The Biggest News of 2018: TCTMD’s Top 10

The most-read news on TCTMD this year included the new cholesterol guidelines, the MitraClip trials, several halted trials, and big meeting news.

The Biggest News of 2018: TCTMD’s Top 10

The biggest stories on TCTMD this year often—but not always—stemmed from big cardiology meetings. Two MitraClip trials, COAPT from TCT 2018 and MITRA-FR from the 2018 European Society of Cardiology (ESC) Congress, were both in the top three. Also in 2018, cholesterol guidelines from the American Heart Association meeting, an apixaban analysis from the American College of Cardiology conference, ORBITA revelations at the Society for Cardiovascular Angiography and Interventions (SCAI) Scientific Sessions, and the ASCEND trial from ESC made the list. Breaking news also proved popular, including the US Food and Drug Administration approval of andexanet alfa, the halting of GALILEO, and the stoppage of two drug-coated balloon trials in PAD.

1. COAPT: MitraClip Reduces Repeat Hospitalizations, Mortality in Functional MR Patients With Severe HF

Physicians responded with shock and excitement to findings, but struggled to reconcile the results with the MITRA-FR trial.

2. Andexanet Alfa, First Reversal Agent for Factor Xa Inhibitors, Finally Gains FDA Approval

The agent is the second antidote approved for the NOACs, joining idarucizumab, dabigatran’s reversal agent.

3. MITRA-FR: No Benefit of MitraClip in Functional MR

Presenting the results, Jean-François Obadia expressed hope that other trials will help identify patients who might benefit from the device.

4. New Cholesterol Guidelines Make Room for Non-Statin Therapy and CAC Screening

While the guidelines don’t recommend a specific target for treatment, they do suggest additional therapy in high-risk patients with LDL cholesterol 70 mg/dL or higher.

5. GALILEO Trial of Rivaroxaban After TAVR Stopped Early for Harm

Rivaroxaban-treated patients had increased risks of all-cause mortality, thromboembolic events, and bleeding versus those on antiplatelet therapy.

6. Apixaban Has Edge Over Other NOACs in Large, Real-World Analysis

The findings jibe with prior observational studies, but head-to-head trials—however unlikely—would provide the best answers, experts say.

7. ORBITA Continues to Surprise: 85% of Sham Arm Opted for PCI When Trial Ended

A discussion at SCAI tackled lingering ORBITA issues, with experts finally grasping a detail the PI says she’s been emphasizing from the outset.

8. Time for Guidelines to Recommend ARBs Over ACE Inhibitors?

The long-running dispute as to the supremacy of these two drug classes should be put to bed once and for all, say the authors of a new review.

9. ASCEND: Aspirin Doesn’t Look Good for Primary CV Prevention in Diabetic Patients

Given the bleeding seen in the study, US guidelines that have been open to using aspirin in this setting need to be revisited, one expert says.

10. Two Trials Halted in Wake of Study Linking Paclitaxel-Coated Devices to Deaths in PAD

A special meeting will be held in the coming months to review the issue. The lead author says he’s pleased endovascular specialists are taking it seriously.

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