Key takeaways from ACC.25: Advances in cardiovascular science
The American College of Cardiology (ACC) 2025 features more than 50 late-breaking clinical trials and research presentations that will guide cardiology practice. To sort through these and pick out those with the most impact, Cardiovascular Business spoke with Hadley Wilson, MD, former ACC president and executive vice chair of Atrium Health Sanger Heart and Vascular Institute, to provided insights into what said are some of the key findings.
He said conference marked a major milestone, explaining attendance was 17,216, which is the first time since 2019 that attendance numbers are back to pre-pandemic levels. This included 841 virtual attendees, but overall there is a trend toward cardiologists wanting to return to in-person experiences and discussions. Wilson also said the exhibit hall floor was one of the largest ACC has ever had.
Semaglutide's expanding benefits
"Probably the most important presentations that resonated with me were looking at the use of semaglutide, a GLP-1 receptor agonist that originally was being used in diabetics to lower sugar and then weight loss and obesity. And now we found that it has multiple effects and we know that people on this agent can reduce cardiovascular risk. One study showed it improves patients who have chronic kidney disease. One of the first late-breaking trials showed how patients who have peripheral arterial disease and claudication when they walk, could actually have improvement in their walk time and their quality of life simply by taking these agents for a few weeks," Wilson explained.
He also pointed to a trial for an oral replacement pill for injectable semaglutide, which performed just as well as the much more widely used injectables.
Read more:
• ‘A practice-changing trial’: Semaglutide linked to key benefits for PAD patients with diabetes
• Oral semaglutide reduces heart risks while helping patients move past ‘fear of the needle’
Optimizing dual antiplatelet therapy post-stenting
A pivotal study addressed ongoing debates about the optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). Findings suggested that maintaining DAPT for three months before transitioning to a single agent for an additional three to nine months yielded better cardiovascular outcomes compared to shorter durations.
Challenges in stroke prevention during TAVR
The British Heart Foundation (BHF) PROTECT-TAVI trial evaluated the efficacy of embolic protection devices in reducing stroke risk during transcatheter aortic valve replacement (TAVR). Despite their intuitive appeal for capturing emboli before they can travel to the brain, these devices did not significantly reduce stroke rates, raising concerns about their cost-effectiveness and future adoption. This is one on many negative trials for these devices that have come up short showing clear evidence that can help reduce stroke rates.
New advances in TAVR
The Jena Valve, a novel transcatheter valve specifically designed for patients with aortic regurgitation, showed promising results with low complication rates. Unlike current TAVR valves designed to treat aortic stenosis, where the valve leaflets and annulus are calcified and forms a firm foundation to anchor the valve, this novel device is designed to clip the native leaflets and anchor in the annulus without a calcified annulus. There is wide expectation among cardiologists this valve will see FDA clearance in the near future to fill an unmet need for a minimally invasive device to treat high-risk aortic regurgitation patients.
Wilson said the Evolut low-risk study five-year results found comparable outcomes comparing transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR). He said this reinforces the viability of TAVR as a preferred approach. TAVR currently make up more than 80% of the aortic valve replacement procedures in the U.S.
Read more:
• So far, so good: TAVR comparable to open heart surgery after 5 years in low-risk patients
AI-driven angiographic FFR for coronary assessment
A new artificial intelligence (AI)-driven angiographic fractional flow reserve (FFR) technology demonstrated its ability to accurately assess hemodeymic flow through coronary lesions without requiring invasive intravascular ultrasound or additional devices. Wilson said this innovation has the potential to streamline procedures and reduce both the number of devices and risks for patients undergoing coronary angiography or PCI.
Targeting lipoprotein(a) for residual cardiovascular risk
An emerging small interfering RNA (siRNA) therapy successfully reduced lipoprotein(a) levels, a known residual cardiovascular risk factor but without a currently FDA approved treatment. While Wilson said the ability to lower Lp(a) is confirmed, further studies are needed to determine whether this translates into improved cardiovascular outcomes over the long term.
He said several drug companies are developing agents to treat Lp(a), which has seen rapidly rising interest at cardiology conferences in recent years.
Cardiogenic shock and mechanical support devices
The Altshock-2 trial showed early intra-aortic balloon pumps (IABP) implantation did not improve outcomes in patients with acute decompensated heart failure. Wilson said the results showed no significant survival benefit, aligning with previous studies that questioned the role of various mechanical circulatory support devices in cardiogenic shock management.
Studies highlight sudden cardiac arrest in athletes
Two studies analyzed sudden cardiac arrest in athletes. One study highlighted that marathon runners were more likely to experience cardiac arrest in the final stages of a race, but survival rates have improved due to increased bystander CPR and the wider availability of automated external defibrillators (AEDs). Another study revealed disparities in sudden cardiac arrest outcomes among young competitive athletes, with underrepresented minorities and lower socioeconomic groups experiencing higher mortality rates, possibly due to reduced access to AEDs and emergency response resources.
Cannabis and cardiovascular disease
A study published in JACC Advances identified a link between frequent cannabis use and an increased risk of cardiovascular disease. Wilson said this finding suggests that physicians should counsel patients about potential cardiovascular risks associated with cannabis consumption.
Hear much more detail on these studies and other insights from Wilson in the video above.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com