Practice Update: Cardiology

AMERICAN COLLEGE OF CARDIOLOGY SCIENTIFIC SESSIONS 4

Dr Joerg Herrmann discusses PARTNER 2, HOPE-3, DANAMI-3 DEFER, Early-BAMI and STITCH Extension studies

ACC 2016 2–4 APRIL 2016 • CHICAGO, USA

The American College of Cardiology’s 65th Annual Scientific Session & Expo saw the presentation of key studies such as the PARTNER 2, PROMISE, HOPE-3, INOVATE-HF and FIRE AND ICE trials. PracticeUpdate Cardiology Editorial Board members Dr Joerg Herrmann and Dr Doug Zipes discuss their top abstracts fromACC 2016.

Joerg Herrmann MD is Assistant Professor of Medicine, Mayo Graduate School of Medicine, and PracticeUpdate Cardiology Editorial Board member. He presents his top abstracts, and their take-home message, from ACC 2016.

Session 401: Opening showcase and the joint ACC/ JACC late-breaking clinical trials featuring the Simon Dack lecture Transcatheter aortic valve replacement compared with surgery in intermediate risk patients with aortic stenosis: final results from the randomised Placement of Aortic Transcatheter Valves 2 study. MB Leon, C Smith, M Mack, et al • In the PARTNER 2 trial, researchers randomised 2032 patients with aortic stenosis and an intermediate risk for surgery to undergo transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement. Assigned vascular access was mainly transfemoral (76.3%). The rate of death from any cause or disabling stroke was similar between the groups; however, when assessing the transfemoral access cohort only, the researchers found that TAVR was associated with a lower rate of death or disabling stroke than surgery (P = 0.05). Overall, surgery was associated with fewer major vascular complications and less paravalvular aortic regurgitation, and TAVR was associated with less kidney injury, severe bleeding, and new-onset atrial fibrillation. • Researchers concluded that TAVR is associated with similar rates of death and disabling stroke when compared with surgery among intermediate-risk patients. Blood pressure lowering in people at moderate risk. The HOPE-3 trial. EM Lonn • In the HOPE-3 trial, researchers randomised 12,705 patients with moderate cardiovascular risk to evaluate candesartan/ hydrochlorothiazide vs placebo for the primary prevention of cardiovascular events. In patients receiving candesartan/hydrochlorothiazide, there was a greater decrease in blood pressure (6.0/3.0 mmHg) than in the placebo group. At baseline, mean blood pressure was 138.1/18.9 mmHg. The rate of cardiovascular death and events was significantly lower among patients

with a systolic blood pressure >143.5 mmHg receiving active treatment. Overall, the rate of cardiovascular death and events were similar between groups. • In patients with an intermediate risk for cardiovascular disease, researchers concluded that lowering blood pressure with candesartan/ hydrochlorothiazide was not associated with fewer major cardiovascular events than placebo. Effects of rosuvastatin on cardiovascular disease in moderate risk primary prevention in diverse ethnic groups. J Bosch • In the HOPE-3 trial, researchers randomised 12,705 patients with moderate risk for cardiovascular disease to evaluate rosuvastatin vs placebo for the primary prevention of cardiovascular events. In patients receiving rosuvastatin, there was a greater decrease in LDL (26.5%) than in patients receiving placebo. Rosuvastatin was also associated with fewer cardiovascular deaths and events than placebo (P = 0.002 and P < 0.001, respectively). Muscle symptoms were more common in the rosuvastatin group. • In patients with an intermediate risk for cardiovascular disease, researchers concluded that rosuvastatin was associated with fewer major cardiovascular events than placebo. Effects of combined lipid and BP-lowering on cardiovascular disease in a moderate risk global primary prevention population. S Yusuf • In the HOPE-3 trial, researchers randomised 12,705 patients with moderate risk for cardiovascular disease to receive candesartan/ hydrochlorothiazide, rosuvastatin, or placebo in combination or alone. In patients receiving combined blood pressure and lipid-lowering therapy, there was a greater decrease in LDL (33.7 mg/dL) and a greater decrease in systolic blood pressure (6.2 mmHg) than in patients receiving dual placebo. The combined-therapy group also had significantly lower rates of

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