Yiwei Lai, Xin Du
Capital Medical University Affiliated Beijing Anzhen Hospital

On March 30, ACC.20/WCC Virtual was brought to a successful conclusion. Although the live meeting did not convene due to the impact of COVID-19, the torch of innovation and revolution was still successfully passed to everyone around the world.

In this year's conference, we were surprised to see so many remarkable clinical drug trials. The first to be unveiled, the VICTORIA Trial, showed us a breakthrough in the treatment of heart failure. Vericiguat's effectiveness in improving the prognosis of HFrEF patients was further validated after the appearance of ARNI and SGLT-2 in recent years. In the field of dyslipidemia, new clinical evidence was added to long-acting PCSK9 inhibitor Inclisiram, which brings great convenience to patients for its over 50% lipid lowering and action time of 18 months. In terms of homogeneous familial hypercholesterolemia (HoFH), two randomized clinical trials reported the effectiveness and safety of PCSK9 inhibitor Alirocumab and LDLR independent drug Evinacumab in LDL-C control of HoFH patients, achieving an multi-target intervention of this tough condition.

Moreover, exploration and advancement in the field of anti-thrombotic therapy was apparent in many trials. The application of NOACs was extrapolated to populations of surgical valve replacement, tumor-associated thrombus and orthopedic surgery. The value of low dose Rivaroxaban was confirmed in patients with lower limb revascularization. TWILGHT sub-studies and a study from Jang et al demonstrated the effectiveness and safety of Ticagrelor mono-therapy 3 months after PCI in patients with complicated coronary lesion, diabetes and acute coronary syndrome.

These trials left us with a lot to consider. First, with the advances of pharmaceutical therapy, we need to stress the regulation of clinical practice. In China, rational drug use is an urgent area in need of improvement. As is reported in an acute heart failure cohort in China (Hero study), Chinese heart failure patients have an unsatisfactory status of rational drug use including the use of β blocker, ACEI/ARB, diuretics. Therefore, there is a need to focus on continuing education of doctors and educating patients.

Second, individualized therapy is an important issue in clinical practice. Advancing lipid-lowering therapy makes it possible for us to achieve different goals of lipid management. On this basis, we should pay more attention to patients' risk factors and genetic background, individualize treatment for lipid management and cardiovascular disease prevention under the guidance of comprehensive cardiovascular risk assessment. Likewise, in terms of antithrombotic therapy, we need to take full account of patients' comorbidities and type of lesion in prescribing proper antithrombotic therapy, especially after balancing the risk of bleeding and thromboembolism. In the future, different risk predictive models that guide individualized therapy may be an important topic of research.

Moreover, current clinical trials of drugs are mainly derived from American and European populations. Considering the difference in genetic backgrounds between Asian and American or European people, we need more clinical trials to confirm the safety and effectiveness of novel medications in Chinese populations.

Meanwhile, the meeting shared several wonderful explorations in medical techniques. The SPYRAL HTN OFF MED trial challenged previous studies, and it indicated that transcatheter renal denervation significantly lowered blood pressure at any time of day, once again arousing a heated discussion of the technique. TAVI achieved primary success in patients without high risk of surgical valve replacement. In the VENOUS trial, ethanol infusion in the vein of Marshall combined with pulmonary vein isolation significantly improved the effectiveness of ablation for persistent AF. Although the technique is not currently completely mature, and the trial may have several limitations (e.g. SPYRAL HTN OFF MED was not blinded for researchers, the baseline character had several intergroup differences, etc.), they stand for remarkable breakthroughs in medical techniques and give us infinite inspiration.

Chinese doctors and scientists have forged ahead on the way of innovation. The world's first transcatheter cryoablation of the renal sympathetic nerve and the world's first transcatheter bi-valve intervention were all performed by Chinese doctors in recent years. But in the future, we still need to deepen our international communication so that we can learn from others to improve our clinical research and to promote the development of medical technique together with our global fellows.

Finally, we are sincerely grateful for the academic feast provided by ACC20 Virtual during such a challenging period of COVID-19 pandemic. We hope ACC will achieve greater success in the future. We also express our warmest welcome here to invite our friends around the world to the Great Wall International Congress of Cardiology in October. Let's gather in Beijing.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: ACC International, Heart Failure, PCSK9 protein, human, ACC Annual Scientific Session, acc20

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