The American Heart Association Scientific Sessions 2019 saw many presentations of exciting and practice-changing trials, novel therapeutic approaches currently in development, guidelines updates, a deeper dive in existing management strategies, in addition to cutting-edge fundamental and translational science.
The ISCHEMIA trial, for example, was long anticipated and reported here that invasive treatment is not clearly the best management strategy for higher-risk patients with stable ischaemic heart disease, when compared with conservative medical therapies (like aspirin or statins) coupled with lifestyle advice, except perhaps for angina burden, which seemed to be better served by an invasive approach.
By contrast, the COLCOT trial reported that low-dose colchicine in patients with a recent MI was not only safe but can prevent major adverse CV events compared with placebo by a 28% margin. The wide accessibility of colchicine could make this trial a game changer.
Also, the ORION series of trials clearly demonstrated the safety and efficacy of inclisiran in lowering cholesterol in patients already on maximum tolerated statins. Inclisiran is a novel inhibitor of PCSK9 through short-interfering RNA, that only needs to be injected twice per year, and managed to at least halve the cholesterol in these difficult-to-manage patient cohorts.
These any many other highlights presented at the AHA 2019 are covered in peer-reviewed summaries in the following pages.
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Table of Contents: AHA 2019
Featured articles
New Approaches to CVD Risk Reduction
Phase 3 BETonMACE trial did not meet its primary endpoint
Inclisiran safely halves LDL-Cholesterol
Colchicine prevents cardiovascular events
Interventional Management for Acute Coronary Syndrome
Drop aspirin after 3 months in non-STEMI ACS patients on dual antiplatelet therapy
Immediate coronary angiography after cardiac arrest does not improve survival
Complete revascularisation for obstructive non-culprit lesions with vulnerable plaque
Colchicine: no difference in peri-procedural cardiovascular events 30 days post-PCI
Intra-aortic balloon pump better than Impella: new observational data
Results for the Ischemia Trials: To Intervene or Not to Intervene
ISCHEMIA trial: Invasive treatment only better for angina burden
Controversies in Contemporary Management of Aortic Stenosis
Full GALILEO results: Why did rivaroxaban fail after TAVR?
Balloon-expandable better than self-expanding transcatheter heart valves
RECOVERY: Benefit of early surgery in asymptomatic severe aortic stenosis
Guidelines: Updates and Controversies
New guidelines on the prevention of cardiovascular conditions
Trials in Electrophysiology and Left Ventricular Function
RENAL-AF trial: Apixaban similar to warfarin
Apple Heart Study: Not just for atrial fibrillation
Early apixaban safe as secondary prevention of stroke from AF
Carvedilol does not improve exercise performance in Fontan patients
New Frontiers in Lipid Therapy
Icosapent ethyl plus statins reduces total plaque volume
ORION-9: Inclisiran RNAi halves LDL in familial hypercholesterolaemia patients
New RNAi therapies to reduce triglycerides: 2 studies show favourable results
Targeting LDL-C <70 mg/dL is better than 100 mg/dL after stroke
Challenges in Heart Failure Management
FUEL trial: Udenafil improves some exercise measurements in Fontan
DAPA-HF: Dapagliflozin also good for heart failure patients without diabetes, of any age, or any health status
PARAGON-HF: Benefits for women and lower ejection fraction
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