What’s Going to Be Hot at ACC 2022, In Person or Virtual

Around 300 sessions will be live on-site, while 80 will be live for remote attendees. Here’s a quick peek at the lineup.

What’s Going to Be Hot at ACC 2022, In Person or Virtual

The American College of Cardiology (ACC)’s annual meeting was the first large cardiology conference to switch to virtual when COVID-19 first hit and is now poised to be the first of its scope to welcome attendees back to the main tent.

The ACC 2022 Scientific Session kicks off Saturday, April 2, in Washington, DC, with what organizers describe as a return to the live, in-person format, but with both virtual and on-demand components for those who won’t be there in the flesh.

In a press briefing earlier this month to preview this year’s most exciting trials and sessions, ACC Program Chair Pamela Morris, MD (Medical University of South Carolina, Charleston), told reporters: “Welcome back and welcome home.”

“I’m most excited by the fact that we are back to live education, and back to live education in the city that is the home of our ACC Heart House,” she said. “I think you’ll find this is everything you’ve come to expect from the college and its flagship meeting and in my opinion, even more.”

As of late last week, the ACC had just under 13,000 registered attendees, although that number was “increasing hourly,” a spokesperson told TCTMD. Some 6,800 health professionals had registered to attend in person and nearly 3,200 had registered to attend virtually. According to Morris, fully 2,500 faculty would be presenting science in person, of whom 419 were from outside the United States. An additional 944 faculty had accepted remote or digital roles, reflecting the ACC’s commitment to both the health and safety of the live, in-person meeting, while retaining the diversity afforded by the pandemic, when remote faculty contributed “international perspectives” without having to be on-site, said Morris.

For those attending in person, ACC will have the classroom- and lecture-theatre-feel of meetings gone by, said Morris, with nearly 300 live sessions. Those watching remotely will need to navigate the six virtual channels to tune in live, with approximately 80 livestreamed sessions to choose from. Over 300 sessions will be offered on demand, after the fact.

Late-Breaking Clinical Trials

This year’s 3-day meeting showcases 39 late-breaking clinical trials (LBCTs), spread over five sessions, as well as 15 featured clinical research presentations, held over three different sessions—all chosen from a total of 117 submissions, 56% of which came from outside the US.

Highlighting some of these trials during the media briefing, ACC Program Vice Chair Douglas Drachman, MD (Massachusetts General Hospital, Boston), observed that the ones that “really promise to be practice-changing science” cover the full spectrum of issues on the radar of cardiologists. Restricted by time, Drachman selected what he termed a “top 10” list of trials that meet this bar, depending on how they ultimately pan out.

VALOR-HCM, LBCT I, Saturday morning. Following the “enormous improvements” seen with first-in-class cardiac myosin inhibitor mavacamten (Bristol Myers Squibb), in EXPLORER-HCM, VALOR-HCM is testing the agent against placebo in 100 people with symptomatic obstructive hypertrophic cardiomyopathy, with the aim of reducing the number of septal reduction therapy procedures.

SODIUM-HF, LBCT I, Saturday morning. Patients with chronic HF are advised to restrict their sodium intake, typically to levels lower than 2,300-2,500 mg per day, said Drachman, but those recommendations are based on limited evidence. SODIUM-HF is randomizing 1,000 patients to either limit dietary sodium on their own, or to adhere to a stricter regimen of 1,500 mg/day or lower, to see whether the latter leads to fewer hospital readmissions or emergency department visits, or better survival.

POISE-3, LBCT I, Saturday morning, and LBCT IV, Monday morning. The 10,000-patient POISE-3 trial in patients undergoing noncardiac surgery makes two appearances in this year’s program, thanks in part to its partial factorial design. In the first late-breaking session, investigators will present the results of the randomization to tranexamic acid (TA) versus placebo to reduce bleeding, hoping to demonstrate superiority of TA for reducing bleeding and noninferiority for thrombotic events. The second aim of the trial, testing a hypotension-avoidance strategy versus a hypertension-avoidance strategy, will be presented during the fourth late-breaking session.

