ACC 2016 Scientific Session Highlights

8/16/2019 ACC 2016 Scientific Session Highlights

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American

College of

Cardiology Annual Scientic Sessions

2016

Key Trials

MARCH 29-31, 2014

WASHINGTON, DC


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CONTENT

1. Non-Statin Therapies only After Lifestyle Interventions and Statins,Says ACC Consensus Statement on LL-redu!tion

". Lo#-dose Statin Therapy Alone and in Com$ination to %& Lo#erin'

(edu!es Lon'-term C) Events in Intermediate-ris* &opulation+ O&E Trial. STE/I &atients /ore 0oun'er O$ese in (e!ent 0ears2. )itamin Supplementation Improves Cardia! 3un!tion in Chroni!

eart 3ailure+ )INICATE Trial4. Evolo!uma$ Lo#ers LL-C Levels in Statin Intolerant &atients+

5A6SS- Trial7. Eva!etrapi$ 3ails to (edu!e /a8or C) Events in i'h (is* &atients+

ACCELA(ATE Trial9. Alis*iren Not %ene:!ial in &atients #ith C3+ AT/OS&E(E Trial;. Losmapimod 3ails to Sho# %ene:t in A/I &atients+ LATIT6E-TI/I 7<

Trial=. (ate and (hythm Control E>ually %ene:!ial in Atrial 3i$rillation

&ost-Cardia! Sur'ery1


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"". TA)( #ith Core)alve Noninferior to Sur'i!al A)( in Improvin'Survival in Severe Aorti! Stenosis &atients+ The Core)alve i'h-(is* Study

". Superiority of %ariatri! Sur'ery plus /edi!al Therapy vs/edi!al Therapy Alone in O$ese@ Over#ei'ht ia$etes &atients

Sustained for 4 0ears+ STA/&EE Trial"2. Cell Therapy #ith I?myelo!el-T may Improve Out!omes in&atients #ith Is!hemi! 3+ i?CELL-C/ TriaNon-Statin Therapies only After Lifestyle Interventions and Statins,

Says ACC Consensus Statement on LL-redu!tion

A latest e?pert !onsensus statement issued $y the Ameri!an Colle'eof Cardiolo'y re!ommends the use of lifestyle modi:!ations andstatins $efore !hoosin' non-statin dru's for lo# density lipoprotein!holesterol LL-CB redu!tion for prevention of !ardiovas!ular C)Bevents.

The 2016 ACC Expert Co!e!"! De#$!$o %&th'&( o the Ro)e o* No-St&t$ Ther&p$e! *or +D+-C +o'er$ $ the M&&eet o* Athero!#)erot$#C&r.$o/&!#")&r D$!e&!e ASCD R$! '&! .$!#"!!e. &t the American Collegeof Cardiology Scientic Sessions 2016 Th$! !t&teet $! &)!o e.or!e. 5(the N&t$o&) +$p$. A!!o#$&t$o N+A

Th$! !t&teet #o!$.ere. re#et)( &/&$)&5)e tr$&) e/$.e#e *or o-!t&t$ther&p$e! !"#h &! eet$$5e, $$ &. proprote$ #o/ert&!e!"5t$)$!$7ex$ t(pe 9 %CS8-9 $h$5$tor! *or *or")&t$ there#oe.&t$o! It pro/$.e! re!po!e to 3 #r$t$#&) "e!t$o! &..re!!$ the

*o))o'$ $!!"e!:1 %&t$et pop")&t$o! $ 'h$#h o-!t&t$ ther&p$e! !ho"). 5e #o!$.ere.2 C)$$#&) !$t"&t$o! $ 'h$#h o-!t&t$ ther&p$e! #& 5e #o!$.ere.

&$t".e o* +D+-re."#t$o &. o-!t&t$ ther&p$e! to 5e #o!$.ere. *or!t&t$ $to)er&#e

3 %&rt$#")&r o-!t&t$ &et! &. or.er o* pre*ere#e o* the!e ther&p$e!

The re#oe.&t$o! &./o#&te &!!"r$ &.here#e to he&)th( )$*e!t()e $p&t$et! 5e*ore #o!$.er$ o-!t&t$ ther&p$e! ;e' e( re#oe.&t$o!o o-!t&t$ ther&p$e! &re e)$!te. &! *o))o'!:

• I p&t$et! '$th ex$!t$ ASCD or +D+-C


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Lo#-dose Statin Therapy Alone and in Com$ination to %& Lo#erin'(edu!es Lon'-term C) Events in Intermediate-ris* &opulation+

O&E - Trial

A##or.$ to The He&rt O"t#oe! %re/et$o E/&)"&t$o3 HO%E-3 tr$&)!,

pre!ete. &t the American College of Cardiology Scientic Sessions 2016,treatment #ith !holesterol-lo#erin' therapy alone and in!om$ination #ith $lood-pressure %&B lo#erin' treatment mayprevent !ardiovas!ular C)B events in patients #ithout *no#n!ardiovas!ular disease C)B, and #ith an intermediate ris* of ma8or C) events 1D annuallyB $ut %& lo#erin' alone doesnt oFerthe same $ene:t unless %& #as hi'h

The !t".( r&.o$e. 12,B0= p&t$et! $ 2 x 2 *tor$&) .e!$ to e$ther &))r&.o$&t$o! 'ere .oe $ & 1:1 *&!h$o: 1 #ho)e!tero) )o'er$ &&)(!$!:ro!"/&!t&t$ 10 6,361 or p)e5o 6,344 2 @% )o'er$

&&)(!$!: #&.e!&rt& 16 7.&( h(.ro#h)oroth$&$.e HTCF 12= 7.&( 6,3=6 or p)e5o 6,349 or 3 #ho)e!tero) &. @% )o'er$&&)(!$!: ro!"/&!t&t$ #&.e!&rt& HCTF 3,10 or p)e5o 3,16 The e.$& *o))o'-"p $! =6 (e&r!

Re!")t! o* the #ho)e!tero) )o'er$ &&)(!$! !ho'e. si'ni:!ant redu!tionin C) out!omes #ith rosuvastatin vs pla!e$o T&5)e 1 +o' .e!$t()$poprote$ +D+ #ho)e!tero) too '&! !$$?#&t)( )o'ere. 5( ro!"/&!t&t$ &tthe e. o* the !t".( per$o. o/er&)) e& .$ere#e, 346 7 .+

T&5)e 1: O"t#oe! '$th #ho)e!tero) )o'er$ ro"p

Out!omes (osuvastatin

&la!e$o

& value

;$r!t #o-pr$&r( o"t#oe #opo!$te o* C.e&th7(o#&r.$&) $*&r#t$o MI7!troeJ

3B> 4> p 0002

Se#o. #o-pr$&r( o"t#oe #opo!$te o* C .e&th7MI7!troe7re!"!#$t&te. #&r.$&rre!t7he&rt *&$)"re7re/&!#")&r$&t$o

44> =B> p K 0001

MI 0B> 11> p < 00=Coro&r( &rter( .$!e&!e CAD 1B> 22> p 002Ho!p$t&)$&t$o *or C #&"!e! 44> => p K 0001Ne'-o!et .$&5ete! e))$t"! 39> 3> p 02

Th"!, ro!"/&!t&t$ '&! 5ee?#$&) $ & .$/er!e pop")&t$o 'ho .$. ot h&/eCD &. 'ho 'ere &t $tere.$&te r$!

