AHA 2015 Promises Appropriate PCI, Ticagrelor Tolerance, Outcomes With IVUS, and More

This week, the American Heart Association (AHA) Scientific Sessions head back to Orlando, FL, for the first time in 4 years. Prominently featured in this year’s program are forward-looking sessions focused on the genomics of CVD and “precision medicine,” and a host of seemingly futuristic findings with a firm footing in the here-and-now. Attendees also will hear important updates from the interventional cardiology field on coronary imaging, structural heart disease interventions, adjunctive medical therapy, and more.

Six late-breaking clinical trial sessions will be spread over 4 days. LBCT.03 in particular, starting on Tuesday, November 10, at 10:45 am, is likely to capture the interest of interventionalists, with a total of 6 presentations dedicated to ACS and PCI:

• PROACT-4, a Canadian trial evaluating ambulance-based biomarker testing to improve acute cardiovascular care and triage
• A Korean trial looking at long-term clinical outcomes of IVUS-guided vs angiography-guided DES implantation in long lesions
• Long-term tolerability of ticagrelor in the PEGASUS-TIMI-54 study
• An analysis of individualized treatment duration in the landmark DAPT trial
• Angina and QoL results from RIVER-PCI using ranolazine (Ranexa; Gilead Sciences) in patients with incomplete revascularization
• A presentation dedicated to the recent STEMI/PCI guideline update.

The showcase late-breaker this year is the Systolic Blood Pressure Intervention Trial (SPRINT), which will be presented in LBCT.05 on Monday, November 9, at 2pm. The entire session is dedicated to these results. SPRINT is a National Heart, Lung, and Blood Institute-sponsored study testing more intensive blood pressure lowering against commonly recommended targets in hypertensive patients over age 50. In early September, the agency released top-line results from the trial showing significantly reduced rates of CVD and death in the intensive management group.

The other 4 late-breaking sessions are loosely grouped according to different subspecialties:

• LBCT.01, on Sunday, November 8, at 3:45 pm, is dedicated to drugs and systems of care in heart failure
• LBCT.02, on Monday, November 9, at 10:45 am, tackles prevention with studies on smoking cessation, diet and lifestyle modification, diabetes drugs and CV risk, and a trial looking at disclosing genomic risk of MI as a means of improving LDL levels 
• LBCT.04, on Wednesday, November 11, at 10:45 am, dubbed “Novel Therapies for Common Problems,” includes an injectable biopolymer (Algisyl; LoneStar Heart) for advanced heart failure, a Beta3-adrenoceptor agonist for use in chronic heart failure, a rivaroxaban reversal agent (Andexanet Alfa; Portola), nitric oxide to prevent kidney injury during CABG, ranolazine to prevent coronary microvascular dysfunction, a new PCSK9-inhibitor tested with biannual or quarterly dosing, and drug strategies to prevent CV dysfunction during adjuvant breast cancer therapy.
• LBCT.06, on Monday, November 9, at 1:30 pm, is dedicated to 2-year results from the CT Surgery Network Severe MR Trial.

Outside of the late-breakers there are 80 different sessions within the Intervention and Surgery Track, including oral abstracts on everything from complete vs incomplete revascularization to controversies in ACS care , advances in structural heart disease, and the utility of CT in transcatheter valve interventions. And on Monday, 2 presentations in the Novel Findings from Next Generation Registries session deserve mention. One will report the impact of appropriate use criteria on coronary revascularization and patient selection in the NCDR-Cath-PCI registry. Another addresses the issue of migraine prevention in patients following transcatheter closure of atrial septal defects.

Several “Special Lectures” are also worth highlighting. On Sunday, AHA president Mark A. Creager, MD, is giving this year’s presidential address entitled “The Crisis of Vascular Disease and the Journey to Vascular Health.” That same day, Deputy FDA commissioner Robert Califf, MD, will speak on the “Affordable Care Act: Effects on Patients, Clinicians, and Scientists.” On Tuesday, Keith A. Fox, MD, will give the Paul Dudley White International Lecture entitled “Identification of Vulnerable Plaque from Bench to Bedside.” 

Speaking with TCTMD, program chair Frank Sellke, MD, of Rhode Island Hospital, Providence, RI, highlighted the SPRINT trial as something he believes will garner widespread interest among attendees, and encouraged interventionalists to keep an eye out for the PEGASUS and DAPT analyses, which will be presented during the PCI/ACS late-breaking session. Of note, the highest-scoring abstract submitted to the meeting was actually a trial comparing intermittent vs continuous chest compressions during cardiac resuscitation. Although ultimately included in the resuscitation science program, Sellke said, it is one of the “most important trials of the meeting.”

Presentations on genomics, digital health, and “precision” and personalized medicine are dotted throughout the program, something Sellke said was intentional. “There’s just been so much interest in this topic,” he commented. “It really continues where ‘Big Data,’ the theme last year, left off. Personalized medicine is really in the headlines now and naturally the AHA has taken that on.”