CHAP, LBCT I. Advice is mixed as to whether low-dose antihypertensives help or harm in pregnancy. CHAP randomized 2,404 pregnant women to BP targets recommended for nonpregnant reproductive-age adults (< 140/90 mm Hg) or to no antihypertensives, testing safety and efficacy for both the baby (primary endpoint) and the mother (secondary endpoint). This study has already won the title for least gender-appropriate trial name of 2022.

TRANSLATE-TIMI 70, LBCT II, Sunday morning. Vupanorsen is an investigational non-HDL cholesterol-lowering drug, given as a subcutaneous injection, being tested in patients with dyslipidemia who are already taking a statin. Topline results for this multicenter dose-finding phase IIb study have already been released, and though the trial met its primary endpoint, the observed effects were ho-hum. Drug developers recently announced they were discontinuing their drug development program.

SuperWIN, LBCT II, Sunday morning. Can delivering point-of-purchase advice to supermarket shoppers improve their decision-making and lead to meaningful improvements in cardiovascular risk factors? That was the question probed by this trial, which compared two different education strategies in 267 participants. Change in DASH score is the study’s primary outcome measure.

PROTECT, LBCT IV, Monday morning. A second noncardiac surgery trial also made Drachman’s list, this one comparing a strategy of aggressive warming (to > 37 °C core temperature) after induction of mild hypothermia versus warming to “usual” levels ( ~ 35.5 °C core temperature), looking at which might be better for reducing myocardial injury.

CLASP-TR, LBCT IV, Monday morning. We already had a peek at 30-day and 6-month results from CLASP-TR, testing the PASCAL transcatheter valve repair system for edge-to-edge repair in tricuspid regurgitation. At ACC 2022, investigators will present the 1-year outcomes.

FLAVOUR, LBCT V, Monday morning. Fractional flow reserve (FFR) has taken its share of knocks in recent years, following several negative trials. FLAVOUR is testing FFR against IVUS for PCI guidance in patients with intermediate coronary artery disease. The 1,700-patient trial’s primary endpoint is a composite of all-cause death, myocardial infarction, or repeat revascularization at 24 months.

PARTITA, LBCT IV, Monday morning. What’s predictive of appropriate ICD shock therapy—is it the burden of untreated, nonsustained episodes of ventricular tachycardia or the number of episodes treated? And is immediate VT ablation warranted after an initial ICD shock, or is it better to wait for the next arrhythmic storm? Understanding timing and efficacy is the goal of this 590-patient PARTITA trial, looking at worsening HF hospitalizations and deaths.

“These are all tremendously exciting studies,” said Drachman. Many of these and “a host of many others . . . have the opportunity to impact on our practice,” he added.

Beyond the Late Breakers

There are a handful of sessions dedicated to new and recent guideline updates, most notably the new American College of Cardiology/American Heart Association 2022 guidelines for the management of heart failure, due out later this week. Both the chest pain and the revascularization guidelines released last year also have focused programming.

The Featured Clinical Research sessions have updates and secondary analyses from a number of high-profile trials including SCORED, COMPLETE, FAME 3, CANTOS, EMPULSE, and the SPYRAL HTN-ON MED pilot study of renal denervation.

This year’s meeting offers a wide range of lectures and research on diversity, equity, inclusion spanning everything from global inequality to physician representation and mentorship, including a 2-hour town hall meeting Friday evening.

All going to plan, the entire TCTMD will be back in person at this year’s ACC: Yael Maxwell, Todd Neale, Michael O’Riordan, Caitlin Cox, and Laura McKeown. If you have studies or presentations you want to tell me about, or suggestions for tackling this year’s conference, drop me a line or reach out to me, Shelley Wood, on Twitter.

Shelley Wood is Managing Editor of TCTMD and the Editorial Director at CRF. She did her undergraduate degree at McGill…

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