6 key sessions from ESC Congress 2022: TAVR mortality, AI vs. sonographers, radial vs. femoral access and more
ESC Congress 2022, the annual meeting of the European Society of Cardiology, was jam-packed with eye-opening new research from many of the leading voices in cardiovascular and vascular medicine.
While Cardiovascular Business has already covered some of the earlier highlights coming out of Barcelona—click here, here or here—there was still a long list of stories we wanted to highlight. Read below for a quick breakdown of 6 of the biggest sessions at ESC Congress 2022.
1. Predicting post-TAVR mortality among atrial fibrillation patients
Researchers have developed a new risk score for predicting mortality for atrial fibrillation (AFib) patients who undergo a successful transcatheter aortic valve replacement (TAVR), presenting their work to attendees Aug. 28.
“Our study focuses solely on high-risk TAVR patients with AFib, which is a well-recognized surrogate of unfavorable prognosis,” lead author George Dangas, MD, PhD, professor of medicine and director of cardiovascular innovation at the Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai in New York City, said in a prepared statement. “Although past research has been mostly focused on procedure risks, this new risk assessment tool focuses on how to stratify patients after completion of successful TAVR when they are ready for discharge, to improve outcomes.”
Dangas et al. examined data from the 1,426 AFib patients who underwent TAVR and participated in the ENVISAGE-TAVI trial. A total of 12.5% of those patients died within the first year. The team found that a majority of those patients were over the age of 64, presented with kidney disease and/or heart failure, had non-paroxysmal AFib, had a history of major bleeding and consumed at least three alcoholic drinks per day, using those predictors to fine-tune a risk score that could anticipate one-year mortality.
The risk score was proven to be accurate; mortality was 17% among TAVR patients with a higher risk score and 4.8% among patients with a lower risk score.
“We will continue to perform focused analyses on high-risk TAVR patients based on combinations of different/other clinical risks to enhance our understanding of patient risks after TAVR so we can then plan clinical investigations on improving prognosis,” Dangas added.
2. AI more accurate than sonographers at evaluating transthoracic echocardiograms
An advanced artificial intelligence (AI) model previously developed by the Smidt Heart Institute at Cedars-Sinai and Stanford University appears to have outperformed a team of trained sonographers, according to new findings presented Aug. 28.
Nearly 3,500 transthoracic echocardiograms (TTEs) were assessed by the AI model or a sonographer. Cardiologists, the researchers found, were more likely to agree with the initial AI assessment than with an assessment made by a human sonographer.
The authors also noted that it was quite difficult for the cardiologists to tell if a TTE was interpreted by the AI or not.
“We asked our cardiologist over-readers to guess if they thought the tracing they had just reviewed was performed by AI or by a sonographer, and it turns out that they couldn’t tell the difference,” principal investigator David Ouyang, MD, a cardiologist with the Smidt Heart Institute, said in a statement. “This speaks to the strong performance of the AI algorithm as well as the seamless integration into clinical software. We believe these are all good signs for future trial research in the field.”
3. P2Y12 inhibitors outperform aspirin when treating coronary artery disease
P2Y12 inhibitor monotherapy is associated with a lower risk of ischemic events than aspirin alone among patients with coronary artery disease (CAD), according to a new meta-analysis presented Aug. 29.
The study’s authors examined data from more than 24,000 CAD patients who participated in one of seven different randomized controlled trials (RCTs). While 50% of patients were treated with clopidogrel or ticagrelor monotherapy, the other 50% were treated with aspirin monotherapy. The median treatment duration was 557 days, and the average patient age was 64 years old.
Overall, the team found, the risk of cardiovascular death, myocardial infarction or stroke was 5.5% for the P2Y12 patients and 6.3% for the aspirin patients.
“The findings from our analysis, which included all available randomized evidence, challenge the central role of aspirin and support a paradigm shift toward single P2Y12 inhibition for secondary prevention in the long-term antithrombotic management of patients with CAD,” Marco Valgimigli, MD, PhD, a cardiologist with the Cardiocentro Ticino Foundation in Switzerland, said in a statement.
4. Radial access vs. femoral access for coronary interventions
Radial artery access during coronary angiography or percutaneous coronary intervention (PCI) is associated with a lower risk of all-cause mortality or bleeding events than femoral artery access, according to new research presented Aug. 29. The findings were also simultaneously published in Circulation.[1]
The authors did note that prior studies had already compared these two treatment options with one another. However, they said, none of those studies had been able to accurately examine the impact radial or femoral access have on a patient’s risk of mortality.
This new meta-analysis included data from more than 21,000 patients who underwent coronary angiography or PCI for one of seven different multicenter RCTs. While 49.9% of patients were treated using transradial access, the other 51.1% were treated using transfemoral access. Overall, all-cause mortality was seen in 1.6% of the transradial access patients and 2.1% of the transfemoral access patients. Transradial access was also linked to a significant reduction in major bleeding events (1.5% vs. 2.7%).
“This analysis provides definitive evidence that TRA should be considered the gold standard for patients undergoing cardiac catheterization with or without PCI, supporting the ‘radial-first’ approach,” first author Giuseppe Gargiulo, MD, PhD, an interventional cardiologist with Federico II University Hospital in Italy, said in a statement.
5. Cardiovascular benefits of statin therapy outweigh the risk of muscle issues
The known cardiovascular benefits of statin therapy—protecting patients from myocardial infarctions and strokes, for instance—far outweigh the fact that they are linked to a slightly higher risk of muscle symptoms, according to a new meta-analysis presented Aug. 29. The findings were simultaneously published in the Lancet.[2]
The study was the work of the Cholesterol Treatment Trialists’ Collaboration, combining data from nearly 155,000 patients who participated in one of 23 different trials. All 23 trials included a minimum of 1,000 patients and occurred from January 1990 to June 2021.
Overall, statin therapy was linked to a 3% relative increase in the number of patients who report muscle symptoms such as muscle pain. Such symptoms were more likely among patients on “more intensive statin regimens,” the researchers noted.
In addition, principal investigator Colin Baigent, MD, director of the Medical Research Council Population Health Research Unit at the University of Oxford, explained that reported muscle pain reported by a patient may not even be related to any concurrent statin therapy.
“For most people taking a statin, any muscle-related symptoms they experience are not likely to be caused by the drug,” he said in a statement. “The known protective effects of statins against cardiovascular disease greatly exceed the slightly increased risk of muscle symptoms.”
6. AI IDs severe aortic stenosis in routine echocardiograms
Researchers have developed an advanced artificial intelligence (AI) algorithm that can identify signs of severe aortic stenosis (AS) in routine echocardiograms, sharing their findings Aug. 28.
The team’s algorithm was trained on more than 1 million echocardiograms taken from more than 630,000 patients. It was designed specifically to pick up all signs of severe AS as defined by European and North American guidelines. All data came from the National Echo Database of Australia (NEDA).
While 70% of the NEDA data were used to train the algorithm, it was tested with the remaining 30%. Overall, 77.2% of patients identified by the AI model met the guideline definition of severe AS. These patients were also associated with a higher mortality rate.
“Given the rising prevalence of AS and its impact on mortality, it is time to revisit the practice of watchful waiting and consider more proactive attempts to identify those at risk,” principal investigator Geoffrey Strange, MD, PhD, a professor with the University of Notre Dame Australia, said in a statement.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.