Leading cardiologists worldwide convened virtually from November 13-15 at the American Heart Association’s 2021 Scientific Sessions, sharing the latest advancements in cardiovascular science and clinical care. The studies highlighted below represent only a sample of the cutting-edge research that experts from Brigham and Women’s Hospital will present at the conference.
REVERSE-IT: Fast-Acting, Antibody-Based Agent Can Reverse the Effects of Ticagrelor
An intravenous monoclonal antibody fragment known as bentracimab may be a promising option for rapidly reversing the antiplatelet effects of ticagrelor, according to the interim results of REVERSE-IT, a multicenter, open-label, prospective single-arm study funded by PhaseBio. Deepak Bhatt, MD, of the Brigham’s Division of Cardiovascular Medicine, presented results in a late-breaking clinical trial presentation.
Antiplatelet drugs such as ticagrelor may cause spontaneous major bleeding and can cause bleeding-associated events if a patient taking the drug needs to undergo an urgent or emergent invasive procedure. REVERSE-IT set out to test if bentracimab could rapidly reverse ticagrelor’s effects. For the pre-specified interim analysis, REVERSE-IT enrolled 150 patients who had used ticagrelor within the last three days and required an urgent reversal. Participants included those who needed urgent surgery or an invasive procedure or were experiencing potentially life-threatening bleeding. The investigators note that there was no control arm to the study as it would have been unethical to randomize to a placebo.
The investigators found that bentracimab provided immediate and sustained reversal of ticagrelor’s antiplatelet effects. Uncontrolled bleeding was effectively stopped (hemostasis) in more than 90 percent of cases, with no drug-related serious adverse events or allergic or infusion-related reactions.
"The ability to rapidly reverse ticagrelor’s effects if a patient experiences severe bleeding or needs an urgent or emergent procedure represents an important advancement for the field," said Bhatt.
Results were presented Monday, Nov. 15 in a session beginning at 11 a.m. ET. An article on the study has been accepted for publication in NEJM Evidence, a new digital journal from the New England Journal of Medicine Group.
Remotely Delivered Program Improves Blood Pressure and Cholesterol Control in 10,000 Patients
A remote monitoring program developed by a team from Brigham and Women’s Hospital and Mass General Brigham Health System has enrolled a broad population of patients at high cardiovascular risk to improve blood pressure and cholesterol levels. Investigators observed similar benefit in terms of blood pressure and cholesterol control across the study’s diverse population of patients. Alexander Blood, MD, of the Brigham’s Division of Cardiovascular Medicine, presented results in a late-breaking clinical trial presentation.
The investigators enrolled 10,803 unique patients in either its hypertension (HTN) program, lipids program or both. For the HTN program, 92 percent of patients who completed the program reached their BP goals. In the lipids program, 94 percent of patients who completed the program achieved their low-density lipoprotein cholesterol goal.
“Our results in over 10,000 patients demonstrate that a remote program can effectively optimize guideline-directed therapy at scale, reduce cardiovascular risk, and minimize the need for in-person visits,” said Blood. “These results highlight that traditionally underserved and undertreated populations can be managed effectively with digitally enabled remote care programs.”
Results were presented Saturday, Nov. 13 in a session beginning at 3 p.m. ET.
Two Left Main Coronary Artery Disease Treatments Show Roughly Similar Survival Rates, But Tradeoffs in Terms of Risk of Subsequent Heart Attack, Stroke, and Repeat Procedures
Two common treatments for left main coronary artery disease, percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG), provide roughly similar five-year survival rates for patients, according to a recent meta-analysis by the Thrombolysis in Myocardial Infarction (TIMI) Study Group at Brigham and Women’s Hospital. However, CABG reduces the risk of having a subsequent heart attack or needing repeat revascularization, whereas PCI had a lower risk of stroke in the first year.
Left main coronary artery disease, a narrowing of the key vessel supplying blood to the heart, is associated with a high risk for death. This new meta-analysis aggregates data from four randomized trials comparing outcomes for at least five years after CABG or PCI. By using detailed individual patient data from each trial, the investigators were able to go beyond prior analyses and look not only at all-cause mortality, but also cardiovascular death, spontaneous and procedural MI, stroke and coronary revascularization.
According to the research, there probably was a greater risk of dying with PCI than with CABG, but the magnitude of this risk was more likely than not less than 0.2 percent per year and less than 0.1 percent per year for dying from cardiovascular causes. The possible benefit of CABG appeared likely to be confined to patients with more complex coronary anatomy. However, in terms of other outcomes, for every 1000 patients treated with PCI rather than CABG, the analysis predicts that 35 more patients would have a heart attack and 76 more would need repeat revascularization over 5 years. On the other hand, there was a lower rate of stroke in the first year after PCI than after CABG.
“There has been persistent uncertainty among clinicians regarding the optimal revascularization strategy in patients with left main disease, said corresponding author Marc Sabatine, MD, MPH, of the Division of Cardiovascular Medicine. “This collaborative effort now provides clinicians with the data they need to assist patients in reaching the best treatment decision for them.”
The study was presented in a Featured Science presentation on Mon., Nov. 15 at 8:32 a.m. ET and published simultaneously in The Lancet.
In-Hospital Implementation of SGLT-2 Inhibitors May Decrease Mortality, Readmission for Heart Failure Patients
Nearly 15,000 deaths and 25,000 readmissions for heart failure could be prevented with the prescription of sodium-glucose cotransporter-2 (SGLT-2) inhibitors during hospitalization among Medicare beneficiaries, according to results presented by Muthiah Vaduganathan, MD, MPH, of the Brigham’s Division of Cardiovascular Medicine. SGLT-2 inhibitors can safely reduce worsening heart failure (HF) events, extend survival, and improve the health of patients with heart failure with reduced ejection fraction (HFrEF). In addition, SGLT-2 inhibitors are easy to use and are tolerated very well alone or in combination with other therapies. SGLT-2 inhibitors are traditionally started in ambulatory care in the outpatient setting; however, these data support beginning treatment at the time of the hospitalization.
The team reached its conclusions by analyzing one-year post-discharge data from Medicare beneficiaries linked with registry data from the American Heart Association’s Get With The Guidelines®-Heart Failure (GWTG-HF) program, which collects detailed information regarding patients hospitalized for HF. Among the more than 7,500 HFrEF patients evaluated in the study, nearly 90 percent would have fit the U.S. Food and Drug Administration label as candidates for the SGLT-2 inhibitor dapagliflozin. Without implementation of dapagliflozin during their hospital stay, the cohort suffered a nearly 40 percent mortality rate, a 33 percent HF readmission rate, and a 63 percent all-cause readmission rate over the course of a year. Mortality and readmission rates were exceedingly high, even among those who were already treated with three evidence-based HF therapies. Had dapagliflozin been implemented while the patients were in the hospital, the researchers estimate the mortality rate would have dropped to under one-third and the HF readmission rate to under one-quarter.
“Medicare beneficiaries eligible for dapagliflozin after HF hospitalization, including those well-treated with other therapies, face high risks of mortality and HF readmission,” said Vaduganathan, who is the lead author of a simultaneous publication. “If risk reductions in clinical trials can be fully realized, absolute benefits of SGLT-2 inhibitors among eligible candidates are anticipated to be substantial in the high-risk post-discharge setting.”
These findings were presented on Monday, Nov. 15 at 1:30 p.m. ET and published simultaneously in The Journal of Cardiac Failure. Expanded rationale for in-hospital initiation of SGLT-2 inhibitors can be found in this JACC review article published ahead of the meeting, on which Vaduganathan is a co-author.