2019 was an exciting year for cardiology research, with many late-breaking trials appearing at the AHA, ACC, EASD, ESC, and HFA annual conferences. In this article, we round up 10 of the most impactful trials in less than 50 minutes of total learning, starting with the groundbreaking trial, DAPA-HF!
You will see the video length next to each trial name, so that you can effectively watch each video as you have time:
1. DAPA-HF (19 minutes, 18 seconds)
The outstanding DAPA-HF trial, which evaluated the SGLT2 inhibitor Dapagliflozin in patients with or without diabetes, showed a 17% decrease in total mortality. In this video, Prof. John McMurray & Prof. Mikhail Kosiborod share their hypotheses and outcomes.
2. DECLARE-TIMI 58 (6 minutes, 29 seconds)
Prof. Itamar Raz explains why he would give Dapagliflozin as the 1st drug therapy (with Metformin) to nearly every diabetic patient over 60, to prevent both CVD & kidney function deterioration. The trial outlines a “very safe and effective drug” that's “easy to give” and reduces the risk of heart failure, as well as kidney function deterioration:
3. ISCHEMIA (2 minutes 46 seconds)
A quick commentary on the invasive vs conservative Ischemia trial by Dr.Rasha Al-Lamee from Imperial College, London. See why she states that: “We don´t need to rush patients to a Cath Lab, even when they have moderate-to-severe ischemia,” and why she describes this international trial as a “monumental moment.”
4. ISAR-REACT 5 (3 minutes, 23 seconds)
In this head-to-head evaluation of Ticagrelor- vs Prasurgrel-based strategies, Prof. Stefanie Shupke discusses which approach is superior and should be preferred in clinical practice. The data is based on 4,018 patients who were hospitalised for ACS and were planned to undergo coronary angiography:
5. REDUCE-IT (3 minutes, 07 seconds)
Dr. Matthew Budoff from the University of California, Los Angeles, updates us on the 5-year follow-up trial of 8,200 statin patients randomised to either Vascepa 4g or placebo. With total events reduced by 30%, including a much more significant p-value, this is a must watch:
6. EMPA-REG OUTCOME TRIAL (6 minutes, 5 seconds)
As Dr. David Fitchett from St. Michael's Hospital, Toronto, explains: This was the “first diabetes cardiovascular trial that showed a cardiovascular benefit of a diabetes drug.” With a 38% reduction in CV mortality, a 35% reduction in heart failure hospitalisation, and preservation of renal function, this is a useful 6 minutes of learning:
7-9. PARTNER 3, COREVALVE LOW RISK & AUGUSTUS Trials
In this wrap-up of late-breaking trials from ACC 2019, Dr. Nicolas van Mieghem concisely and articulately describes key data from no fewer than 7 topics in less than a total of 11 minutes! Read below the video for information on where to skip to the relevant time positions within the video to view each specific trial:
- PARTNER 3 Trial (1:50 to 3:44 - 1 minute, 54 seconds): Randomised data from 1,000 patients to balloon expandable TAVR (transcatheter aortic valve replacement) with a sapien 3 valve vs surgical aortic valve replacement. In favour of TAVR, the compelling results show a combined death or stroke rate of 1% vs 2.9% and a re-hospitalisation rate of 7.3% vs 11%. According to Martin Leon, “TAVR needs to be the preferred treatment of patients at low operative risk in this day-and-age.”
- CoreValve Low Risk Study (3:44 to 6:26 - 2 minutes, 42 seconds): Included within our list, due to the similarities with the PARTNER 3 trial, this study of 1,400 patients again showed a positive trend towards TAVR. Whilst the number of pacemakers was greater in the TAVR arm, haemodynamic performance was also greater. According to Dr. Mieghem, “If two trials are combined, I think it's fair to say that if you would consider a bioprosthesis for a treatment for severe aortic stenosis, you need to talk to your patients and inform him or her about TAVR...I don't think that it's fair or even ethical to have a patient undergoing open-heart surgery without offering the possibility or option of transcatheter aortic valve replacement.”
- AUGUSTUS TRIAL (8:14 to 9:40 - 1 minute, 26 seconds): “After 1 week, AUGUSTUS seems to suggest that there is no place for aspirin anymore.” In this trial, compared to apixaban, aspirin only leads to more bleeding and no additional benefit when considering the combined end-point of death and re-hospitalisation.
10. LUS_HF TRIAL (2 minutes, 43 seconds)
As outlined by Dr. Mercedes Rivas-Lasarte from Hospital de Sant Pau Barcelona, this was a single-centre study with a small sample size. However, it revealed a wide difference in the combined endpoint (40% vs 23%) for an inexpensive, broadly available tool. Watch the video to learn more: