, and “quarantine” wasn’t confused with “isolation.”

This year’s 6603 abstract submissions are a 19-year record for the meeting, which opens March 4 as the American College of Cardiology (ACC) Scientific Session/World Congress of Cardiology (WCC) 2023, or ACC.23/WCC.

“This is outstanding,” meeting program chair Douglas Drachman, MD, said at a recent presentation for the media. “It represents a 24% increase in the number of submissions since just last year. And it’s the greatest number of abstract submissions we’ve seen since 2004.”

A total of 4160 submissions were accepted for oral or poster presentation at the 3-day conference, said Drachman, of Boston’s Massachusetts General Hospital.

New research scheduled for the first day highlights a dyslipidemia drug envisioned as an alternative for the statin-intolerant. Its limited but encouraging topline results were already revealed in December.

Also featured at ACC.23/WCC: new insights into transcatheter repair of mitral and tricuspid valves, clinical outcomes on a ketogenic diet, exercise, and lifestyle management for hypertrophic cardiomyopathy (HCM), a potential device-based therapy for heart failure with preserved ejection fraction (HFpEF), pulsed field ablation (PFA) for atrial fibrillation (AF), and prospects for a minimally invasive possible alternative to sternotomy for mitral valve (MV) surgery.

“Global Health Spoken Here”

At the press conference, Drachman hailed the partnership that once again brings together College and WCC sponsor World Heart Federation (WHF). “There really was a tremendous amount of international representation throughout the entire planning process,” he said. “Our focus on global health and international perspective therefore is truly baked into the entire conference.”

International flavor may be most on show at the WHF Heart Café, a feature of the venue’s Lounge and Learn pavilion, “where World Heart Federation members will host educational sessions focused on global health,” Drachman said.

“And you’ll certainly find sessions throughout the entire meeting that are focused on international cardiovascular burden of disease as well as global health,” including the “Global Health Spoken Here” events scheduled throughout the 3 days.

How to Catch Concurrent Sessions

Live streaming and on-demand access, legacies of the virtual formats that rescued scientific conferences in the earliest pandemic years and have stayed on as useful adjuncts, will be available for more than 80 sessions at ACC.23/WCC, Drachman said.

Live streaming not only allows remote “attendance” for those who can’t make it to New Orleans, it will be available to on-site participants via the ACC.23/WCC smartphone app, he said. “So, you could be sitting, theoretically, in one lecture and beaming another through your live stream on your handheld device — if you so desire.”

At center stage, on site and virtually, across the 3 days are the 5 Late-Breaking Clinical Trials (LBCT) and 3 Featured Clinical Research (FCR) sessions along with a Clinical and Investigative Horizons session on Sunday. The schedules reflect Central Time in New Orleans.

LBCT-1, Saturday, March 4, 9:30 – 10:30 AM (ACC/Journal of the American College of Cardiology joint session)

Leading the session, the CLEAR Outcomes trial compared the ATP-citrate lyase inhibitor bempedoic acid (Nexletol) to placebo in more than 14,000 patients with demonstrated statin intolerance. Those assigned to the drug showed a significant benefit for the composite primary cardiovascular (CV) endpoint, that was announced in December. The presentation should reveal just how much of a benefit, its level of significance, and perhaps any adverse effects.

Next up, the TRILUMINATE Pivotal Trial tested Abbott’s investigational TriClip device for transcatheter edge-to-edge repair (TEER) of the tricuspid valve against optimal medical therapy. It entered an estimated 700 adults with severe, symptomatic tricuspid regurgitation despite optimal meds considered at intermediate to high surgical risk.

The session concludes with the phase-2, placebo-controlled STOP-CA trial, which explored whether coadministration of atorvastatin may lessen anthracycline cardiotoxicity in patients with newly diagnosed non-Hodgkin’s lymphoma. The 300-patient trial’s primary endpoint is left ventricular ejection fraction (LVEF) at 1 year.

FCR-1, Saturday, March 4, Noon – 1:15 PM

In a meeting presentation last year, the REVIVED-BCIS2 trial showed no difference in outcomes between percutaneous coronary intervention (PCI) and coronary bypass surgery (CABG) in a population with advanced coronary artery disease (CAD), low LVEF, and dysfunctional but viable myocardium. A follow-up analysis slated for ACC.23/WCC will highlight relationships between the main findings and type of revascularization, viability, and functional outcomes.

The session also includes the phase-2, placebo-controlled HALO trial of the selective aldosterone-synthase inhibitor baxdrostat in patients with uncontrolled hypertension. In topline results unveiled late last year, the drug failed to show an advantage for the primary endpoint of 8-week change in systolic blood pressure (BP). But, it was reported, the drug seemed to bring down systolic BP significantly in a large, prospectively defined subgroup, “non-Hispanics.”

