What’s Going to Be Hot at ACC 2024

Later this week, the American College of Cardiology (ACC) 2024 Scientific Session celebrates its 75th anniversary by heading back to Atlanta for the first time since 2010, with the plans to return in 2021 dashed by the COVID-19 pandemic. In this year’s lineup are some eagerly awaited cardiovascular trials in the drug and device space, but also some less traditional approaches assessing game-based and financial incentives, spirituality, and unique population approaches.

According to Douglas Drachman, MD (Massachusetts General Hospital, Boston), the scientific session’s chair, 2024 will be “a blockbuster of a year” for the meeting, which received 1,100 more abstracts than last year and the most it’s received in two decades, with submissions coming from 79 countries worldwide. “There was truly global input into this meeting and certainly we hope for global impact,” Drachman told a media telebriefing last week.

Late-Breaking Lineup

There will be a total of five late-breaking clinical trial (LBCT) sessions spread over the 3-day meeting. LBCT I, on Saturday, showcases just three trials: RELIEVE-HF, EMPACT-MI, and AEGIS II. This last trial, we already know from top-line results, came up empty-handed and in doing so delivered what might be a mortal blow to the HDL-raising hypothesis.

RELIEVE-HF, by contrast, is exploring newer terrain. This the second-ever randomized trial of an atrial shunt to relieve pulmonary pressure in heart failure: early positive signals reported 2 years ago raised some hopes that this trial might yield better results than REDUCE LAP-HF II, where a different atrial shunt device proved no better than a sham procedure for relieving pulmonary wedge pressures.

“From my standpoint, I’m hopeful that this allows us to advance the care of people who are still refractory,” said Katie Berlacher, MD (University of Pittsburgh, PA), who serves as the meeting’s vice chair and co-moderated the briefing. “There are many patients who we have, both with reduced and preserved ejection fraction, that despite many of our really good medical therapies, they either can't be on more because they don't tolerate more, or they're on the most and they are still having heart failure [symptoms]. So I'm incredibly curious about a structural change to the heart that then treats this.”

Rounding out LBCT I is EMPACT-MI, testing empagliflozin (Jardiance; Boehringer Ingelheim/Eli Lilly) prescription immediately after acute MI to reduce subsequent MACE over usual care. Here, too, ACC attendees will be thinking of a predecessor: DAPA-MI, presented at last year’s American Heart Association meeting, which tested dapagliflozin (Farxiga; AstraZeneca) in acute MI and also came up empty-handed. Notably, however, DAPA-MI specifical excluded patients with diabetes, whereas EMPACT-MI did not.

Sunday morning features two late-breaking sessions. LBCT II, at 8 AM, features a mix of lipid-lowering trials, the phase II KARDIA-2 hypertension trial testing zilebesiran (Alnylam), and a novel approach using gamification, financial incentives, or both to induce patients at risk of adverse CV events to be more physically active.

LBCT III, at 11 AM, is dominated by MI and ACS trials, the most hotly anticipated being DANGER-SHOCK testing the Impella percutaneous transvalvular micro-axial flow pump (Abiomed) in patients presenting with acute MI complicated by cardiogenic shock. As previously reported by TCTMD, this trial has faced uphill battles enrolling and randomizing the sickest of patients, leading to a steady stream of imperfect, observational studies to try to fill the knowledge gap.

Other LBCT III trials also will likely make headlines. TACT2 is revisiting the enticing idea that chelation might help post-MI in patients with diabetes. REDUCE-AMI is tackling the long-running question of whether long-term beta-blockers are helpful after MI in patients with preserved ejection fraction, particularly in the current era of guideline-directed medical therapy. Lastly, the ULTIMATE DAPT trial is the latest trial to try to cut down on post-PCI antiplatelet therapy regimens, this time with a strategy of just 1-month of ticagrelor monotherapy after ACS.

A lone structural heart disease trial appears in that session: the SMART trial is comparing a balloon-expandable and a self-expanding TAVI valve in patients with small aortic annuli.

Cardiomyopathies get the spotlight Monday morning. LBCT IV features two new agents and one old, in this space. ARISE-HF tested a selective aldose reductase inhibitor (at-001; Applied Therapeutics) for the treatment of diabetic cardiomyopathy. IMPROVE-HCM examined ninerafaxstat (Imbria Pharmaceuticals), a novel cardiac mitotrope, in patients with symptomatic nonobstructive hypertrophic cardiomyopathy. PROACT, however, features an old drug, the ACE inhibitor enalapril, for the possibility of preventing anthracycline-induced cardiotoxicity in breast cancer and lymphoma patients. The last two trials in LBCT IV are a study of tranexamic acid to prevent seizures after cardiac surgery and TACTiC, testing a technology-assisted means of administering nonprescription rosuvastatin.  

The last late-breaking session of ACC 2024 delivers an interventional cardiology wallop. LBCT V includes ORBITA-COSMIC, a placebo-procedure-controlled trial of a coronary sinus reducer for refractory angina; DEDICATE-DZHK6, pitting surgery against TAVI in low- and intermediate-risk patients; the Target BP I trial of renal denervation, an IVUS versus angiography to guide drug-coated balloon therapy in femoropopliteal artery disease; and “preventive PCI” versus medical therapy in patients with unstable coronary plaques. This last, said Drachman during the ACC press briefing, is “sort of the Holy Grail of cardiology—preventing a future heart attack—[and] I hope this trial will give more insights.”

More Science

Each of the late breakers get a second look in “deep-dive” sessions scheduled later in the day each day. There are also three featured clinical research sessions, one per day, showcasing updates from recent trials or novel registry analyses.

Some outside-the-box studies have been grouped under the umbrella of “Clinical and Investigative Horizons” on Saturday and include a registry-based, decentralized trial addressing ways of providing more equitable cardiovascular care, a study of CVD risk factors among National Football League players and families, an implementation science study aimed at increasing heart failure therapies among members of the Navajo Nation, and a study gauging the effects of spirituality on blood pressure.

It's not all trials and science, of course, as the meeting’s CV Team Lead Kimberly Guibone, DNP (Beth Israel Deaconess Medical Center, Boston, MA), explained to the media. There are dedicated sessions focused on business of medicine concerns for healthcare professionals, 11 game show-style sessions complete with quizzes, lights, and buzzers, and—by popular demand—the puppies are back for stressed out conference attendees to get their hands on.

For more on what’s to come at ACC 2024, check out the latest Rox Heart Radio. The TCTMD team will be on-site in Atlanta. Please reach out with tips, complaints, and comments: we hope to see you there.