The European Society of Cardiology (ESC) Congress 2024 in London convened global experts to discuss groundbreaking advances in cardiovascular medicine, from new clinical guidelines to late-breaking trial results. The congress emphasized personalized care, innovative therapies, and redefined approaches to cardiovascular risk assessment.
New Clinical Guidelines: Personalized and Individualized Patient Care
Four new clinical guidelines were introduced, emphasizing personalized care. In atrial fibrillation, the guidelines stressed considering individual patient characteristics and comorbidities. For hypertension, innovative quadruple and triple combination therapies in single-pill forms aim to improve adherence and blood pressure control. Guidelines also addressed peripheral artery disease, aortic diseases, and chronic coronary syndromes, focusing on myocardial ischemia-related chest pain even without obstructive coronary artery disease.
Landmark Clinical Trials: Transforming Treatment Paradigms
The congress featured 38 new, large-scale clinical trials. The FINEARTS-HF trial demonstrated that finerenone, a non-steroidal mineralocorticoid receptor antagonist (MRA), significantly reduces the risk of heart failure escalation and hospitalizations in patients with heart failure with mildly reduced or preserved ejection fraction. Specifically, finerenone was associated with a statistically significant 16% relative reduction in the rate of a composite endpoint of cardiovascular death and total heart failure events compared with placebo therapy (RR, 0.84; 95% CI, 0.74 to 0.95; P = 0.007). A breakdown of individual components of the primary endpoint suggested use of finerenone was associated with an 18% relative reduction in incidence of heart failure hospitalization (RR, 0.82; 95% CI, 0.71 to 0.94; P = .006) and nonsignificant 7% relative risk reduction for death from cardiovascular causes (HR, 0.93; 95% CI, 0.78 to 1.11).
Two trials evaluating transcatheter edge-to-edge mitral valve repair in secondary mitral regurgitation showed the transcatheter approach is at least as effective as traditional surgery, offering a less invasive option with comparable outcomes. The RESHAPE-HF2 trial met each of its 3 primary endpoints, with a statistically significant effect on a composite of cardiovascular death and hospitalization for heart failure (RR, 0.64; 95% CI, 0.48 to 0.85; P = .002), hospitalization for heart failure (RR, 0.59; 95% CI, 0.42 to 0.82; P = .002), and change in KCCQ-OS (Least-squares mean difference, 10.9 points; 95% CI, 6.8 to 15.0; P < .001).
Redefining Cardiovascular Risk Assessment
Studies presented at the ESC Congress indicated that current methods for cardiovascular risk assessment may be inadequate. A retrospective analysis of 166 patients aged 65 or younger who experienced their first acute coronary syndrome (ACS) event found that 51% were classified as low or borderline risk and would not have been candidates for preventive statin therapy a week before the event. Researchers advocated for a shift towards directly assessing the disease rather than relying on risk factors or surrogates.
Other Key Trials
The ABYSS trial examined the use of beta-blockers among 3698 patients with a LVEF of at least 40% who had a history of myocardial infarction at least 6 months before enrollment and were being treated with beta-blockers. Results indicated a primary outcome event occurred among 23.8% of the interruption group compared to 21.1% of the continuation group (risk difference, 2.8 percentage points; 95% CI, <0.1 to 5.5; HR, 1.16; 95% CI, 1.01 to 1.33; P = .44 for noninferiority).
The SHAM-PVI trial was a double-blind randomized clinical trial designed to assess whether pulmonary vein isolation was more effective than a sham procedure for improving outcomes in atrial fibrillation among a cohort of patients with symptomatic paroxysmal or persistent atrial fibrillation. Results demonstrated the ablation group experienced a greater absolute mean atrial fibrillation burden change from baseline to 6 months(60.31% vs 35.0%; geometric mean difference, 0.25; 95% CI, 0.15 to 0.42; P < .001), greater estimated difference in the overall Atrial Fibrillation Effect on Quality of Life score at 6 months (Difference, 18.39 points; 95% CI, 11.48 to 25.30 points), and greater improvement on the Short Form 36 general health score at 6 months (Estimated difference, 9.27 points; 95% CI, 3.78 to 14.76 points).
Plozasiran Receives FDA Breakthrough Therapy Designation
The US Food and Drug Administration has granted Breakthrough Therapy designation to investigational plozasiran as an adjunct to diet for reducing triglycerides in adults with familial chylomicronemia syndrome. In the phase 3 PALISADE trial, plozasiran significantly reduced triglyceride levels and pancreatitis incidence compared to placebo, showing median triglyceride reductions of up to 80%.
