Advances in Clinical Cardiology 2019: A Summary of Key Clinical Trials

Abstract

Introduction: A large number of important clinical trials in cardiology were published or presented at major international conferences during 2019. This paper aims to offer a concise overview of these significant advances and to put them into clinical context.

Methods: Trials presented at the major international cardiology meetings during 2019 were reviewed including The American College of Cardiology (ACC), Euro PCR, The European Society of Cardiology (ESC), Transcatheter Cardiovascular Therapeutics (TCT), and the American Heart Association (AHA). In addition to this a literature search identified several other publications eligible for inclusion based on their relevance to clinical cardiology, their potential impact on clinical practice and on future guidelines.

Results: A total of 70 trials met the inclusion criteria. New interventional and structural data include trials examining use of drug-coated balloons in patients with acute myocardial infarction (MI), interventions following shockable cardiac arrest, mechanical circulatory support in cardiogenic shock complicating MI, intervention in stable coronary artery disease, surgical or percutaneous revascularisation strategies in left main coronary artery disease, revascularisation strategy in ST elevation MI, transcatheter aortic valve replacement in low-risk patients, and percutaneous mitral or tricuspid valve interventions. Preventative cardiology data included the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors (dapagliflozin), proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors (evolocumab), bempedoic acid, and novel approaches to the management of hypertension. Antiplatelet data included trials evaluating both the optimal length of course and combination of antiplatelet agents and regimes including combination antithrombotic therapies for patients with atrial fibrillation. Heart failure data included trials of sacubitril-valsartan in heart failure with preserved ejection fraction and the use of SGLT2 inhibitors in patients with heart failure but without diabetes. Electrophysiology data included trials examining alcohol in atrial fibrillation and the use of wearable fitness devices for identifying atrial fibrillation.

Conclusion: This article presents key clinical trials completed during 2019 and should be valuable to clinicians and researchers working in cardiology.

Keywords: Acute coronary syndrome; Anticoagulation; Atrial fibrillation; Cardiology; Coronary revascularisation; Heart failure; Lipids; Mitral clip; Myocardial infarction; Transcatheter aortic valve implantation.

Fig. 1

a Flattened view of the cobalt chromium stent platform (small vessel model). b Details of the straight and curved link connectors. c Comparison with LEADERS (historical control), with propensity matching and landmark analysis at day 3 for the primary endpoint of major adverse cardiac events at 9 months [3]

Fig. 2

Kaplan–Meier estimates of the 5-year outcomes in the NOBLE intention to treat population Reprinted from Holm et al. [8], with permission from Elsevier

Fig. 3

Computed tomography image demonstrating hypoattenuation of the right cusp of TAVI prosthesis consistent with a focal area of thrombus

Fig. 4

Leaflex™ performer catheter system. Image courtesy of Pi-Cardia (Rehovot, Israel)

Fig. 5

The Moderato device, which reduces blood pressure using cardiac neuromodulation therapy. Image permitted and courtesy of Orchestra BioMed (New Hope, PA, USA)