Advances in Clinical Cardiology 2022: A Summary of Key Clinical Trials

Abstract

Introduction: Over the course of 2022, numerous key clinical trials with valuable contributions to clinical cardiology were published or presented at major international conferences. This review seeks to summarise these trials and to reflect on their clinical context.

Methods: The authors reviewed clinical trials presented at major cardiology conferences during 2022, including the American College of Cardiology (ACC), European Association for Percutaneous Cardiovascular Interventions (EuroPCR), European Society of Cardiology (ESC), Transcatheter Cardiovascular Therapeutics (TCT), American Heart Association (AHA), European Heart Rhythm Association (EHRA), Society for Cardiovascular Angiography and Interventions (SCAI), TVT-The Heart Summit (TVT) and Cardiovascular Research Technologies (CRT). Trials with a broad relevance to the cardiology community and those with potential to change current practice were included.

Results: A total of 93 key cardiology clinical trials were identified for inclusion. Interventional cardiology data included trials evaluating the use of new generation novel stent technology and new intravascular physiology strategies such as quantitative flow ratio (QFR) to guide revascularisation in stable and unstable coronary artery disease. New trials in acute coronary syndromes and intervention focused on long-term outcomes of optimal medical therapy (OMT), revascularisation in ischaemic dysfunction and left main (LM) intervention. Structural intervention trials included latest data on optimal timing and anticoagulation strategies in transcatheter aortic valve replacement (TAVR), in addition to expanding evidence in mitral and tricuspid valve interventions. Heart failure data included trials with sodium-glucose cotransporter 2 (SGLT2) inhibitors, iron replacement and novel drugs such as omecamtiv. Prevention trials included new data on proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and polypill strategies. In electrophysiology, new data regarding optimal timing of ablative therapy for atrial fibrillation (AF) in addition to novel screening strategies were evaluated.

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

Keywords: Acute coronary syndrome; Antiplatelet therapy; Atrial fibrillation; Cardiology; Clinical trial; Electrophysiology; Heart failure; Prevention.

Fig. 1

The PASCAL ACE™ system, designed for percutaneous tricuspid valve leaflet repair in severe tricuspid regurgitation. Reproduced with kind permission by Edwards Lifesciences LLC, Irvine, CA, USA

Fig. 2

The TriClip™ G4 Transcatheter Edge-to-Edge Repair System (Abbott), designed for percutaneous tricuspid valve leaflet repair in severe tricuspid regurgitation. Reproduced with the kind permission of permission of Abbott, © 2022. All rights reserved

Fig. 3

Post-Watchman implantation antithrombotic strategies and associated risk of adverse outcomes. The most common strategy was warfarin plus aspirin. The lowest risk of adverse events was seen in groups anticoagulated with either warfarin or NOAC alone (primarily driven by reduced bleeding rates). Interestingly, there was no difference in ischaemia stroke or device-related thrombus between groups. Reproduced with the kind permission of the Journal of the American College of Cardiology [38]

Fig. 4

Kaplan–Meier survival Curves demonstrating cumulative event rate of all-cause mortality and CV mortality at 8 years in the ISCHAEMIA-EXTEND trial. Notably, a lower 7-year rate CV mortality was demonstrated in the invasive group [6.4% vs. 8.6%; adjusted hazard ratio, 0.78 (95% CI, 0.63–0.96)]; however, there was no difference in all-cause mortality [7-year rate, 12.7% in invasive strategy, 13.4% in conservative strategy; adjusted hazard ratio, 1.00 (95% CI, 0.85–1.18)] [39]. Reproduced with the kind permission of Circulation

Fig. 5

Illustration reproduced from TACTICS registry demonstrating OCT (Optical Coherence Tomography) images of the different causes of ACS (Acute Coronary Syndromes) using OCT-defined morphological assessment. Reproduced with kind permission from the Journal of American College of Cardiology [43]

Fig. 6

Central illustration from the LBBP-RESYNC trial indicating the randomization process and total numbers in LBBP-CRT group and the BiVP-CRT group. Also bar graph highlighting the change in LVEF (%) from baseline, at 6 months of treatment int the LBBP-CRT group 21.1% vs. 15.6% in the BiVP-CRT group (P = 0.039, 95% CI 0.3–10.9). Reproduced with kind permission from the Journal of the American College of Cardiology [52]

Fig. 7

Graphical abstract from Vijayaraman et al. demonstrating the improvements in QRS duration (ms), NYHA class, ejection fraction (%) and end diastolic dimension (mm) in patients receiving rescue LBBBAP in patients with lead failure or non-responders. For all patients, the QRS duration reduced by 31 ms (P < 0.001), ejection fraction increased from 29 to 40% (P < 0.001), NYHA class reduced from between 2.3–3 to < 2 (P < 0.001) and end diastolic diameter reduced from 59 to 56 mm (P < 0.001). Reproduced with kind permission from the Heart Rhythm Journal Ltd [54]

Fig. 8

Primary efficacy outcome and components demonstrated in the EMPULSE trial using the stratified win ratio. Overall, a win ratio of 1.36 was found in favour of empagliflozin (95% CI: 1.09–1.68, P = 0.0054) [84]. Reproduced with the kind permission of the Nature publishing group