TCTMD’s Top 10 Most Popular Stories for September 2019

DAPA-HF’s big win for dapagliflozin in heart failure patients, both with and without diabetes, led the top 10 list this month. The TWILIGHT trial from TCT 2019 also made the top three, along with new European Society of Cardiology (ESC) guidelines for the freshly coined concept of “chronic coronary syndromes.” In fact, all but two of the most-clicked stories on TCTMD this month came from the ESC Congress, covering everything from CV risk-factor exposure to antiplatelet choices in ACS, 2-year MITRA-FR numbers, and the COMPLETE trial results for culprit versus complete revascularization in STEMI.

1) DAPA-HF Details: Dapagliflozin Slashes HF Outcomes, Even in Nondiabetics

Investigators saw benefits with the SGLT2 inhibitor across all subgroups. One observer predicts a new era of heart failure care.

2) New ‘Chronic Coronary Syndrome’ Guidelines Stress There’s Nothing Stable About CAD

“You may have stable phases and less stable phases,” says one writing group chair. But the disease is, in most cases, progressing.

3) TWILIGHT: Ticagrelor Monotherapy Lowers Bleeding Without Increasing Ischemic Events

Experts agree the findings suggest that aspirin can be dropped in practice 3 months after PCI in this high-risk patient cohort.

4) Lifelong Exposure to Lower LDL and BP Linked With Big Reduction in CVD Events

Even small reductions in LDL and BP along with lifestyle and diet changes can have a positive effect on cardiovascular health.

5) Prasugrel Bests Ticagrelor in ACS Patients Heading to PCI: ISAR-REACT 5

Investigators actually designed the trial expecting to demonstrate superiority for ticagrelor. Things didn’t go as planned.

6) MITRA-FR at 2 Years: Still No Benefit of MitraClip Over Meds

Two-year data allow for more direct comparison with the COAPT results, and a post hoc analysis offers a “surprise.”

7) COMPLETE Beats Culprit-Only PCI in Multivessel STEMI and Timing Doesn’t Matter

The results justify waiting to completely revascularize if a complex patient presents in the middle of the night, an expert says.

8) PARAGON-HF Misses Primary Endpoint, but Hints of Benefit Seen

The full results contain a “glimmer of hope” that sacubitril/valsartan will be an option for some HFpEF patients.

9) Onyx ONE: Shorter DAPT Plus ZES Noninferior to Polymer-Free Stent in High-Bleeding-Risk Patients

While the study adds needed data, it does not fully answer the question of whether 1-month therapy strikes the perfect balance.

10) For A-fib/PCI Combo, Edoxaban Matches VKA but Not Superior: ENTRUST-AF PCI

This latest study “closes the loop” in a series of trials testing the NOACs in this setting and is the first not to get a win for bleeding.

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SEE ALSO: Our top blog post of September 2019, by Off Script blogger Quinn Capers IV, MD.

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