https://doi.org/10.55788/70591a37
“ATTR cardiomyopathy leads to heart failure, arrhythmias, hospitalisations, and reduced survival,” said Prof. Marianna Fontana (University College London, UK) [1]. “We are, however, seeing a trend towards earlier diagnosis, improved management for heart failure, and better treatment options for ATTR cardiomyopathy, such as tafamidis and SGLT2 inhibitors.” Prof. Fontana and colleagues investigated the RNA interference therapeutic vutrisiran in patients with ATTR cardiomyopathy in the double-blind, randomised-controlled, phase 3 HELIOS-B trial (NCT04153149).
The participants (n=655) were randomised 1:1 to vutrisiran or placebo every 12 weeks for up to 36 months. The primary endpoint was a composite of all-cause mortality and recurrent cardiovascular events at 36 months. “Approximately 40% of the participants were on tafamidis at baseline, raising the bar for vutrisiran to demonstrate its efficacy,” emphasised Prof. Fontana.
The primary endpoint was met, with a hazard ratio of 0.72, and a P-value of 0.012 (95% CI 0.55–0.93) [1,2]. “This effect was driven by both components of the primary endpoint,” added Prof. Fontana [1]. Important secondary endpoints were also in favour of the vutrisiran arm, including change in the 6-minute walk test at 30 months (LS mean difference 26.46; P=0.00008) and Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Score change at 30 months (LS mean difference 5.80; P=0.0008).
The safety profiles of vutrisiran and placebo were similar, with 67.1% and 61.7% of the participants experiencing serious adverse events (AEs) in the placebo and vutrisiran arm, respectively. In addition, there were no AEs that were typical for vutrisiran.
“Vutrisiran has the potential to become a standard-of-care for previously untreated patients with ATTR cardiomyopathy and for those who progress on stabilising therapies,” concluded Prof. Fontana.
- Fontana M, et al. HELIOS-B: Primary results from phase 3 study of vutrisiran in patients with transthyretin amyloidosis with cardiomyopathy. HOTLINE 1, ESC Congress 2024, 30 Aug–02 Sept, London, UK.
- Fontana M, et al. N Engl J Med 2024; Aug 30. DOI: 10.1056/NEJMoa2409134.
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Table of Contents: ESC 2024
Featured articles
Meet the Expert: Dr Abdullahi Mohamed on Iron Deficiency in Patients with HF
2024 ESC Guidelines in a Nutshell
Guidelines for the management of elevated blood pressure and hypertension
Guidelines for the management of chronic coronary syndromes
Guidelines for the management of atrial fibrillation
Guidelines for the management of peripheral artery and aortic diseases
Crossing Borders in Arrhythmia
EPIC-CAD: What is the best antithrombotic approach in high-risk AF plus stable CAD?
OCEANIC-AF: Asundexian inferior to apixaban for ischaemic stroke prevention in AF
MIRACLE-AF: Elegant solution to improve AF care in rural China
SUPPRESS-AF: What is the value of adding LVA ablation to PVI in AF?
Clever Ideas for Coronary Artery Disease
ABYSS: Can beta-blocker safely be interrupted post-MI?
SWEDEGRAFT: Can a no-touch vein harvesting technique improve outcomes in CABG?
Bioadaptor meets expectations in reducing target lesion failures in coronary artery disease
REC-CAGEFREE I: Can we avoid permanent stenting with drug-coated balloons?
OCCUPI: OCT-guided PCI improves outcomes in complex CAD
Highway to Hypertension Control
Low-dose 3-drug pill GMRx2 shows promise in lowering BP
Is administering BP medication in the evening better than in the morning?
VERONICA: Improving BP control in Africa with a simple strategy
High-end Trials in Heart Failure
FINEARTS-HF: Finerenone improves outcomes in heart failure with preserved ejection fraction
MRAs show varied efficacy in heart failure across ejection fractions
MATTERHORN: Transcatheter repair matches surgery for HF with secondary mitral regurgitation
RESHAPE-HF2: Not a “tie-breaker” for TEER in heart failure
Practical Gains in Screening and Diagnostics
STEEER-AF: Shockingly low adherence to ESC atrial fibrillation guidelines
SCOFF: To fast or not to fast, that’s the question
WESTCOR-POC: Point-of-care hs-troponin testing increases emergency department efficiency
PROTEUS: Can AI improve decision-making around stress echocardiography?
RAPIDxAI: Can AI-augmented chest pain assessment improve cardiovascular outcomes?
Miscellaneous Achievements in Cardiology
HELIOS-B: Vutrisiran candidate for SoC in ATTR cardiomyopathy
Does RAS inhibitor discontinuation affect outcomes after non-cardiac surgery?
Novel approach to managing severe tricuspid regurgitation proves its value
NOTION-3: TAVI plus PCI improves outcomes in CAD plus severe aortic stenosis
RHEIA: TAVI outperformed surgery in women with aortic stenosis
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