Summary of some ESC 2023 studies that will impact your practice

The European Society of Cardiology (ESC) Congress 2023 was once again the primary stage for the presentation of cutting-edge research that has the potential to redefine cardiological practice.

This Congress was the catalyst for prolific discussions and revelations, which generated an abundance of information. Aware of this, we selected some of the most relevant studies and focused on highlighting their implications and concrete contributions to medical practice. We hope you find it useful.

Objective:The ATTRibute-CM trial assessed the efficacy and safety of acoramidis in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) compared to placebo.

Participants:Eligible patients with symptomatic wild-type or variant ATTR-CM.

Contributions:Acoramidis enhances outcomes in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) compared to placebo. Therefore, it may serve as an effective and safe alternative to tafamidis.

Objective:ADVENT was the first randomized controlled trial that compared pulsed field ablation (PFA) with conventional ablation (either radiofrequency or cryoablation).

Participants:Patients with symptomatic drug-resistant paroxysmal atrial fibrillation.

Contributions:PFA is as effective and safe as cryoablation for treating paroxysmal atrial fibrillation. Procedure times were faster for PFA than for cryoablation, but there was increased X-ray exposure with PFA.

Objective: To test whether AFib ablation is superior to medical therapy regarding mortality and the need for urgent heart transplantation or left ventricular assist device (LVAD) implantation.

Participants:Patients with the following characteristics:

• Symptomatic atrial fibrillation
• End-stage heart failure eligible for heart transplantation
• New York Heart Association functional class II, III, or IV
• Left ventricular ejection fraction (LVEF) ≤35%
• Fitted with a cardiac device for continuous monitoring

Contributions:In patients with end-stage heart failure, AFib ablation is associated with lower rates of death, urgent heart transplantation, or LVAD implantation compared to medical therapy. Patients with end-stage heart failure eligible for heart transplantation have been excluded from major clinical trials; however, CASTLE-HTx demonstrated that AFib ablation improves outcomes in this group.

Objective:To investigate if immediate complete revascularization at the time of primary percutaneous coronary intervention (PCI) was non-inferior to staged multivessel PCI (within 19 to 45 days) among hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease.

Participants: Patients with STEMI (presenting within 24 hours of symptom onset) and multivessel coronary artery disease (that was defined as ≥1 coronary lesion with ≥70% diameter stenosis on coronary angiography based on visual check in a non-culprit coronary artery of ≥2.25 mm and ≤5.75 mm in diameter), who remained hemodynamically stable after successful primary PCI of the infarct-related coronary artery.

Contributions:Immediate multivessel PCI is not inferior to staged multivessel PCI for reducing death and ischemic events in patients with STEMI and multivessel coronary artery disease. Immediate PCI of non-culprit lesions is equally effective and safe as a staged procedure. The results of MULTISTARS AMI were generally consistent across specified key subgroups, mainly among women and men (both young and older) and patients with or without diabetes.

Objective:To test whether treatment with semaglutide, in addition to aiding in weight loss, can significantly improve symptoms, physical limitations, and exercise capacity in patients with heart failure with preserved ejection fraction (HFpEF) and obesity.

Participants: Patients with HFpEF who met the following criteria:

• Left ventricular ejection fraction ≥45%.
• BMI ≥30 kg/m2.
• Heart failure symptoms.
• Functional limitations (New York Heart Association functional class II-IV and Kansas City Cardiomyopathy Questionnaire Clinical Summary Score [KC-CQ-CSS] <90 points).

Contributions: Semaglutide improves heart failure-related symptoms and physical function and results in greater weight loss compared with placebo in patients with HFpEF and obesity. The results of STEP-HFpEF show that obesity is not merely a comorbidity in HFpEF patients but rather a root cause and a target for therapeutic intervention.

Objective: This is the first trial investigating the efficacy and safety of oral anticoagulation in patients with atrial high-rate episodes (AHRE) but without documented Afib on the electrocardiogram (EKG).

Participants: Patients aged ≥65 years with the following characteristics:

• AHRE episodes of ≥6 minutes detected by implantable devices.
• ≥1 additional stroke risk factor: heart failure, diabetes, hypertension, prior stroke or transient ischemic attack, vascular disease, age ≥75 years.
  
  

Contributions: Blood thinners cause bleeding without preventing strokes in patients with AHRE, but without atrial fibrillation diagnosed by EKG. The results of NOAH-AFNET 6 clearly suggest the need to demand EKG documentation of atrial fibrillation before initiating oral anticoagulation.

Objective: This randomized and pragmatic group trial examined the ability of a stepped diagnostic strategy to identify coronary artery disease (CAD), atrial fibrillation (AF), and heart failure (HF) in patients with COPD or type 2 diabetes, using tools readily available in primary care.

Participants: Primary care practices across the Netherlands that could integrate the early diagnosis strategy into their usual disease management programs for type 2 diabetes and COPD.

Contributions: RED-CVD demonstrated that a proactive diagnostic strategy is capable of identifying CAD, AF, and HF within the community. Active surveillance of patients with type 2 diabetes or COPD allowed for doubling new diagnoses of cardiovascular disease compared to usual care.

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