Re!")t! o* the @% )o'er$ &&)(!$! !ho'e. th&t the :?ed-dose!om$ination of !andesartan and CTG #as not superior to pla!e$oin redu!in' C) events despite a 7@ mm' de!rease in %& T&5)e 2


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T&5)e 2: O"t#oe! '$th @% )o'er$ ro"p

Out!omes Candesartan H CTG

&la!e$o

& value

;$r!t #o-pr$&r( o"t#oe #opo!$te o* C.e&th7MI7!troe

41> 44> p 040


49> =2> p 0=1

S(pto&t$# h(pote!$o 30> 21> p K 0001

%&rt$#$p&t! $ the su$'roup for the upper third of systoli! %& 12.4mm 'B #ho re!eived !andesartanHCTG had si'ni:!antly lo#errates of the :rst and se!ond !oprimary out!omes than those in thepla!e$o 'roup h&&r. r&t$o: 0B6 'h$)e ee#t! 'ere e"tr&) $ the

!"5ro"p 'ho h&. $..)e 1316 143= H &. )o'er K131= Hth$r. o* !(!to)$# @%

Th"!, #&.e!&rt&HCTF '&! ot &!!o#$&te. '$th & )o'er r&te o* C e/et!&o per!o! &t $tere.$&te r$! 'ho .$. ot h&/e CD Ho'e/er, $p&rt$#$p&t! '$th "#op)$#&te. $). h(perte!$o, #&.e!&rt&HCTF!$$?#&t)( re."#e. the r$! o* #&r.$o/&!#")&r e/et!

Re!")t! o* the &&)(!$! th&t #o5$e. #ho)e!tero) &. @% )o'er$ .&t&!ho'e. si'ni:!ant redu!tion in C) out!omes #ith rosuvastatin H!andesartan H CTG vs pla!e$o T&5)e 3

T&5)e 3: O"t#oe! '$th #o5$e. #ho)e!tero) &. @% )o'er$ ro"p

Out!omes (osuvastatin

&la!e$o

& value

;$r!t #o-pr$&r( o"t#oe #opo!$te o* C.e&th7(o#&r.$&) $*&r#t$o 7!troe

36> =0> p 000=


46> 6=> p 0001

C .e&th 24> 29> p < 00=A)) !troe! 10> 1B> p K 00=

MI 0B> 12> p K 00=Ho!p$t&)$&t$o *or C #&"!e! 44> 60> p 000=

Th"!, ?xe. .o!e #o5$&t$o o* ro!"/&!t&t$ &. t'o &t$h(perte!$/e&et! '&! &!!o#$&te. '$th & !$$?#&t)( )o'er r$! o* C e/et! &o$tere.$&te-r$! per!o! '$tho"t pre/$o"! CD


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' ngl J )ed. April 2nd, 2016 (early online publication.doi!10.10%6"'J)oa16001*6' ngl J )ed. April 2nd, 2016 (early online publication. doi!10.10%6"'J)oa16001*%' ngl J )ed. April 2nd, 2016 (early online publication. doi!

10.10%6"'J)oa16001**


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STE/I &atients /ore 0oun'er O$ese in (e!ent 0ears

A##or.$ to & !t".( pre!ete. &t the American College of Cardiology Scientic Session 2016, ST-se'ment elevation myo!ardial infar!tionSTE/IB is o!!urrin' in youn'er patients, espe!ially those #ho are

more o$ese and those #ho are more li*ely to have preventa$le ris* fa!tors su!h as !hroni! o$stru!tive pulmonary disease CO&B,dia$etes, hypertension and smo*in'.

Th$! !t".( &&)(!e. the he&rt .$!e&!e r$! *tor! &o 3,912 #o!e#"t$/ep&t$et! 'ho 'ere tre&te. *or STEMI &t the C)e/e)&. C)$$# 5et'ee 199=&. 2014 D"r$ the 20-(e&r *o))o' "p per$o. $t '&! o5!er/e. th&t themean a'e at STE/I presentation de!reased from 74 years to 7<years and the prevalen!e of o$esity in!reased from 1D to 2 &)) the!e re!")t! 'ere !$$?#&t The !t".(&)!o re/e&)e. & si'ni:!ant in!rease 74D to ;4DB in the proportion of patients #ho have three or more ma8or ris*-fa!tors. In addition,there #as also a rise in the num$er of STE/I patients #ho reportedsmo*in' from ";D in 1==4 to 27D in "


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)itamin Supplementation Improves Cardia! 3un!tion in Chroni!eart 3ailure+ )INICATE Trial

i'h-dose vitamin supplementation for one year si'ni:!antlyimproves !ardia! fun!tion in patients #ith !hroni! heart failure

C3B and vitamin de:!ien!y, #or.$ to re!")t! o* the $t&IN Dtre&tI p&t$et! '$th Chro$# heArT *&$)"rE INDICATE !t".( pre!ete. &tthe American College of Cardiology Scientic Sessions 2016

Th$! r&.o$e., p)e5o-#otro))e. .o"5)e-5)$. tr$&) ero))e. & tot&) o* 299p&t$et! '$th CH; !e#o.&r( to )e*t /etr$#")&r + !(!to)$# .(!*"#t$o+SD &. /$t&$ D .e?#$e#( 2=OH /$t&$ D3 K=0o)7+K207+J %&t$et! &)re&.( o opt$&) e.$#&) ther&p( 'ere r&.o$e.to re#e$/e /$t&$ D3 !"pp)eet&t$o 4000IL 100 2=OHD3J .&$)( or&t#h$ o-#&)#$"-5&!e. p)e5o The pr$&r( e.po$t '&! #h&e $!$x-$"te '&) .$!t&#e *ro 5&!e)$e to 12 oth!, &. the !e#o.&r(

e.po$t $#)".e. the #h&e $ )e*t /etr$#")&r ee#t$o *rt$o &t oe (e&r

A)tho"h the re!")t! !ho'e. th&t oe (e&r o* /$t&$ D !"pp)eet&t$o h&.o ee#t o 6-$"te '&) .$!t&#e, $t !$$?#&t)( $pro/e. #&r.$*"#t$o o e#ho#&r.$or&ph( re!")t$ $ & $#re&!e $ + ee#t$o *rt$o+E; 5( 60B> It &)!o #&"!e. & re/er!&) o* + reo.e))$, 5( re."#$ +e. .$&!to)$# +ED .$&eter 5( 249 &. + e. !(!to)$# .$&eter+SD 5( 209 T&5)e

T&5)e: Ee#t o* 12 oth! o* /$t&$ D !"pp)eet&t$o o pr$&r( &.!e#o.&r( o"t#oe /&r$&5)e!

Endpoint (andomiJed

treatment

/ean!han'eafter 1"months

iFeren!e in mean!han'e

&-value

&rimary Out!omeS$x $"te'&) .$!t&#e

%)e5o 1010 -2411 02==$t&$ D -12=6

Se!ondary Out!ome+E; > %)e5o 136 60B K0001

$t&$ D B6=

+ED %)e5o -00 -249 0002$t&$ D -24=

+SD %)e5o -099 -209 0043$t&$ D -2B2

Thus, althou'h one year of hi'h-dose vitamin supplementation didnot aFe!t the 7-minute #al* distan!e in patients #ith C3, it


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improved L) stru!ture and fun!tion. The!e re!")t! potet$&te the ee.*or *"rther tr$&)! to e!t&5)$!h the ro)e o* /$t&$ D $ $pro/$ o"t#oe! $he&rt *&$)"re e!pe#$&))( !$#e /$t&$ D .e?#$e#( $! #oo $ p&t$et! '$thCH; J Am Coll Cardiol. April t3, 2016 (early online publication

doi:10.1016/j.jacc.2016.0.!0"

http://dx.doi.org/10.1016/j.jacc.2016.03.508http://dx.doi.org/10.1016/j.jacc.2016.03.508


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Thus evolo!uma$ resulted in si'ni:!antly 'reater LL-C redu!tionas !ompared to eJetimi$e after "2 #ee*s of treatment in patients#ith statin intoleran!e due to mus!le-related eFe!ts.