Also in the session:

  • AIMI-HF, the Alternative Imaging Modalities in Ischemic Heart Failure trial of myocardial viability imaging in heart failure

  • YELLOW III, a “multimodality imaging study” of the effects of PCSK9-inhibitor evolocumab (Repatha) on coronary plaque features in patients with stable CAD

  • TARGET, a randomized trial of CT-derived fractional flow reserve (FFR) to guide therapy in patients with stable CAD

LBCT-2, Sunday, March 5, 8:00 – 9:15 AM (ACC/New England Journal of Medicine joint session)

First in the session, the UK Mini Mitral trial has compared standard surgical MV repair via midline sternotomy to a mini-thoracotomy approach in a projected 400 patients in the United Kingdom. Endpoints include patient-centered outcomes like recovery time and return-to-work time as well as clinical outcomes and costs. Patients spent a week wearing a wrist accelerometer to track activity levels.

In RENOVATE-COMPLEX-PCI, more than 1600 patients with complex coronary lesions were assigned to PCI guided by either standard angiography or intracoronary imaging, either intravascular ultrasound (IVUS) or optical coherence tomography (OCT), at operator discretion. The primary endpoint is target-vessel failure by at least 1 year after the procedure.

LBCT-2 also includes the following:

  • Five-year outcomes from the COAPT trial of TEER for functional mitral regurgitation (MR) in patients with heart failure

  • Three-year outcomes from the seminal Evolut Low Risk trial that compared aortic valve replacement transcatheter and surgical approaches for patients at low surgical risk.

  • The BIOVASC noninferiority trial, which compared immediate vs staged complete revascularization PCI in 1525 patients with multivessel disease and acute coronary syndromes.

LBCT-3, Sunday, March 5, 9:45 – 11:00 AM

The ACCESS trial randomly assigned 4764 patients in Canada — aged 65 or older with low income and with chronic CV or renal disease or multiple major CV risk factors — to 1 of 4 intervention arms and followed them for clinical outcomes. They were assigned to receive high-impact CV medications without insurance copayments; education on optimal medical use; both interventions; or neither intervention as a control. The ACC.23/WCC presentation will examine the effects of eliminating drug copayments.

The late-breaker session will also include the following:

  • PCDS Statin, described as a randomized trial of a Personalized Clinical Decision Support intervention to improve statin prescribing in patients with atherosclerotic cardiovascular disease

  • BETTER CARE-HF, billed as a pragmatic, cluster-randomized trial comparing two ambulatory clinical decision support tools for enhancing heart failure management

  • The randomized NUDGE-FLU trial testing electronically delivered nudges aimed at improving influenza vaccination uptake

  • A study exploring translation of polygenic risk for CAD into clinically actionable information using causal artificial intelligence

FCR-2, Sunday, March 5, 12:15 – 1:30 PM

This session’s STREAM-2 trial explored a reperfusion strategy for ST-segment-elevation myocardial infarction (STEMI) that updates an approach that failed to impress in trials conducted years ago. The new study randomly assigned about 600 patients with STEMI to receive either standard primary PCI or invasive management preceded by half-dose tenecteplase (TNKase, Genentech), a thrombolytic. The latter group received TNK followed by coronary angiography within 24 hours and rescue PCI as needed.

Pacing therapy for heart failure is generally limited to selected patients with reduced LVEF, but the RAPID-HF trial is exploring a pacing approach that may ultimately help in managing some with HFpEF. The trial enrolled 32 patients with HFpEF and chronotropic incompetence, all implanted with the same model of rate-adaptive, dual-chamber pacemaker, with atrial pacing programmed either “on” or “off.” The settings were switched midway through the trial. The trial addresses the question, would restoration of a normal heart-rate response during daily activity boost exercise capacity or quality of life?

Also on the bill for FCR-2:

  • A population-based study exploring effects of a low-carbohydrate, high-fat ketogenic diet on plasma lipid levels and measures of cardiovascular risk

  • The HOST-IDEA randomized comparison of 3-month and 12-month dual antiplatelet therapy after PCI using “contemporary drug-eluting stents with ultrathin struts and advanced polymer technology”

  • A safety and efficacy analysis of TEER for degenerative MR based on STS/ACC TVT Registry data

LBCT-4, Monday, March 6, 8:30 – 9:45 AM (ACC/Journal of the American Medical Association joint session)

Leading off the session: the pivotal-trial portion of PULSED AF, a nonrandomized safety and effectiveness test of Medtronic’s PFA system for pulmonary-vein isolation (PVI) in patients with paroxysmal or persistent AF. The 30-day safety endpoints may be of particular interest, as PFA’s tissue selectivity is thought to protect against some complications, especially esophageal injury, a rare concerning risk of PVI using radiofrequency energy.

