The European Society of Cardiology (ESC) Congress 2023 was once again the primary stage for the presentation of cutting-edge research that has the potential to redefine cardiological practice.
This Congress was the catalyst for prolific discussions and revelations, which generated an abundance of information. Aware of this, we selected some of the most relevant studies and focused on highlighting their clinical implications and contributions to medical practice.
ATTRibute-CM
Objective: Assess the efficacy and safety of acoramidis in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) compared to placebo.
Participants: Eligible patients with symptomatic wild-type or variant ATTR-CM.
Contributions: Acoramidis enhances outcomes in patients with ATTR-CM compared to placebo and may serve as an effective and safe alternative to tafamidis.
ADVENT
Objective: First randomized controlled trial comparing pulsed field ablation (PFA) with conventional ablation (radiofrequency or cryoablation).
Participants: Patients with symptomatic drug-resistant paroxysmal atrial fibrillation (AFib).
Contributions: PFA is as effective and safe as cryoablation for AFib treatment, with faster procedure times but slightly higher X-ray exposure.
CASTLE-HTx
Objective: Evaluate whether AFib ablation is superior to medical therapy regarding mortality and the need for heart transplantation or LVAD implantation.
Participants: Patients with end-stage heart failure, LVEF ≤35%, and symptomatic AFib.
Contributions: In patients with end-stage heart failure, AFib ablation reduced death, heart transplant need, or LVAD implantation. This trial provides strong evidence supporting ablation in advanced HF patients.
MULTISTARS AMI
Objective: Compare immediate complete revascularization versus staged PCI (19–45 days) in hemodynamically stable STEMI patients with multivessel CAD.
Participants: STEMI patients with ≥70% non-culprit lesion stenosis who remained stable after successful primary PCI.
Contributions: Immediate multivessel PCI is non-inferior to staged PCI for reducing death and ischemic events. The benefits were consistent across subgroups, including sex, age, and diabetes status.
STEP-HFpEF
Objective: Test whether semaglutide improves symptoms, physical function, and exercise capacity in HFpEF patients with obesity.
Participants: HFpEF patients with BMI ≥30 kg/m², EF ≥45%, and NYHA class II–IV.
Contributions: Semaglutide improves HF symptoms, physical function, and weight loss compared with placebo. The findings reinforce obesity as a root cause and therapeutic target in HFpEF.
NOAH-AFNET 6
Objective: First trial evaluating oral anticoagulation in patients with atrial high-rate episodes (AHRE) but no AFib documented on ECG.
Participants: Patients ≥65 years with AHRE ≥6 minutes and ≥1 stroke risk factor (HF, diabetes, hypertension, prior stroke, vascular disease).
Contributions: Oral anticoagulants cause bleeding without preventing strokes in AHRE patients lacking ECG-confirmed AFib. Results emphasize EKG documentation before starting anticoagulation.
RED-CVD
Objective: Evaluate a stepped diagnostic strategy for identifying CAD, AF, and HF in COPD or type 2 diabetes patients in primary care.
Participants: Primary care practices in the Netherlands integrating early cardiovascular diagnosis into usual management.
Contributions: The proactive diagnostic approach doubled new cardiovascular diagnoses compared with standard care. It highlights the value of early screening in high-risk populations.
We hope this summary helps you stay updated with the latest ESC 2023 evidence and apply these findings to deliver the highest-quality cardiological care to your patients.
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