JA)A. April $rd, 2016 (early online publication. doi!10.1001"#ama.2016.$60-


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Eva!etrapi$ 3ails to (edu!e /a8or C) Events in i'h (is* &atients+ACCELA(ATE Trial

The #ho)e!ter() e!ter tr&!*er prote$ CET% $h$5$tor, eva!etrapi$ 8oinedthe ran*s of other failed dru's of its !lass, tor!etrapi$ and

dal!etrapi$ as it did not sho# redu!tion in ma8or !ardiovas!ular C)Bevents a!!ordin' to the results of the Assessment of Clini!al EFe!tsof Cholesteryl Ester Transfer &rotein Inhi$ition Mith Eva!etrapi$ in&atients at a i'h-(is* for )as!ular Out!omes ACCELA(ATEB trialpre!ete. &t the American College of Cardiology Scientic Sessions 2016

Th$! tr$&) r&.o$e. 12,092 p&t$et! '$th h$h /&!#")&r r$! .e?e. &! ACS5et'ee 30 &. 36= .&(!, per$pher&) &rter( .$!e&!e, .$&5ete! '$th #oro&r(&rter( .$!e&!e or #ere5ro/&!#")&r .$!e&!e $ & 1:1 r&t$o to re#e$/ee/etr&p$5 130 or p)e5o The e& &e o* the p&rt$#$p&t! '&! 6=(e&r! '$th 23> *e&)e! &. 6> .$&5et$#! The pr$&r( e.po$t '&! &

#opo!$te o* C .e&th, (o#&r.$&) $*&r#t$o MI, !troe, #oro&r(re/&!#")&r$&t$o or ho!p$t&)$&t$o *or &$& The tr$&) '&! !#he.")e. to )&!t"t$) 1,6B0 p&t$et! exper$e#e. the pr$&r( e.po$t &. B00 exper$e#e.C .e&th, MI or !troe, '$th & $$" *o))o'-"p o* 30 oth!

The trial #as terminated earlier as the preliminary analysis did notsho# any impa!t of eva!etrapi$ on the primary endpoint vs. pla!e$o1".;D vs. 1".9D, p /! 41> HR 04 9=> CI, 0B1-101, 'h$#h '&! deemed to $e a!han!e :ndin' #or.$ to the &"thor!

These results from the ACCELA(ATE trial indi!ated that althou'heva!etrapi$ resulted in a 1


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Alis*iren Not %ene:!ial in &atients #ith C3+ AT/OS&E(E Trial

A##or.$ to the A)$!$re Tr$&) to M$$$e O"t#oeS $ %&t$et! '$th HE&rt*&$)"RE ATMOS%HERE tr$&), pre!ete. &t American College of Cardiology Scientic Sessions 2016, alis*iren sho#ed no $ene:t in redu!in' the

ris* of death from !ardiovas!ular C)B !auses or hospitaliJation dueto heart failure 3B vs enalapril alone or in !om$ination, in patients#ith !hroni! heart failure C3B and redu!ed e8e!tion fra!tion

ATMOS%HERE, & 366 oth! *o))o'-"p tr$&), ero))e. B,012 CH; p&t$et! '$thNe' or He&rt A!!o#$&t$o #)&!! II-I &. e& )e*t /etr$#")&r ee#t$o*rt$o P 03=, 'ho 'ere r&.o$e. $ & 1:1:1 *&!h$o to re#e$/e e$ther&)$!$re 300 .&$)( 2,340, e&)&pr$) =-10 .&$)( 2,336, ore&)&pr$) =-10 &)$!$re 300 .&$)( 2,340

The primary out!ome !omposite of C) death or C3 hospitaliJationB

#ith alis*iren H enalapril #as not si'ni:!antly redu!ed vs. enalaprilhaJard ratio (


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The 8&!&! C$t( C&r.$o(op&th( Q"e!t$o&$re 8CCQ !#ore '&! e/&)"&te. '$th the "!e o* & repe&te.-e&!"re!&&)(!$! '$th the 5&!e)$e /&)"e &! & #o/&r$&te &. tre&tet, .o!e !tr&t", NHA #)&!!, &. /$!$t &! *tor! &. &/$!$t-5(-tre&tet $tert$o & !#ore o* 0 '&! "!e. $ p&t$et! 'ho .$e. S#ore! 'ere &/&$)&5)e &t 12 oth! *or111 p&t$et! $ the #o5$&t$o-ther&p( ro"p, *or 1B96 $ the &)$!$re ro"p, &. *or 104 $ the e&)&pr$) ro"p

I ter! o* !&*et(, the r$! o* h(pote!$/e !(pto! 'ere !$$?#&t)(re&ter $ the &)$!$re e&)&pr$) ro"p /! e&)&pr$) ro"p 13> /!110>, % 000= The #o5$&t$o '&! &)!o &!!o#$&te. '$th h$her r$!! o* e)e/&te. !er" #re&t$$e )e/e) 41> /! 2B>, % 0009 &. e)e/&te.pot&!!$" )e/e) 1B1> /! 12=>, %K0001 /! e&)&pr$) &)oe ro"p

Th"! &)$!$re ot o)( *&$)e. to !ho' o$*er$or$t(, $ re."#$ the r$! o* .e&th *ro C #&"!e! or ho!p$t&)$&t$o ."e to he&rt *&$)"re, to e&)&pr$)e$ther &! oother&p( or &! #o5$&t$o ther&p( $ p&t$et! '$th CH;, 5"t'&! &)!o &!!o#$&te. '$th h$her $#$.e#e o* !$.e ee#t!, $#)".$h(pote!$o &. h(per&)e$&

ngl J )ed4 Apr ! 2016 (early online publication 5!10.10%6"'J)oa1%1-%&


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Losmapimod 3ails to Sho# %ene:t in A/I &atients+ LATIT6E-TI/I 7<Trial

Losmapimod, a p; mito'en-a!tivated protein *inase /A&KBinhi$itor, is not superior to pla!e$o in redu!in' adverse

!ardiovas!ular C)B events at 1" #ee*s in patients hospitaliJed #ithan a!ute myo!ardial infar!tion A/IB and on optimal medi!altherapy, #or.$ to the re!")t! o* +ATITLDE-TIMI 60 !t".( pre!ete. &t the American College of Cardiology Scientic Session 2016 &. !$")t&eo"!)(p"5)$!he. o)$e $ Journal of American )edical Association.

A#t$/&t$o o* p3 MA%8 !t$")&te! $&&t$o 'h$#h, $ t"r, $! $p)$#&te.$ &theroee!$!, p)&"e .e!t&5$)$&t$o, &. &)&.&pt$/e pro#e!!e! $(o#&r.$&) $*&r#t$o MI +o!&p$o. '&! there*ore po!t")&te. to h&/e!&)"t&r( 5ee?#$&) ee#t! $ AMI 5( re."#$ $&&t$o The +ATITLDE- TIMI 60 '&! & r&.o$e., p)e5o-#otro))e., .o"5)e-5)$., p&r&))e)-ro"p

ph&!e 3 tr$&) #o."#te. &t 322 !$te! $ 34 #o"tr$e! It '&! .e!$e. to 5e#o."#te. $ t'o ph&!e!: ph&!e A to &&)(!e $$t$&) !&*et( &. exp)or&tor(e#( &. & )&rer ph&!e @ to e/&)"&te the pr$&r( e#( &. '&! to 5e#o."#te. $* ph&!e A '&! po!$t$/e %&t$et! ho!p$t&)$e. *or AMI o STe)e/&te. (o#&r.$&) $*&r#t$o '$th$ 24 ho"r! o* $!#he$# !(pto! or STe)e/&te. (o#&r.$&) $*&r#t$o '$th$ 12 ho"r! o* o!et 'ho h&. &t )e&!t 1&..$t$o&) pre.$#tor o* #&r.$o/&!#")&r r$! 'ere r&.o$e. to e$ther t'$#e-.&$)( )o!&p$o. B= 1B3 or &t#h$ p)e5o 1B6= o &5ro". o* "$.e)$e-re#oe.e. ther&p( The p&t$et! 'ere tre&te.*or 12 'ee! &. 'ere &..$t$o&))( *o))o'e. *or 12 'ee! The pr$&r( e.po$t '&! the #opo!$te o* C .e&th, MI, or !e/ere re#"rret $!#he$&

re"$r$ re/&!#")&r$&t$o &t 12 'ee!