The COORDINATE study is exploring whether a “clinic-level educational intervention” to promote “cardiology and endocrinology partnerships and guideline-recommended care pathways” may improve management of patients with both CV disease and type 2 diabetes. The cluster-randomized trial with more than 1000 patients is looking foremost at whether the multidisciplinary strategy can be implemented and, secondarily, the effectiveness of recommended medical therapy for both diseases over 1 year.

The LBCT session also includes the following:

  • The BMAD trial, which explored the management impact of thoracic fluid monitoring using the wearable μCor sensor (Zoll Medical) in ambulatory patients with decompensated heart failure

  • A study of a wrist-worn transdermal troponin I sensor (RCE Technologies) for risk assessment in patients with suspected acute myocardial infarction

  • The randomized, phase-3 A DUE study exploring the efficacy and safety of a fixed-dose combination of the endothelin-receptor antagonist macitentan (Opsumit, Actelion) and the PDE-5 inhibitor tadalafil for the treatment of pulmonary arterial hypertension (PAH)

LBCT-5, Monday, March 6, 11:00 AM – 12:15 PM

The session is to include primary outcomes from the LIVE-HCM trial, which compared exercise and activity levels in 1798 patients with clinical or genetically identified HCM. The 41% of participants who reported engaging in vigorous exercise, many of whom were competitive athletes, and the remaining group reporting moderate to low exercise levels were followed for arrhythmic events. It’s hoped the study will provide insights into the safety of exercise and competitive sports for patients with HCM.

The oral PCSK9 inhibitor MK-0616 (Merck) has progressed from promising phase 1 studies to the current phase 2b randomized, controlled, dose-ranging MK-0616-008 trial, which enrolled 381 patients with elevated lipids who were with or at high risk for atherosclerotic cardiovascular disease (ASCVD). Patients were followed for changes in LDL-cholesterol over 8 weeks and adverse events over 16 weeks.

Also on the schedule for LBCT-5:

  • A study of return-to-play issues in elite-level athletes with genetic heart diseases that predispose to development of sudden cardiac death

  • Principal outcomes of the FREEDOM COVID trial exploring anticoagulation strategies in hospitalized patients with COVID-19 who aren’t critically ill

  • The STELLAR phase 3 trial of the investigational sotatercept (Merck) atop standard therapy in patients with PAH. In previously reported topline results, patients who received the drug showed significant gains in 6-minute walk distance, the primary endpoint

FCR-3, Monday, March 6, 12:45 – 2:00 PM

The third FCR session includes LOADSTAR, which randomly assigned 4400 adults in Korea with a spectrum of clinical ASCVD, from stable angina to STEMI, to a fixed-dose, high-intensity statin regimen or statins titrated to an LDL-cholesterol target, typically <70 mg/dL. The fixed-dose regimen consisted of atorvastatin 40 mg or rosuvastatin 20 mg. Patients were followed about 3 years for major adverse cardiac events.

Also on the bill:

  • The Masters@Heart study, which explored relationships between lifelong endurance exercise and coronary atherosclerosis

  • A “collaborative analyses” of patients in the PROMINENT, REDUCE-IT, and STRENGTH trials, with a focus on residual inflammatory risk in statin-treated patients

  • CAMEO-DAPA, an evaluation of Dapagliflozin’s mechanism of benefit in HFpEF

  • The IMPLEMENT-HF safety and efficacy study of virtual team-guided therapeutic optimization during hospitalization in patients with HFrEF

From Guidelines to Practice

Drachman drew attention to a dozen sessions throughout the meeting that focus on guidelines developed by the ACC with other organizations, including the 2022 documents on diagnosis and management of aortic disease and heart failure.

The presentations will focus on how each of the guidelines relate to real-world clinical situations and issues as discussed by expert panelists. “Really in these sessions,” Drachman said, “our objectives were to distill these important documents down into practical pearls that attendees can then use for guidance as they return home to their practices.”

The presentations also cover in the 2021 guideline on the evaluation and diagnosis of chest pain; the same year’s controversial guideline on coronary artery revascularization; the 2020 document on valvular heart disease; and the 2019 guideline on primary prevention of cardiovascular disease.

American College of Cardiology (ACC) Scientific Session/World Congress of Cardiology (WCC) 2023

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