Cardiology Today's Intervention top 5 articles from ACC.18

Cardiology Today’s Intervention has compiled a list of the top stories from the American College of Cardiology Scientific Session, held March 10-12 in Orlando, Florida.

This year, our readers were most interested in the effect of combining rivaroxaban and aspirin in reducing major adverse limb events in peripheral artery disease, the results of the SMART-DATE trial, the top takeaways from the meeting of Cardiology Today’s Intervention Chief Medical Editor Deepak L. Bhatt, MD, MPH, the results of the DEFINE-FLAIR trial, pacemaker dependence after transcatheter aortic valve replacement procedures and more.

Combination rivaroxaban, aspirin reduces major adverse limb events in PAD

ORLANDO, Fla. — Patients with lower-extremity PAD have a significantly worse prognosis after experiencing a major adverse limb event, but combination therapy with rivaroxaban and aspirin may be effective for prevention.

Sonia S. Anand, MD, PhD, from the Population Health Research Institute at McMaster University, presented findings from a subanalysis of the randomized, double-blind, placebo-controlled COMPASS trial, which randomly assigned more than 27,000 patients with CAD or PAD to treatment with a combination of aspirin and low-dose rivaroxaban (Xarelto, Janssen), rivaroxaban alone or aspirin alone. Of these patients, 6,391 had lower-extremity PAD and 128 experienced a major adverse limb event, defined as severe limb ischemia requiring intervention or major amputation of vascular cause.

SMART-DATE: Shorter DAPT duration noninferior to longer duration, but increases MI risk

ORLANDO, Fla. — Six months of dual antiplatelet therapy was noninferior to 12 months’ duration, but shorter therapy was associated with a significantly increased risk for MI in patients with ACS who underwent PCI with a drug-eluting stent, according to new data from the SMART-DATE trial.

In the intention-to-treat analysis, the cumulative rate of the primary endpoint of MACCE — a composite of all-cause death, MI or stroke at 18 months — did not differ significantly in patients assigned to 6 months of DAPT compared with those assigned to at least 12 months of DAPT (4.7% vs. 4.2%; absolute risk difference, 0.5%; upper limit of one-sided 95% CI, 1.8%; P = .03 for noninferiority).

VIDEO: Deepak L. Bhatt, MD, MPH, highlights top takeaways from ACC

ORLANDO, Fla. — In this video exclusive, Cardiology Today’s Intervention Chief Medical Editor Deepak L. Bhatt, MD, MPH, provides his take on four trials presented at the American College of Cardiology Scientific Session.

Bhatt, executive director of interventional cardiovascular programs at Brigham and Women’s Heart & Vascular Center and professor of medicine at Harvard Medical School, said “there will be a lot of discussion” about results of the ODYSSEY Outcomes trial of alirocumab (Praluent, Sanofi/Regeneron) in patients with ACS on statin therapy.

DEFINE-FLAIR: iFR confers cost savings vs. FFR

ORLANDO, Fla. — When instantaneous wave-free ratio was used to guide revascularization, a savings of almost $900 per patient occurred compared with fractional flow reserve-guided procedures, according to new data from DEFINE-FLAIR presented at the American College of Cardiology Scientific Session.

Manesh R. Patel, MD, professor of medicine and chief of the divisions of cardiology and clinical pharmacology at Duke University Medical Center and member of the Duke Clinical Research Institute, and colleagues assessed whether iFR was cost-effective compared with FFR in the DEFINE-FLAIR cohort. Unlike FFR, iFR does not use adenosine.

Pacemaker dependency common at 1 year after TAVR

ORLANDO, Fla. — About one-third of patients who required a permanent pacemaker after TAVR were pacemaker-dependent at 30 days, with no decrease in this percentage at 1 year, according to a subanalysis of the REPRISE III trial.

Additionally, the results indicated that the rate of new pacemaker implantation was higher among patients who received the Lotus valve system (Boston Scientific) vs. the CoreValve TAVR system (Medtronic; 35.5% vs. 19.6%), and that 1-year clinical outcomes were similar regardless of pacemaker status or dependency, according to Cardiology Today’s Intervention Editorial Board Member Dean J. Kereiakes, MD, medical director of the Christ Hospital Heart and Vascular Center and the Lindner Research Center at Christ Hospital, and colleagues.