Throu'h #ee* 1", the primary end point o!!urred in ;.1D of patients on losmapimod and 9.


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(ate and (hythm Control E>ually %ene:!ial in Atrial 3i$rillation&ost-Cardia! Sur'ery

%oth rate !ontrol and rhythm !ontrol strate'y #ere similarlyeQ!a!ious in patients #ho developed atrial :$rillation A3B after

!ardia! sur'ery, &! per the re!")t! o* & tr$&) pre!ete. &t the AmericanCollege of Cardiology Scientic Sessions 2016

A tot&) o* =23 p&t$et! ".ero$ e)e#t$/e #&r.$ !"rer( #oro&r( &rter(5(p&!! r&*t$ CA@G, /&)/e !"rer( or 5othJ 'ho .e/e)ope. e'-o!etpo!t-oper&t$/e A; th&t per!$!te. *or ore th& 60 $"te! or re#"rretep$!o.e! o* &tr$&) ?5r$))&t$o ."r$ the $.ex ho!p$t&)$&t$o PB .&(! &*ter!"rer(, 'ere r&.o$e. to ".ero e$ther r&te #otro) 262 orrh(th #otro) 261 The r&te #otro) !tr&te( $#)".e. .r"! to re."#ehe&rt r&te '$th & t&ret o* h$e/$ & re!t$ he&rt r&te o* K100 5e&t! per$"te, 'h$)e the rh(th #otro) ro"p re#e$/e. &$o.&roe '$th or '$tho"t

& r&te-!)o'$ &et The pr$&r( e. po$t '&! the tot&) "5er o* .&(! o* ho!p$t&)$&t$o '$th$ 60 .&(! &*ter r&.o$&t$o, &! e/&)"&te. 5( theW$)#oxo r&-!" te!t

O* the r&.o$e. p&t$et!, $!o)&te. CA@G '&! per*ore. $ &5o"t 40>,$!o)&te. /&)/e !"rer( $ &5o"t 40>, &. #o5$e. CA@G &. /&)/e !"rer($ &5o"t 20> The pre/&)e#e o* po!toper&t$/e A; '&! 21>, 33B>, &.4B3> $ the!e #&!e!, re!pe#t$/e)(

At !t".( e., 5oth r&te #otro) &. rh(th #otro) ro"p! !ho'e. !$$)&rre!")t! $ the tot&) "5er o* ho!p$t&) .&(! e.$&, =1 .&(! &. =0 .&(!,

re!pe#t$/e)( %0B6 '$th o !t&t$!t$#&))( !$$?#&t .$ere#e 5et'ee thet'o ro"p! e/e *or t(pe o* !"rer( T&5)e 1 J

T&5)e 1: Re!")t! e.$& o5!er/e. $ the r&te #otro) &. rh(th #otro)ro"p!

)aria$le (ate!ontrol

n "7"B

(hythm!ontrol

n "71B

&-value

No o* .&(! $ ho!p$t&) *ror&.o$&t$o to 60 .&(!

=1 =1 0B6

A*ter $!o)&te. CA@G 4 =1 096

A*ter $!o)&te. /&)/e rep&$r orrep)eet

=0 44 0B6

A*ter CA@G /&)/e rep&$r orrep)eet

=3 B1 011

There 'ere o !$$?#&t .$ere#e! $ ort&)$t( &! 'e)) &! !er$o"! &./er!ee/et! 5et'ee the t'o ro"p!, $#)".$ thro5oe5o)$# &. 5)ee.$e/et! At !t".( e., the per#et&e o* p&t$et! '$th !t&5)e he&rt rh(th


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'$tho"t A; *or the pre/$o"! 30 .&(! 'ere 93> $ the r&te-#otro) ro"p &.9B9> *or tho!e $ rh(th #otro) ro"p 'h$)e 42> &. 69> .$. ot h&/eA; *ro .$!#h&re to 60 .&(!

Thus rate !ontrol and rhythm !ontrol fared e>ually in terms of

hospitaliJation for A3 after !ardia! sur'ery. I the )$ht o* the!e re!")t!,#hoo!$ e$ther o* the!e !tr&te$e! !ho"). .epe. o the $.$/$."&) p&t$et&. ph(!$#$& pre*ere#e!

'e ngl J )ed. April t3, 2016 (early online publication doi:10.10!6/#$%&oa1602002

http://dx.doi.org/10.1016/j.jacc.2016.03.508http://dx.doi.org/10.1016/j.jacc.2016.03.508http://dx.doi.org/10.1016/j.jacc.2016.03.508http://dx.doi.org/10.1016/j.jacc.2016.03.508


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&ro'nosti! )alue of the Cardia! Non-Invasive Tests (esults )aries $yTest Type and &atient 5ender+ &(O/ISE Trial

A##or.$ to the %ro!pe#t$/e M")t$#eter I&$ St".( *or E/&)"&t$o o* Che!t %&$ %ROMISE tr$&), pre!ete. &t American College of Cardiology

Scientic Sessions 2016, #omen appear to derive more pro'nosti!information from !oronary !omputed tomo'raphy an'io'raphyCTAB, #hile men tend to derive similar pro'nosti! information from$oth CTA and stress test.

I the &$ %ROMISE tr$&), )o'- to $tere.$&te-r$! p&t$et! '$th #he!t p&$'ere r&.o$e. to e/&)"&t$o '$th & &&to$#&) !tr&te( 4,996 or*"#t$o&) !tr&te( =,00B ;or &&to$#&) !tr&te( p&t$et! ".er'et& 64-!)$#e #oro&r( CTA, 'h$)e p&t$et! $ *"#t$o&) !tr&te( ".er'etexer#$!e e)e#tro#&r.$or&ph( ECG, exer#$!e $&$, or ph&ro)o$#$&$ Th$! tr$&) '$th the e.$& *o))o'-"p o* 2= oth!, !ho'e. th&t

tho"h #oro&r( CTA $! ot !"per$or 5"t $t $! & ee#t$/e &)ter&t$/e to !tre!!te!t$ &o )o'- to $tere.$&te-r$! p&t$et! pre!et$ '$th #he!t p&$;or th$! &&)(!$! o* %ROMISE, 966 p&t$et! *ro the &$ tr$&) 'ere&!!e!!e. to ".er!t&. the re)&t$o!h$p 5et'ee !ex &. #&r.$ o-$/&!$/e te!t! NIT te!te. &! r&.o$e. 4=00 CTA, =2> *e&)e 4466!tre!! te!t$, =3> *e&)e

There 'ere 9B> o* tot&) 'oe pop")&t$o 'ho h&. & po!$t$/e te!t re!")t,'$th & si'ni:!antly smaller proportion havin' positive CTAs!ompared to positive stress tests ;D vs. 1"D, pR


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si'ni:!ant asso!iation $et#een a positive CTA vs. a ne'ative CTA( ".;B, and a positive stress test vs. a ne'ative stress test (2.2B. Ne&t$/e CTA &. !tre!! te!t! 'ere e"&))( )$e)( to pre.$#t & e/et $5oth !exe! &."!te. p-/&)"e!NS

Th"! the !t".( $.$#&te! th&t there ex$!t! .$ere#e! 5et'ee !tre!! te!t$&. &&to$# te!t$ $ e &. 'oe '$th re!pe#t to po!$t$/$t( r&te! &.the proo!t$# $*or&t$o pro/$.e. 5( eh t(pe

J Am Coll Cardiol. Apr t3 2016 (early online publication.doi!10.1016"#.#acc.2016.0$.%2$


21/41

&la>ue /orpholo'y in Sta$le CA &atients Similar Irrespe!tive of 5ender

&la>ue !hara!teristi!s assessed $y multimodality ima'in' amon'patients #ith sta$le !oronary artery disease CAB #ere similar in

