Late-Breakers of ACC.23/WCC and Potential Impacts on Clinical Practice in China: Summary and Perspective

The three-day annual ACC.23/WCC conference has been undoubtfully a great success. More than 20 late-breaking clinical trials have been presented with results that can be practice-changing. For physicians in China, ACC.23/WCC can be considered the very first annual scientific session in the so-called "post-COVID era". Findings from these late-breakers are also quite enlightening for cardiologists in China.

Statins are considered the cornerstone of lipid-lowering therapy. Yet there're still a certain group of population that cannot benefit from statins due to intolerance. PCSK9 inhibitors could be an alternative, but their use in China has also been limited due to economic considerations as well as resistance to injection. The CLEAR Outcomes trial was designed to evaluate whether treatment with bempedoic acid, a new lipid-lowering agent, reduces the risk of cardiovascular events in statin-intolerance patients who are at high risk for cardiovascular diseases. According to the results, bempedoic acid reduced the combined rate of major adverse cardiovascular event by 13%. Patients receiving bempedoic acid had their low-density lipoprotein cholesterol levels dropped by approximately 20% to 25%. Although the lipid-lowering effect seems to be generally mild as compared to statins or PCSK9 inhibitors, these results are still quite positive and promising.

Speaking of statins, some recent studies have argued that they might present preventive and protective effects against cardiotoxicity from anthracyclines, a widely used type of chemotherapy drugs. In the STOP-CA trial, researchers found that among lymphoma patients receiving anthracyclines, those who additionally took atorvastatin were significantly less likely to suffer from heart dysfunction at one year than those who took placebos. "These data support the use of atorvastatin among patients with lymphoma being treated with anthracyclines, where prevention of cardiac systolic dysfunction is important," said Tomas G. Neilan, MD, MPH, FACC, the co-lead author. China is one of the leading countries in both number of patients and deaths of cancer, among which many receive chemotherapy as a treatment. The results of STOP-CA showed a possibility that for these patients, the widely used statins could be developed with new indications and might in the future be administered as a prevention/protection against cardiotoxicity from chemotherapy.  

Structural heart disease, or valvular heart disease, is considered one of the top difficulties against human longevity. In China, rheumatic heart disease is still the major cause of valvular heart disease, while there's also a significant increase in degenerative heart disease. Late-breakers from ACC.23/WCC also focused on this field. Final five-year results from the COAPT trial maintained the positive results from earlier follow-ups, showing reduction in death and hospitalization, as well as durable mitral regurgitation reduction in patients receiving Mitraclip. As for aortic valve, the 3-year outcomes from the Evolut Low Risk trial confirmed the benefits and good outcomes of transcatheter aortic valve replacement were maintained over time. These results are encouraging for Chinese patients as well as physicians.

Pulsed field ablation (PFA) is a nonthermal mode that uses electrcical pulses for ablation of atrial fibrillation (AFib) The Pulsed AF Pivotal trial is the first prospective, global, multicenter study for PFA treatment in patients with paroxysmal and persistent AFib. According to the results, PFA was effective at 1 year in 66.2% of patients with paroxysmal AFib and in 55.1% of patients with persistent AFib. Although the nonrandomized and single-arm design is considered a limitation, these results are still promising and enlightening. 

The growing use of wearable devices in healthcare has become a hot topic. Wearable device combined with artificial intelligence and machine learning has been used more frequently in cardiovascular clinical practice. An interesting late-breaker presented at ACC.23/WCC focused on the role of an experimental wrist-worn troponin sensor in prediction of rising troponin-I level and obstructed coronary arteries. This very first multicenter study in this field showed an 90% accuracy of the wrist-worn device. "This is an exciting opportunity because it increases our capability for early diagnosis of heart attacks in both community settings and in acute care environments," said Partho P. Sengupta, MD, FACC, the study's lead author. China has been the emerging market of wearable devices. Taken together with the large number of cardiovascular patients, these results showed the potential of a flourishing market in our country. 

Other late-breakers such as TRILUMINATE Pivotal, HALO, RENOVATE-COMPLEX-PCI, IMPLEMENT-HF, etc. has also showed inspiring results. ACC.24 will take place April 6th to 8th in Atlanta, GA. We all look forward to reuniting in the "Big Peach" for yet another successful conference in 2024!

Authored by Yi Xu, BM, PhD, FACC, and Jun Guo, MD, PhD, from the department of cardiology at The First Affiliated Hospital of Ji'Nan University.

Clinical Topics: Arrhythmias and Clinical EP, Cardio-Oncology, COVID-19 Hub, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Interventions and Structural Heart Disease, Mitral Regurgitation

Keywords: Lipoproteins, Wearable Electronic Devices, Percutaneous Coronary Intervention, Follow-Up Studies, Prospective Studies, Atrial Fibrillation, Artificial Intelligence, Mitral Valve Insufficiency, Rheumatic Heart Disease, Cardiotoxicity, Troponin I, Proprotein Convertase 9, PCSK9 protein, human, Anthracyclines, Atorvastatin, Hydroxymethylglutaryl-CoA Reductase Inhibitors, COVID-19, ACC23, ACC Annual Scientific Session, ACC International

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