Yuxiang Dai, MD, Department of Cardiology, Shanghai Fudan University Zhongshan Hospital, Major in Coronary Intervention
Junbo Ge, MD, FACC, Director of Department of Cardiology, Shanghai Fudan University Zhongshan Hospital, Academician of Chinese Academy of Sciences, Major in Coronary Intervention and Structural Heart Disease Intervention

Due to the outbreak and spread of COVID-19, ACC.20 Together With World Congress of Cardiology was held virtually for the first time between March 28 to 30, however, new data from Late-Breaking Clinical Trials was presented as scheduled, some of which are of great significance in guidance of clinical practice in China.

Despite receiving current standard treatment, there is still a high rate of mortality and rehospitalization in HFrEF patients with recent heart failure (HF) decompensation. VICTORIA study showed that Vericiguat can further reduce the rate of mortality and rehospitalization in these high-risk patients. According to the result of China-HF Registry, the prevalence of HF in China is about 0.9%. The 5-year survival rate of HFrEF in China is about 34%. There is still much room for improvement for high-risk HFrEF patients in China, while Vericiguat may provide a novel treatment and a new option.

DAPT with aspirin and a P2Y12 receptor inhibitor was a cornerstone for secondary prevention in patients with ACS or undergoing PCI. However, the current guidelines have not recommended routine genetic testing of CYP2C19 dysfunction alleles to guide the selection of P2Y12 receptor inhibitors. Although the TAILOR PCI study found that genetic testing to guide DAPT failed to reduce the incidence of MACEs, this strategy may be useful for specific ethnicities such as Chinese, considering notably higher rate of CYP2C19 loss-of-function alleles in Chinese and other Asian populations.

Patients undergoing PCI with high-risk features were also of high risk of both bleeding and ischemic events. The best antiplatelet strategy in these patients aimed to meet the balance between bleeding and ischemia. TWILIGHT COMPLEX suggested that a shortened course of DAPT followed by ticagrelor alone was proved to be an effective and safe antiplatelet strategy in high risk patients. This strategy might be especially meaningful for Chinese patients in current clinical practice for two reasons. Besides the CYP2C19 polymorphism mentioned above, Chinese patients tend to be more susceptive with high bleeding risk in terms of the lower body weight, especially in old female patients.

PARTNER 3 was a landmark trial, expanding the penetration of TAVR in the treatment of aortic stenosis. The two-year results of PARTNER 3 in patients with aortic stenosis at low risk for surgery continued to show a numerical benefit of TAVR over surgery, even though the leading edge has narrowed. Valve thrombosis might be a possible reason for some catch-up in the TAVR arm between years 1 and 2, which also indicated that an optimal antithrombotic regimen was an important issue after TAVR.

In China, there has been a tendency to perform TAVR for patients at low risk for surgery because the clinical practice has proved that TAVR is very safe and effective in Chinese patients. POPular TAVI study showed that oral anticoagulation (OAC) monotherapy significantly reduces bleeding and is non-inferior in reducing clotting-related complications in patients with a long-term need for anticoagulation after TAVI compared to concomitant OAC with clopidogrel. Since the majority of TAVR patients are elderly patients with multiple comorbidities, the risk of bleeding is very high. In PARACHUTE China study, concomitant OAC with antiplatelet drugs caused high incidence of major bleeding. So, we believe concomitant OAC with antiplatelet drugs is inappropriate for TAVR patients.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: ACC International, Aspirin, Transcatheter Aortic Valve Replacement, acc20, ACC Annual Scientific Session

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