$oth men and #omen referred for !oronary an'io'raphy, #or.$ to& !t".( pre!ete. &t the American College of Cardiology Scientic Session2016 &. !$")t&eo"!)( p"5)$!he. $ JACC! Cardio7ascular maging

Th$! !t".( retro!pe#t$/e)( &&)(!e. .&t& *ro 33 p&t$et! 26 e &.11= 'oe '$th !t&5)e CAD 'ho 'ere re*erre. *or #oro&r( &$or&ph(&. ".er'et opt$#&) #ohere#e toor&ph( OCT Ao the 12 &)!o".er'et $tr&/&!#")&r ")tr&!o". ILS7 e&r $*r&re. !pe#tro!#op(NIRS

The OCT $&$ .&t& !ho'e. o !$$?#&t .$ere#e $ re*ere#e )"e

#ro!! !e#t$o&) &re& CSA, $$" )"e CSA, or &re& !teo!$! ILS7NIRS$&$ .&t& .$. ot re/e&) &( !$$?#&t .$ere#e 5et'ee exter&)e)&!t$# e5r&e CSA &. )"e CSA $ 5oth re*ere#e &. !teot$#!eet &la>ue !hara!teristi!s $y I)6S #ere similar $et#een $oththe 'ender e?!ept for an in!rease in pla>ue $urden in men!ompared to #omen in the referen!e se'ment 22.2 vs. =.P p


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%reast Arterial Cal!i:!ation Stron'ly Asso!iated #ith CoronaryArtery Cal!i:!ation

A !t".( pre!ete. &t the American College of Cardiology Scientic Session2016 &. p"5)$!he. !$")t&eo"!)( $ JACC! Cardio7ascular maging, *or the

:rst time demonstrated a stron' >uantitative asso!iation of $reastarterial !al!i:!ation %ACB $y di'ital mammo'raphy #ith !oronaryartery !al!i:!ation CACB in a lar'e female !ohort It '&! o5!er/e. th&t@AC $! !"per$or to !t&.&r. #&r.$o/&!#")&r r$! *tor!, 'h$)e $t '&!e"$/&)et to 5oth ;r&$h& r$! !#ore ;RS &. 2013 Cho)e!tero)G"$.e)$e! poo)e. Cohort E"&t$o! %CE *or $.et$?#&t$o o* h$h-r$!'oe

The pre!et !t".( $/o)/$ & tot&) o* 291 &!(pto&t$# 'oe '$th .$$t&)&or&ph( &. o&te. #op"te. toor&ph( e/&)"&te. $* @ACpre.$#t! CAC The 4 &$ #oro&r( &rter$e! - )e*t &$, )e*t &ter$or

.e!#e.$, #$r#"ex, &. r$ht- 'ere $.et$?e. o #he!t CT !#&! &. theextet o* CAC $ eh &rter( '&! #&teor$e. &! &5!et, $). 'he K173 r. o* the )eth o* the et$re &rter( !ho'e. #&)#$?#&t$o, o.er&te 'he 173 r. to273r. o* the &rter( !ho'e. #&)#$?#&t$o, or !e/ere 'he


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< in!reased from ";D to 44D to 9=D, respe!tively, amon' the a'e'roups ' R *or %CE r$!#&teor$e! *or CAC &. =4> 5( @AC %AC < had area under the !urve of uivalentto $oth 3(S


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/o$ile-health Intervention Asso!iated #ith Improvement in &hysi!alA!tivity+ The Stepathlon Cardiovas!ular ealth Study

A##or.$ to & The Step&th)o C&r.$o/&!#")&r He&)th St".( pre!ete. &t the American College of Cardiology Scientic Sessions 2016, a lo#-!ost

intervention throu'h mo$ile health mealthB pro'rams isasso!iated #ith lar'e-s!ale improvement in physi!al a!tivity, sittin'duration and #ei'ht

Th$! )o5&) &&)(!$! #o))e#te. .&t& *ro p&rt$#$p&t! #op)et$ Step&th)o,& &"&) 100-.&( )o5&) e/et $ 2012, 2013, &. 2014 /$& & $tert$/e")t$-p)&t*or &pp &/&$)&5)e o o5$)e .e/$#e! &. the 'or).'$.e 'e5 Atot&) o* 69,219 &.")t! p&rt$#$p&te. *ro 41 ep)o(er! $ 1,41 #$t$e! 64#o"tr$e! The e& &e o* the ro"p '&! 36 (e&r!, $t #o!$!te. 239>*e&)e &. 920> 'ere *ro )o'er-$..)e $#oe #o"tr$e! %&rt$#$p&t!'ere or&$e. $ 'or!$te-5&!e. te&!, 'ere $!!"e. pe.oeter!, &. 'ere

e#o"r&e. to $#re&!e .&$)( !tep! &. ph(!$#&) t$/$t(

On !ompletion of Stepathlon parti!ipants sho#ed si'ni:!antimprovement in step !ount H,41= steps@dayP p R


25/41

eferred Stent Implantation Not Superior to Conventional &CI inSTE/I &atients+ ANA/I -E3E( Trial

eferred stentin' at the time of primary per!utaneous !oronaryintervention &CIB in ST-se'ment elevation myo!ardial infar!tion

STE/IB patients is not superior in redu!in' the adverse!ardiovas!ular out!omes !ompared #ith !onventional &CI #or.$to the DANAMI 3-DE;ER !t".( pre!ete. &t the American College of Cardiology Scientic Session 2016. The !t".( '&! !$")t&eo"!)( p"5)$!he.$ /3e 8ancet

I & ope-)&5e))e., r&.o$!e. #otro))e. tr$&) $/o)/$ 121= STEMIp&t$et! &t *o"r pr$&r( %CI #etre! $ De&r 'ere r&.o)( &!!$e. tore#e$/e e$ther !t&.&r. pr$&r( %CI '$th $e.$&te !tet $p)&t&t$o or.e*erre. !tet $p)&t&t$o 4 h &*ter the $.ex pro#e."re The pr$&r(e.po$t '&! & #opo!$te o* &))-#&"!e ort&)$t(, ho!p$t&)$&t$o *or

#oe!t$/e he&rt *&$)"re, re#"rret $*&r#t$o, &. &( "p)&e. o* thet&ret /e!!e) re/&!#")&r$!&t$o TR '$th$ 2 (e&r! *o))o'-"p

A*ter e.$& *o))o'-"p o* 2" months, primary endpoint o!!urred in 1;Dof patients #ho had under'one standard &CI and in 19D of patients#ho had deferred stent implantation haJard ratio


26/41

Is!hemi! &ost!onditionin' Added No Clini!al %ene:t overConventional &rimary &CI in STE/I+ ANA/I -i&OST Trial

Is!hemi! post!onditionin' #ith short $ursts of $alloon o!!lusionimmediately after esta$lishin' perfusionB is not superior to

!onventional primary per!utaneous !oronary intervention &CIB inST-se'ment elevation myo!ardial infar!tion STE/IB patients. The!e&re the ?.$! o* the UTh$r. DAN$!h St".( o* Opt$&) A#"te Tre&tet o* %&t$et! '$th ST-!eet E)e/&t$o M(o#&r.$&) I*&r#t$oV DANAMI 3-$%OSTth&t '&! pre!ete. &t the American College of Cardiology Scientic Sessions2016 The ?.$! #)e&r)( $.$#&te & )o' #)$$#&) "t$)$t( o* $!#he$#po!t#o.$t$o$ ."r$ ro"t$e pr$&r( %CI

Th$! !t".( '&! #o."#te. to #op&re the "t$)$t( o* $!#he$# po!t-#o.$t$o$ $ STEMI p&t$et! ".ero$ pr$&r( %CI STEMI p&t$et!".ero$ pr$&r( %CI &. h&/$ TIMI thro5o)(!$! $ (o#&r.$&)

$*&r#t$o 0-1 o' $ the $*&r#t-re)&te. &rter( 1214, e& &e 62(e&r! 'ere r&.o$e. $ & 1:1 *&!h$o to $!#he$# po!t#o.$t$o$ or#o/et$o&) %CI Ao!t the p&t$et! r&.o$e. to the po!t#o.$t$o$ro"p, re!tor&t$o o* #oro&r( o' '&! $e.$&te)( *o))o'e. 5( & 5&))oo&$op)&!t( &t the #")pr$t )e!$o or !tete. !eet The 5&))oo '&! $&te.4 t$e! *or 30 !e#o.! eh $!t&#e o* $&t$o !ep&r&te. 5( 30 !e#o.! o* reo' %&t$et! 'ere *o))o'e. *or & e& per$o. o* 3B= oth!, ."r$'h$#h the $#$.e#e o* pr$&r( e.po$t! th&t $#)".e. &or #&r.$o/&!#")&re/et! MACEJ, &))-#&"!e ort&)$t(, ho!p$t&)$&t$o *or #oe!t$/e he&rt*&$)"re CH;J '&! re#or.e.

