Post congress highlights in acute cardiovascular care: a report from the American College of Cardiology 2022 scientific sessions

The 2022 American College of Cardiology annual scientific sessions were recently held in Washington, DC. The meeting was associated with significant enthusiasm and excitement as it returned to a live in person format, albeit while retaining a strong virtual and on demand presence. By all accounts, the meeting was an outstanding success. A few late breaking highlights relevant to the care of patients in the cardiac intensive care unit are summarized below. The Complete versus Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI trial (n = 4041) had previously established the benefits of complete revascularization on the endpoint of cardiovascular death or myocardial infarction over 3 years follow-up in the setting of STEMI with multivessel disease (7.8 vs. 10.5%, P = 0.004).1 The investigators extended the benefits of this approach to an improvement in angina related quality of life utilizing the Seattle Anginal Questionnaire at baseline, 6 months and 3 years. Randomization to a multivessel revascularization strategy resulted in a decrease in anginal frequency by 6 months. This was sustained at 3 years, a benefit seen with non-culprit lesions >80% with an improvement in both physical limitation as well as overall treatment satisfaction. The Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction trial randomized 300 patients with an acute myocardial infarction in the setting of an LDL >125 mg/dL to receive biweekly alirocumab or placebo within 24 h after percutaneous intervention in addition to 20 mg of rosuvastatin.2 On IVUS follow-up at 52 weeks, the initiation of a PCSK9-inhibitor was associated with a significant coronary plaque regression as measured in the non-infarct artery utilizing percent atheroma volume (−2.13 vs. −0.92%, P < 0.001). The impact of these favourable mechanistic changes on clinical outcomes remains to be determined. Bentracimab (PB2452) is a recombinant, intravenous, human monoclonal antibody antigen binding fragment that is specifically designed to reverse the antiplatelet activity of ticagrelor, a potent reversible P2Y12 inhibitor, by binding to free ticagrelor with both high affinity as well as specificity. The administration of bentracimab results in sustained reversal of ticagrelor activity and the phase 1 data have been previously presented.3 A phase II B study evaluating this agent in 205 healthy subjects pretreated with a combination of ticagrelor and aspirin for 48 h utilizing the VERIFYNOW assay was presented. Bentracimab exposure resulted in rapid reversal of the anti-platelet effects of ticagrelor, with no evidence of rebound and no drug related adverse events. The agent is being evaluated in an ongoing phase 3 trial enrolling subjects on ticagrelor, who either require urgent surgery/invasive procedure or present with major/life-threatening bleeding. Conflict of interest: None declared.