Hello, I’m Dr. Deepak Bhatt, the Director of the Mount Sinai Fuster Heart Hospital at the Icahn School of Medicine at Mount Sinai in New York, and the Dr. Valentin Fuster Professor of Cardiovascular Medicine.

There have been a lot of great trials this year at the American College of Cardiology. I’m just going to pick three to discuss.

The first is actually an update of the SURPASS-CVOT trial. This was a more expanded analysis from SURPASS-CVOT, which compared tirzepatide versus dulaglutide. The primary results were already published in The New England Journal of Medicine, showing non-inferiority of tirzepatide versus dulaglutide.

What this study did — expanding upon the initial publication — was look at additional endpoints, highlighting that all-cause mortality was significantly lower with tirzepatide compared to dulaglutide. A more expanded six-point MACE endpoint, which included kidney and heart failure outcomes, was also significantly reduced.

So this gives a broader sense that tirzepatide likely performed better than dulaglutide. Of course, for the primary endpoint, non-inferiority was met, but superiority wasn’t. The p-value trended toward statistical significance but didn’t reach it, so for any secondary endpoint — as I’m discussing now — one needs to be cautious. Nonetheless, all-cause mortality is a hard one to argue with.

The next trial I’ll mention is HI-PEITHO. This was a trial that randomized patients with intermediate-risk acute pulmonary embolism to either ultrasound-facilitated catheter-directed thrombolysis or anticoagulation alone, and found that the ultrasound-facilitated catheter-based approach was superior in reducing PE-related complications without a significant increase in bleeding. So it did seem like a win for ultrasound-facilitated lysis in that context.

Finally, the third trial I’ll highlight is the SURVIVE trial. This was a randomized study conducted in hospitals in Brazil, enrolling patients with a failing mitral bioprosthesis — that is, a degenerated surgical mitral valve. It’s a tough situation: what do you do?

The trial randomized 150 patients to either a transcatheter valve-in-valve approach or a redo surgical mitral valve replacement. The primary endpoint favored the transcatheter approach significantly. The composite endpoint was 1-year all-cause death or disabling stroke, driven mainly by reduced all-cause mortality in the transcatheter group — both at 30 days and at 1 year.

Longer-term follow-up is ongoing, but these are promising results supporting a transcatheter approach for patients with a failing surgical bioprosthesis.