Doug Drachman, MD, ACC.23 program chair and director of education and the interventional cardiology fellowship program, Massachusetts General Hospital, explains some of the key takeaways from the American College of Cardiology (ACC) 2023 annual meeting.

According to Drachman, the top three late-breakers were the first ones presented at the ACC opening session. 

The CLEAR Outcomes study showed benpedoic acid can be used in statin-intolerant patients to lower LDL cholesterol and improve outcomes.

"I think it is incredibly exciting to be able to use other medications for individuals who might be intolerant to taking statins," he explained. 

The TRILUMINATE study showed the use of a transcatheter clip device to treat severe tricuspid valve regurgitation and improve quality of life. The current standard of care for tricuspid regurgitation is medical therapy, because surgical valve replacements generally have poor outcomes. Drachman said this new therapy will open the door to treating this unmet need patient population. 

The STOP-CA study looked at the use of statin therapy as a way to reduce anthracycline cardio-toxicity during cancer chemotherapy. He said this trial will likely have a big impact on preventive care of cardio-oncology patients.

"Taking a statin for a year is a pretty innocuous therapy with very few downsides and this therapy can offer hope for patients that are already dealing with a new cancer diagnosis and will receive important therapies for their cancer that can also have cardio toxicity, and it is great that we now have an option that may help," Drachman explained. 

On the interventional cardiology side of the late-breakers, the BIOVASC study of complete revascularization strategies in patients presenting with acute coronary syndromes and multivessel coronary disease will help inform how to best treat these patients. 

"This is something we deal with all the time in the catheterization lab. We did find that immediate, full revascularization was non-inferior to the stage 3 revascularization approach and actually reduced the development of spontaneous myocardial infarction, or the need for unplanned additional revascularization," Drachman said. "That was something with a very important take-home message for us."

The five-year results of the COAPT study was also insightful, Drachman explained. This looked at the long-term outcomes of edge-to-edge repair (TEER) procedures using transcatheter clip devices to reduce mitral regurgitation in patients with severe heart failure. When data from this trial was first presented a few years ago at the 2018 Transcatheter Cardiovascular Therapeutics (TCT) meeting, it became an instant landmark study and changed how heart failure patients with MR are treated to relive their symptoms and improve their quality of life. Drachman said that positive data trend continued to five years out, helping reduce hospitalizations and death. 

Another major heart health study looked at the association of a low-carbohydrate high-fat ketogenic diets, which found a keto diet raises LDL and results in a two-fold increase in adverse cardiovascular events. 

Another study that looked at a new wrist-worn troponin sensor for patients presenting to emergency departments with chest pain may hold promise to reducing or eliminating regular interval blood draws to check cardiac enzyme levels, Drachman said. 

ACC 2023 also included more than 300 educational sessions, with multiple stages, plus the main tent presentation arena, innovation hub theater on the expo floor, Heart 2 Heart stage for informal and interactive discussions with key opinion leaders, the Engage Stage, Heart Cafe discussion area and hands-on simulator training. According to Drachman, the simulator area was packed with more than 800 participants the first day of ACC