A total of 1 7s. 4B>, p 064)e*t /etr$#")&r ee#t$o *rt$o +E; &t 1 oth!: =2B> 7s. =0>, p K00= +E; : 0> 7s. B2>, p 001=

A)tho"h $!#he$# po!t#o.$t$o$ '&! &!!o#$&te. '$th $pro/eet $+E; &t 1 oth!, there '&! o re."#t$o $ CH; ho!p$t&)$&t$o! Th$!perp)ex$ ?.$ ee.! *"rther $/e!t$&t$o thro"h *"t"re $-.epth!t".$e!


27/41

CA%5 added to /edi!al Therapy Improves Lon'-Term Survival and&ro'nosis vs. /edi!al Therapy Alone in &atients #ith Is!hemi!

Cardiomyopathy+ STIC Trial

&atients #ith is!hemi! !ardiomyopathy #ho under'o a !oronary

artery $ypass 'raftin' CA%5B #hile re!eivin' standard medi!altherapy have improved overall survival as #ell as lesserhospitaliJation due to !ardiovas!ular C)B events over a period of 1<years #hen !ompared to patients re!eivin' only medi!al therapy. The!e &re the ?.$! o* the US"r$#&) Tre&tet *or I!#he$# He&rt ;&$)"reVSTICH !t".( th&t '&! pre!ete. &t the American College of Cardiology Scientic Session, 2016 &. !$")t&eo"!)( p"5)$!he. o)$e $ the 'england Journal of )edicine

It $! "#)e&r 'hether & !tr&te( o* CA@G &..e. to "$.e)$e-.$re#te. e.$#&)ther&p( 'o"). pro/$.e &..e. !"r/$/&) 5ee?t o/er the e.$#&) ther&p(

&)oe, $ p&t$et! '$th #oro&r( &rter( .$!e&!e CAD, he&rt *&$)"re, &.!e/ere )e*t /etr$#")&r !(!to)$# .(!*"#t$o Th$! !t".( '&! there*ore#o."#te. to e/&)"&te the )o-ter 5ee?t! o* CA@G $ p&t$et! '$th$!#he$# #&r.$o(op&th(

%&t$et! '$th & ee#t$o *rt$o P 3=> &. CAD &e&5)e to CA@G 1212 'ere r&.o$e. to e$ther CA@G ro"p CA@G p)"! e.$#&) ther&p(, 610 or e.$#&)-ther&p( ro"p e.$#&) ther&p( &)oe, 602 p&t$et!%&t$et! 'ere pr$&r$)( *o))o'e. *or .e&th *ro &( #&"!e De&th *ro C#&"!e! &. .e&th *ro &( #&"!e or ho!p$t&)$&t$o *or C e/et! #o!t$t"te.the &or !e#o.&r( o"t#oe! o* the !t".( The e.$& ."r&t$o o* *o))o'-

"p, $#)".$ the #"rret exte.e.-*o))o'-"p !t".(, '&! 9 (e&r!

eath due to any !ause #as re!orded in appro?imately 4;.=Dpatients in the CA%5 'roup and 77.1D in the medi!al-therapy 'rouphaJard ratio ( #ith CA%5 (s. medi!al therapy,


28/41


29/41

ro$-!$te #op)$#&t$o! r&.$o*re"e#( ro"p: 16 /! #r(o5&))oo ro"p: B&. phre$#-er/e $"r( r&.$o*re"e#( ro"p: 0 /! #r(o5&))oo ro"p: 10

' ngl J )ed. April t3, 2016 (early online publication 5!

10.10%6"'J)oa160201


30/41


31/41

)a'al Nerve Stimulation not %ene:!ial in Chroni! eart 3ailure+INO)ATE-3 Trial

The re!")t! o* the IN#re&!e O* A&) ToE $ He&rt ;&$)"re INOATE-H; tr$&),pre!ete. &t the American College of Cardiology Scientic Sessions 2016,

!ho'e. that va'al nerve stimulation )NSB fails to redu!e mortalityrate or heart failure 3B events as !ompared to optimal medi!altherapy in patients #ith !hroni! 3.

The INOATE-H; '&! & ")t$&t$o&), r&.o$e. p&r&))e) ro"p tr$&)#o."#te. &t = #etre! 'h$#h ero))e. & tot&) o* B0B #hro$# H; p&t$et! o* Ne' or He&rt A!!o#$&t$o NHA #)&!! III !(pto! &. ee#t$o *rt$o K40> %&t$et! 'ere r&.o$e. $ & 3:2 r&t$o to e$ther .e/$#e $p)&t&t$o topro/$.e NS A#t$/e ro"p or #ot$"&t$o o* e.$#&) ther&p( Cotro)ro"p The pr$&r( e.po$t o* the tr$&) '&! the #opo!$te o* .e&th *ro&( #&"!e or ?r!t e/et *or 'or!e$ H;

The tr$&) '&! ter$&te. &*ter & e& *o))o'-"p o* 16 oth! ."e to *"t$)$t(o* re!")t! The pr$&r( o"t#oe .e&th or H; ho!p$t&)$&t$o o##"rre. $303> o* the p&t$et! $ the NS ro"p /! 2=> o* tho!e $ the #otro)ro"p '$th o !t&t$!t$#&))( !$$?#&t .$ere#e 5et'ee the t'o ro"p!H&&r. r&t$o HR 114, p 03BJ There '&! &)!o o !$$?#&t .$ere#e5et'ee the NS &. the #otro) ro"p $ &"&) .e&th r&te 93> &. B1>,p 03B

A)tho"h the NS ro"p !ho'e. *&/o"r&5)e $pro/eet! $ "&)$t( o* )$*e,6-$"te '&) te!t &. NHA #)&!!, there '&! o .$ere#e $ the )e*t

/etr$#")&r e.-!(!to)$# /o)"e $.ex $.$#&t$ th&t NS .oe! ot re/er!e#&r.$ o.e))$ $ p&t$et! '$th #hro$# H;

J Am Coll Cardiol. April t3, 2016 (early online publicationdoi:10.1016/j.jacc.2016.0.!2!

http://dx.doi.org/10.1016/j.jacc.2016.03.525http://dx.doi.org/10.1016/j.jacc.2016.03.525


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TA)( Compara$le to SA)( in Intermediate-(is* &atients #ith SevereAorti!-)alve Stenosis+ &A(TNE( "A Trial

Re!")t! o* & )&te!t r&.o$e. tr$&) .eo!tr&te th&t trans!atheter aorti!-valve repla!ement TA)(B is similar to sur'i!al aorti!-valve

repla!ement SA)(B in terms of redu!in' the primary endpoint of all-!ause mortality and disa$lin' stro*e at " years in intermediate-ris* patients #ith severe aorti! stenosis. Moreo/er, TAR &ppe&re. to5e !"per$or to SAR 'he & tr&!*eor&) &pproh "!e. $ &5o"t B=> o* the!t".( pop")&t$o '&! "!e. Th$! )&.&r tr$&) $ the ?e). o* &ort$# /&)/erep)eet '&! pre!ete. &t the American College of Cardiology ScienticSessions 2016, &. !$")t&eo"!)( p"5)$!he. $ /3e 'e ngland Journal of )edicine

Re#et e/$.e#e !"e!t! !$$)&r !"r/$/&) r&te! '$th TAR &. SAR&o!t h$h-r$! p&t$et! '$th &ort$# !teo!$! Th$! r&.o$e. !t".( '&!

