What’s Going to Be Hot at ESC 2024

The 12 Hot Line sessions are sprinkled across the 4 days, with just one on Friday, four on Saturday, four on Sunday, and three on Monday; all take place in the “London” theater. TCTMD has published a handy list of all ESC Hot Line trials, but here’s an overview of the groupings.

Friday’s lone Hot Line 1 shines the spotlight on ABYSS, addressing beta-blocker interruptions post-MI, STOP-or-NOT comparing the impact of continuing or stopping renin-angiotensin-aldosterone-system (RAAS) inhibitors ahead of major surgery, and HELIOS-B, the phase III study of vutrisiran (Amvuttra; Alnylam) in transthyretin amyloidosis with cardiomyopathy—we know from top-line trial results released in June that the primary endpoint was met.

On Saturday, Hot Line 2 features four trials of blood pressure combination pills and optimized time-of-day dosing. Hot Line 3 features three transcatheter edge-to-edge repair trials: Tri.FR in tricuspid regurgitation and MATTERHORN and RESHAPE-HF 2 in functional mitral regurgitation. Hot Line 4 is a mixed bag of high-profile topics: ASSURE DES looks at perioperative antiplatelet therapy management before noncardiac surgery in patients with coronary DES; SWEDEGRAFT examines “no-touch” vein-graft harvesting to improve patency in CABG; and TIGHT-K tests potassium supplementation to prevent post-cardiac surgery atrial fibrillation (AF). Hot Line 5 is all TAVI, featuring POPular PAUSE TAVI testing oral anticoagulation strategies, NOTION-3 tackling PCI in TAVI patients, and RHEIA looking at TAVI versus SAVR in women with severe aortic stenosis.

On Sunday, Hot Line 6 zeroes in on AF, with STEEER-AF (stroke prevention and rhythm control) and EPIC-CAD (edoxaban versus dual antiplatelet therapy for AF in patients with stable coronary disease). The third trial in this batch, OCEANIC-AF, was stopped early when asundexian (Bayer) failed to beat apixaban for curbing stroke and pulmonary embolism in patients with AF.

Rounding out Sunday, Hot Line 7 groups three selective mineralocorticoid receptor antagonist studies in heart failure: FINEARTS-HF, FINE-HEART, and a patient-level meta-analysis. Hot Line 8 features several timely interventional topics: SCOFF comparing fasting versus no fasting ahead of cardiac catheterization; EARTH-STEMI testing complete versus culprit revascularization in older adults; and SENIOR-RITA comparing medical therapy versus invasive treatment in patients 75 and older. Hot Line 9 revisits atrial fibrillation, this time with screening approaches in GUARD-AF, STROKESTOP II, and MIRACLE-AF.

Finally, on Monday, Hot Line 10 features three ablation approaches to atrial arrhythmias—namely, pulmonary vein isolation (SHAM-PVI), low-voltage-area ablation (SUPPRESS-AF), and cryoablation versus radiofrequency ablation (CRABL-HF). Hot Line 11 broaches more hot topics in interventional cardiology: OCT-guided interventions for complex PCI in OCCUPI, Elixir Medical’s novel unlocking “Bioadaptor” scaffold in INFINITY-SWEDEHEART, and a DCB versus DES comparison for de novo CAD in REC-CAGEFREE I. The futuristic Hot Line 12 includes trials of artificial intelligence (AI)-assisted stress echocardiography (PROTEUS), AI-assisted chest pain workup (RAPIDxAI), and a point-of-care troponin test (WESTCOR-POC).

New Guideline Drop

The ESC always uses its annual Congress to release new guidelines. This year’s meeting sees updates to atrial fibrillation, chronic coronary syndromes, hypertension, and (in a single document) peripheral artery disease and aortic diseases. All four guidelines are being released in the very first big-tent session of the meeting at 8:15 AM on Friday morning, with additional deep dives for each dotted throughout the program.

Of note, the official “opening” of the ESC in the form of the welcome address by President Franz Weidinger, MD (Landstrasse Clinic, Vienna, Austria), takes place at 5:30 PM Friday.

Big Picture Aims

In addition to digital innovation, which McMurray singled out as a key theme of the meeting, ESC program planners also created a special track addressing obesity. “We recognize how important obesity is as a public health problem worldwide,” he said. There’s also a track dedicated to implementation science. “Cardiology is blessed with fantastic evidence and great treatments, but they aren’t always used as well as they should be,” said McMurray.

Unique this year, he concluded, is “a special emphasis on the patient voice.” Across every cardiology topic in this year’s program, he said, is at least one session with patient involvement. Moreover, the unifying theme of the 2024 Congress is “personalizing cardiovascular care.” To that end, the program pays particular attention to precision medicine at all stages of disease development, from risk prediction to tailored therapeutics.

“[There’s] so much happening at the Congress, it’s really hard to summarize,” said McMurray, who pointed out that the organizers had the difficult task of choosing from almost 4,500 abstracts submitted by researchers from nearly 100 countries. “Please come to London.”

For more on what to expect at ESC 2024, check out the August edition of Rox Heart Radio. TCTMD journalists Todd Neale and Michael O’Riordan will join me on the ground in London, with key backup stateside from Caitlin Cox, Laura McKeown, and Yael Maxwell. Check out TCTMD.com throughout the meeting, sign up for our daily newsletter, and follow us on X, Facebook, and Instagram to catch breaking news and in-depth commentary.