Advances in Clinical Cardiology 2020: A Summary of Key Clinical Trials

Abstract

Introduction: Despite the challenge of a global pandemic, 2020 has been an invaluable year in cardiology research with numerous important clinical trials published or presented virtually at major international meetings. This article aims to summarise these trials and place them in clinical context.

Methods: The authors reviewed clinical trials presented at major cardiology conferences during 2020 including the American College of Cardiology, European Association for Percutaneous Cardiovascular Interventions, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics and the American Heart Association. Trials with a broad relevance to the cardiology community and those with potential to change current practice were included.

Results: A total of 87 key cardiology clinical trials were identified for inclusion. New interventional and structural cardiology data included trials evaluating bifurcation percutaneous coronary intervention (PCI) techniques, intravascular ultrasound (IVUS)-guided PCI, instantaneous wave-free (iFR) physiological assessment, new generation stents (DynamX bioadaptor), transcatheter aortic valve implantation (TAVI) in low-risk patients, and percutaneous mitral or tricuspid valve interventions. Preventative cardiology data included new data with proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors (evolocumab and alirocumab), omega-3 supplements, evinacumab and colchicine in the setting of chronic coronary artery disease. Antiplatelet data included trials evaluating both the optimal length of course following PCI and combination of antiplatelet agents and regimes including combination antithrombotic therapies for patients with atrial fibrillation (AF). Heart failure data included the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors (sotagliflozin, empagliflozin and dapagliflozin) and mavacamten in hypertrophic cardiomyopathy. Electrophysiology trials included early rhythm control in AF and screening for AF.

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

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

Fig. 1

Central illustration. Conceptual framework for the in vivo detection and focal passivation of vulnerable plaques. PCI percutaneous coronary intervention. GDMT guideline-directed medical therapy (Reproduced with the permission of the Journal of the American College of Cardiology [29])

Fig. 2

Kaplan-Meier hazard curves for a target lesion failure, the primary safety outcome measure, through the 24-month follow-up and b randomised lesion-related major adverse cardiac events (MACE) through the 4-year follow-up in the PROSPECT-ABSORB trial (Reproduced with the permission of the Journal of the American College of Cardiology [29])

Fig. 3

PASCAL implant and PASCAL Ace implant repair systems with a central spacer, broad contoured paddles and independent clasps for leaflet capture (Reproduced with permission of Edwards Lifesciences Corp., ^© 2021. All rights reserved)

Fig. 4

TriClip™ delivery system (Reproduced with permission of Abbott, ^© 2020. All rights reserved)

Fig. 5

Symplicity Spyral catheter (Used with the permission of Medtronic. ^© 2013 Medtronic)

Fig. 6

Xio XT ECG patch (Image supplied courtesy of iRhythm Technologies Ltd.)

Fig. 7

Changes in resting (a) and post-exercise (b) LVOT gradients in patients taking Mavacamten compared with placebo [130]