#o."#te. to &!!e!! the !&*et( &. e#( o* 5&))oo-exp&.&5)e TAR#op&re. '$th SAR $ $tere.$&te-r$! p&t$et! '$th &ort$# !teo!$! A tot&)o* 2032 $tere.$&te-r$! p&t$et! e& &e 16 (e&r! '$th !e/ere &ort$#!teo!$! *ro ro!! =B #eter! 'ere ero))e. $ th$! !t".( @&!e. o the#)$$#&) &. $&$ ?.$!, p&t$et! 'ere #&teor$e. &! tr&!*eor&)-#e!! #ohort B63> &. tr&!thor$#-#e!! #ohort 23B>, 5e*orer&.o$&t$o %&t$et! 'ere the r&.o$e. to e$ther TAR or SAR ro"p The pr$&r( e. po$t o* the !t".( '&! .e&th *ro &( #&"!e or .$!&5)$!troe &t 2 (e&r!%oth the study 'roups e?hi$ited similar rates of mortality anddisa$lin' stro*e &


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*idney in8ury, as !ompared to SA)( O the other h&., SAR '&!&!!o#$&te. '$th *e'er &or /&!#")&r #op)$#&t$o! &. )e!! p&r&/&)/")&r&ort$# re"r$t&t$o

' ngl J )ed. April 2nd, 2016 (early online publication. 5!

10.10%6"'J)oa1%1616


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TA)( #ith SA&IEN &referred over Sur'ery in Treatment of Intermediate-(is* &atients #ith Severe Aorti! Stenosis

A! per the ?.$! o* & !t".( pre!ete. &t the American College of Cardiology Scientic Sessions 2016, &. !$")t&eo"!)( p"5)$!he. $ /3e

8ancet , Trans !atheter aorti! valve repla!ement TA)(B usin' SA&IEN valve is asso!iated #ith a lo#er in!iden!e of all-!ause mortality,stro*e, and re'ur'itation at 1 year in intermediate-ris* patients#ith severe aorti! stenosis. ;"rtherore, the #)$$#&) o"t#oe! '$thSA&IEN TA)( #ere mu!h more superior to those asso!iated #ithsur'ery, th"! !"e!t$ th&t TAR $ht 5e the pre*erre. tre&tet&)ter&t$/e $ !"#h p&t$et !"5ro"p

SA%IEN 3 $! & o5!er/&t$o&) !t".( th&t ero))e. 1,0BB $tere.$&te-r$!p&t$et! '$th !e/ere &ort$# !teo!$! *ro o/er =1 #eter! $ the L$te. St&te!&. C&&.& %&t$et! 'ere &!!$e. to re#e$/e TAR '$th the SA%IEN 3 /&)/e

> /$& tr&!*eor&) #e!! The $#$.e#e o* &))-#&"!e ort&)$t(, !troe!,re-$ter/et$o, &. &ort$# /&)/e re"r$t&t$o &t 1 (e&r &*ter $p)&t&t$o'&! &!!e!!e. The *o))o'$ t&5)e $/e! the $#$.e#e o* #)$$#&) o"t#oe! &t1 (e&r $ the !t".( !"5e#t! T&5)e

T&5)e: The o"t#oe! $ !t".( !"5e#t! &t 1 (e&r

Out!ome In!iden!eA))-C&"!e Mort&)$t( B4> tr&!*eor&) !"5-ro"p:

6=>D$!&5)$ Stroe 2>Aort$# &)/e Re-Iter/et$o 1>

Mo.er&te-Se/ere %&r&/&/")&rRe"r$t&t$o

2>

The oe (e&r o"t#oe! $ th$! pop")&t$o 'ere #op&re. '$th tho!e *or$tere.$&te-r$! p&t$et! tre&te. '$th !"r$#&) /&)/e rep)eet $ the%ARTNER 2A tr$&) "!$ & pre!pe#$?e. prope!$t( !#ore &&)(!$! to #o"t*or 5et'ee-tr$&) .$ere#e! $ 5&!e)$e #h&rter$!t$#! I & prope!$t(-!#ore&&)(!$! 'h$#h $#)".e. 963 p&t$et! tre&te. '$th SA%IEN 3 TAR &. B4B'$th !"r$#&) /&)/e rep)eet, TA)( appeared to $e $oth, non-inferiorpooled #ei'hted proportion diFeren!e of =."DP p R


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8ancet. April $rd, 2016 (early online publication.5! 3ttp!""d9.doi.org"10.1016"S0106*$6(16$00*$$


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TA)( #ith Core)alve Noninferior to Sur'i!al A)( in Improvin'Survival in Severe Aorti! Stenosis &atients+ The Core)alve i'h-(is*

Study

The ?.$! o* the Core&)/e H$h-R$! !t".( pre!ete. &t the American

College of Cardiology Scientic Sessions, 2016 &. !$")t&eo"!)( p"5)$!he.$ the Journal of t3e American College of Cardiology .eo!tr&te th&tamon'st patients #ith severe aorti! stenosis, the !lini!al $ene:tsprovided $y trans!atheter aorti!-valve repla!ement TA)(B #ith theself-e?pandin' Core)alve are non-inferior to those provided $ysur'i!al valve repla!ement SA)(B at years.

The #)$$#&) 5ee?t! o* TAR $ ter! o* $pro/e. !"r/$/&) &t 2 (e&r! &re&)re&.( 'e))-e!t&5)$!he. The Core&)/e H$h-R$! !t".( '&! #o."#te. to.eter$e $* the #)$$#&) 5ee?t! o* TAR 'o"). exte. "p to 3 (e&r!

A tot&) o* B4B p&t$et! '$th !e/ere &ort$# !teo!$! .eee. &t $#re&!e. r$!*or !"rer( 'ere ero))e. $ th$! !t".( Approx$&te)( 6> o* the p&t$et!h&. Ne' or He&rt A!!o#$&t$o NHA #)&!! III or I !(pto! St".(!"5e#t! 'ere r&.o$e. 1:1 to TAR 390 or SAR 3=B C)$$#&).&t& &. .et&$)e. e#ho#&r.$or&ph$# o"t#oe! 'ere o5t&$e. *or &)) the!t".( !"5e#t! A))-#&"!e ort&)$t( &t 1, 2, &. 3 (e&r! '&! the pr$&r(e.po$t o* the !t".( I &..$t$o, the $#$.e#e o* MACE or #ere5ro/&!#")&re/et! ."r$ ho!p$t&)$&t$o, &t 30 .&(!, &. ."r$ et$re !t".( per$o. '&!&)!o &!!e!!e.

%&t$et! r&.o$e. to TAR h&. & !$$?#&t)( )o'er r&te! o* 3-(e&r &))-

#&"!e ort&)$t( or !troe 7s. p&t$et! r&.o$e. to SAR 3B3> 7s. 46B>p 0006 Also, all-!ause mortality at ea!h year #as si'ni:!antlylo#er in the T)A( 'roup as !ompared to the SA)( 'roup T&5)e 1

T&5)e 1: A))-#&"!e ort&)$t( $ the !t".( ro"p!

