Advances in Clinical Cardiology 2017: A Summary of Key Clinical Trials

Abstract

Introduction: Numerous important cardiology clinical trials have been published or presented at major international meetings during 2017. This paper aims to summarize these trials and place them in clinical context.

Methods: The authors reviewed clinical trials presented at major cardiology conferences during 2017 including the American College of Cardiology, European Association for Percutaneous Cardiovascular Interventions, European Society of Cardiology, European Association for the Study of Diabetes, Transcatheter Cardiovascular Therapeutics, and the American Heart Association. Selection criteria were trials with a broad relevance to the cardiology community and those with potential to change current practice.

Results: A total of 75 key cardiology clinical trials were identified for inclusion. New interventional and structural cardiology data include left main bifurcation treatment strategy, multivessel disease management in cardiogenic shock, drug-eluting balloons for in-stent restenosis, instantaneous wave-free physiological assessment, new-generation stents (COMBO, Orsiro), transcatheter aortic valve implantation, and closure devices. New preventative cardiology data include trials of liraglutide, empagliflozin, PCSK9 inhibitors (evolocumab and bococizumab), inclisiran, and anacetrapib. Antiplatelet data include the role of uninterrupted aspirin therapy during non-cardiac surgery and dual antiplatelet therapy following coronary artery bypass grafting. New data are also included from fields of heart failure (levosimendan, spironolactone), atrial fibrillation (apixaban in DC cardioversion), cardiac devices (closed loop stimulation pacing for neuromediated syncope), and electrophysiology (catheter ablation for atrial fibrillation).

Conclusion: This paper presents a summary of key clinical cardiology trials during the past year and should be of practical value to both clinicians and cardiology researchers.

Keywords: Acute coronary syndrome; Anticoagulation; Atrial fibrillation; Bioabsorbable polymer; Cardiology; Coronary revascularization; Heart failure; Lipids; Myocardial infarction; Patent foramen ovale; Transcatheter aortic valve implantation.

Fig. 1

CrossBoss—dedicated CTO crossing catheter. Image provided courtesy of Boston Scientific. ©2018 Boston Scientific Corporation or its affiliates. All rights reserved

Fig. 2

a LAD CTO with retrograde filling from circumflex septal collaterals. b LAD following recanalization using rCART technique

Fig. 3

Single-vessel moderate lesion with FFR value 0.74, typical of that included in the ORBITA trial

Fig. 4

a Target lesion failure with severe in-stent restenosis 3 years following revascularization with BVS. b Corresponding optical coherence tomography image with reduced minimal luminal area and intimal hyperplasia

Fig. 5

a SENTINEL cerebral protection device. b, c Debris caught by cerebral protection device during TAVR. Images reproduced with permission from Claret Medical

Fig. 6

Watchman left atrial appendage closure device mounted on delivery catheter. Image provided courtesy of Boston Scientific. ©2018 Boston Scientific Corporation or its affiliates. All rights reserved

Fig. 7

Reduction of CV death, MI, or stroke with the IL-1β inhibitor canakinumab vs. placebo in the CANTOS study

Fig. 8

Reduction of CV death, MI, or stroke with the combination of very low dose rivaroxaban plus aspirin vs. aspirin alone in the COMPASS study

Fig. 9

Reduction in clinically relevant non-major bleeding with dabigatran compared to warfarin in RE-DUAL PCI

Fig. 10

Percentage VTE recurrence/major bleeding in three trial arms, rivaroxaban 10 mg, rivaroxaban 20 mg, aspirin 100 mg. **P < 0.001 vs. aspirin

Fig. 11

Isolated pulmonary veins using cryotherapy with aid of CARTO mapping system