0ear-Mise All-Cause /ortality

TA)( SA)( p )alue

1 e&r 142> 191> K000012 e&r! 222> 26> 0043 e&r! 329> 391> 00B

The $#$.e#e o* !troe &t 30 .&(! &. &t 1 (e&r '&! )o'er '$th TAR 7s.SAR 49> 7s. 62> &t 30 .&(!J > 7s. 126> &t 1 (e&rJ Thein!iden!e of stro*e in!ludin' ma8or stro*eB and /ACE at years#as also lo#er #ith TA)( (s. SA)( T&5)e 2

T&5)e 2: I#$.e#e o* !troe &. MACE $ the !t".( ro"p! &t 3 (e&r!O"t#oe TAR SAR p &)"eStroe 126> 190> 0034


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MACE 402> 4B9> 003

3urther, TA)( patients e?hi$ited $etter aorti! valve hemodynami!sat years mean aorti! valve 'radient, 9.7" mm' (s. 11.2< mm',p R


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Superiority of %ariatri! Sur'ery plus /edi!al Therapy vs /edi!alTherapy Alone in O$ese@ Over#ei'ht ia$etes &atients Sustained for

4 0ears+ STA/&EE Trial

The ?/e (e&r *o))o'-"p o* the S"r$#&) Ther&p( A. Me.$#&t$o! %otet$&))(

Er&.$#&te D$&5ete! E#$et)( STAM%EDE tr$&) pre!ete. &t the AmericanCollege of Cardiology Scientic Sessions 2016 h$h)$ht! th&t the!om$ination of intensive medi!al therapy and $ariatri! sur'ery issuperior to intensive medi!al therapy alone in a!hievin' ade>uate'ly!emi! !ontrol in type " dia$etes mellitus /B patients #ho areo$ese or over#ei'ht, #ith results $ein' sustained up to 4 years of follo#-up. @oth &!tr$# 5(p&!! &. !)ee/e &!tre#to( !ee to h$e/e!$$)&r re!")t!

The STAM%EDE tr$&) $! the )&re!t r&.o$e. tr$&) #op&r$ e.$#&)ther&p( to 5&r$&tr$# !"rer( The tr$&) ero))e. 1=0 DM p&t$et! '$th )(#&te.

heo)o5$ H5A1# &. 5o.( &!! $.ex @MI 5et'ee 2B-43 72

e& &e: 49 (e&r! *e&)e!: 66> The e& ."r&t$o o* DM '&! 3 (e&r!&. =3> 'ere o X3 .$&5ete! e.$#&t$o! 4B> o* tot&) "!e. $!")$ Thee& @MI '&! 36 72 34> h&. @MI K3= 72 &. &5o"t 92> h&.et&5o)$# !(.roe %&t$et! 'ere r&.o$e. to e$ther o* the 3 &r!: 1$te!$/e e.$#&) ther&p( &)oe 2 $te!$/e e.$#&) ther&p( Ro"x-e-&!tr$# 5(p&!! !"rer( or 3 $te!$/e e.$#&) ther&p( !)ee/e&!tre#to( The $te!$/e e.$#&) ther&p( re#e$/e. 5( the p&t$et! '&! $)$e! '$th the Aer$#& D$&5ete! A!!o#$&t$o "$.e)$e! &. $#)".e.)$*e!t()e #o"!e)$ &. *re"et hoe )"#o!e o$tor$ %&t$et! 'ere*o))o'e.-"p &. .&t& '&! e/&)"&te. &t 1 (e&r, 3 (e&r! &. = (e&r! The e(

o"t#oe '&! to e/&)"&te the per#et&e o* p&t$et! 'ho h$e/e. H5A1# o* P6>

The = (e&r *o))o'-"p .&t& #o?r! the !"per$or$t( o* 5&r$&tr$# !"rer( o/ere.$#&) ther&p( &)oe $ o5e!e or o/er'e$ht DM p&t$et! &! '&! e&r)$er!ho' $ the 1-(e&r &. 3 (e&r report! The per!enta'e of patients #ith$A1! V7D #as hi'her in the 'astri! $ypass "=DB and sleeve'astre!tomy arms "DB as !ompared to the intensive medi!altherapy alone arm 4DP p


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maintained 'reater #ei'ht loss than sleeve 'astre!omy, #hilere>uirin' fe#er medi!ations

The in!iden!e of 'ly!emi! relapse i.e. patients #ho a!hieved $A1!of V7D at 1 year, $ut not at 4 years, #as lo#est in $oth the sur'i!al

arms vs intensive medi!al therapy alone 2


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Cell Therapy #ith I?myelo!el-T may Improve Out!omes in &atients#ith Is!hemi! 3+ i?CELL-C/ Trial

The ?.$! o* $xCE++-DCM, the )&re!t #e)) ther&p( !t".( .oe $ p&t$et!'$th he&rt *&$)"re H;, .eo!tr&te th&t transendo!ardial delivery of

i?myelo!el-T in 3 patients #ith redu!ed e8e!tion fra!tion due tois!hemi! dilated !ardiomyopathy results in a si'ni:!ant redu!tion inad8udi!ated !lini!al !ardia! events The re."#t$o $ #)$$#&) e/et! 'h$#h'&! !$$?#&t)( re&ter th& th&t o5!er/e. '$th p)e5o, #as alsoasso!iated #ith improved patient out!omes. The !t".( '&! pre!ete.&t American College of Cardiology Scientic Session, 2016 &. &)!op"5)$!he. o)$e $ /3e 8ancet

E&r)(-ph&!e #)$$#&) tr$&)! '$th $x(e)o#e)-T ")t$#e))")&r ther&p( pro."#e.*ro & p&t$etV! o' 5oe &rro' h&/e $.$#&te. th&t $tr& (o#&r.$&).e)$/er( o* $x(e)o#e)-T $ht $pro/e #)$$#&), *"#t$o&), !(pto&t$#, &.

"&)$t(-o*-)$*e o"t#oe! $ H; p&t$et! '$th $!#he$# .$)&te. #&r.$o(op&th( Th$! !t".( '&! there*ore #o."#te. to &!!e!! the !&*et( &. e#( o* #&theter-5&!e. tr&!e.o#&r.$&) $e#t$o o* $x(e)o#e)-T #e)) ther&p( $ H;p&t$et! '$th re."#e. ee#t$o *rt$o

A tot&) o* 126 !(pto&t$# $!#he$# .$)&te. #&r.$o(op&th( H; p&t$et!*ro ro!! 31 !$te! $ North Aer$#& 'ere ero))e. $ th$! r&.o$e.,.o"5)e-5)$., p)e5o-#otro))e. ph&!e 2@ tr$&) $xCE++-DCM A)) p&t$et! h&.)e*t /etr$#")&r ee#t$o *rt$o +E; P3=>, & &"to&t$# $p)&t&5)e#&r.$o/erter .e?5r$))&tor ?tte., &. 'ere $e)$$5)e *or re/&!#")&r$&t$opro#e."re! St".( !"5e#t! 'ere r&.o)( &!!$e. 1:1 to re#e$/e

$x(e)o#e)-T 60 or p)e5o 66 &t the t$e o* 5oe &rro'&!p$r&t$o, &. *o))o'e. *or 12 oth! The pr$&r( e.po$t '&! &#opo!$te o* &))-#&"!e .e&th, ho!p$t&)$&t$o ."e to #&r.$o/&!#")&r e/et!,&. "p)&e. #)$$# /$!$t! to tre&t "te .e#ope!&te. H;

The per-proto#o) pr$&r( e#( &&)(!$! $#)".e. 109 p&t$et! = $ the$x(e)o#e)-T ro"p &. =1 $ the p)e5o ro"p The in!iden!e of theprimary endpoint #as hi'her in the pla!e$o 'roup 4< events in "42=D of 41 patientsB as !ompared to the i?myelo!el-T 'roup ;events in "" ;D of 4; patientsB. Th"!, as !ompared to pla!e$o,i?myelo!el-T #as asso!iated #ith a 9D redu!tion in !ardia! events

ris* ratio


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8ancet. April t3, 2016 (arly 5nline +ublication.3ttp!""d9.doi.org"10.1016"S0106*$6(16$01$*

Documents

ACC 2016 Scientific Session Highlights