Experts from NYU Langone Health presented their latest clinical findings and research discoveries at the American Heart Association’s Scientific Sessions 2022, from November 4 to November 7, in Chicago.
Lead presentations covered cardiovascular outcomes data, women and heart disease, COVID-19 outcomes, and updated outcomes from the landmark ISCHEMIA trial.
“We’re excited for our experts to present new research this year, which creates opportunities for collaboration with other leaders in the field that accelerate efforts to design better treatments for our patients,” says Glenn I. Fishman, MD, the William Goldring Professor of Medicine and director of the Leon H. Charney Division of Cardiology at NYU Grossman School of Medicine.
At this year’s meeting, NYU Langone’s cardiac specialists presented more than 40 papers, posters, videos, symposia, courses, and special sessions. Notable research from this year’s conference includes the following.
Late Breaker Session: ISCHEMIA-EXTENDed Follow-Up Interim Report
Date and Time: Sunday, November 6 at 6:39PM ET
After seven years of follow-up, interim results from the landmark continuing international study ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) were presented as a late-breaker presentation this year. Findings from the ISCHEMIA-EXTEND study published simultaneously in the journal Circulation.
The initial ISCHEMIA trial randomized more than 5,000 patients across 38 countries with chronic coronary disease and moderate or severe ischemia. ISCHEMIA-EXTEND is tracking survivors of ISCHEMIA for overall follow-up of nearly 10 years.
“These longer-term results build on our original findings, which is that patients with daily or even weekly angina will likely see improved quality of life, but we have more robust data that an invasive approach is not going to prolong life,” says ISCHEMIA study chair Judith S. Hochman, MD, the Harold Snyder Family Professor of Cardiology and senior associate dean for clinical sciences at NYU Langone. “Although cardiovascular mortality was reduced, with an invasive approach it was offset by higher non-cardiovascular mortality, so all-cause mortality is the same over time in both groups. Either strategy is acceptable, which is good news for patients, who have different preferences.”
Both patient groups in the study received “guideline-directed medical therapy,” the term for medications and lifestyle advice, with one group receiving invasive procedures soon after having an abnormal stress test, and the other treated invasively only if symptoms worsened despite drug therapy, or in the case of an emergency (heart attack). Various types of stress tests were used in the study to determine the degree of blood flow restriction (ischemia) in patients’ coronary arteries.
Poster Presentation: Effect of Therapeutic-Dose Heparin on Acute Kidney Injury in Non-Critically Ill Hospitalized Patients with COVID-19: The ACTIV4a and ATTACC Randomized Trial
Date and Time: Sunday, November 6 at 11:30PM ET
Acute kidney injury (AKI) is common in patients who have COVID-19. Studies have shown that in non-critically ill patients with COVID-19, the use of higher-dose blood thinners (therapeutic-dose heparin) increases the probability those patients will recover and be discharged from the hospital. It also has been shown to reduce the need for cardiovascular or respiratory organ support. NYU Langone researchers investigated whether higher-dose blood thinners also reduced the incidence of AKI or death in moderately ill patients hospitalized for COVID-19.
Researchers analyzed the outcomes of 1,694 non-critically ill patients hospitalized for COVID-19 who were enrolled in an open-label, multiplatform randomized trial, and compared the use of higher-dose blood thinners versus the prophylactic use of lower-dose blood thinners (usual-care pharmacologic thromboprophylaxis). The investigators found that treating patients with higher-dose blood thinners was associated with a high probability (97.7 percent) of superiority to reduce the incidence of severe (stage 3) AKI or death compared to the usual standard of care.
“These findings are incredibly important when we think about how to best treat patients hospitalized with COVID-19,” says Jeffrey S. Berger, MD, associate professor of medicine and surgery and director of the Center for the Prevention of Cardiovascular Disease at NYU Langone. “These data arm physicians with important information about how to reduce the incidence of significant kidney injury, as well as death, in non-critically ill hospitalized patients.”
Poster Presentation: Prevalence and Predictors of Normotensive Shock in Intermediate-Risk Pulmonary Embolism
Date and Time: Monday, November 7 at 2:40PM ET
The care management for patients with intermediate-risk pulmonary embolism who have stable blood pressure is controversial with most getting anticoagulation (blood thinners) alone. However, a subset of these patients do poorly and go into cardiogenic shock, with a higher in-hospital death rate. It is not clear what the prevalence and predictors of shock are in such patients with only an intermediate-risk of pulmonary embolism.
Researchers at NYU Langone evaluated 384 patients from the FLASH registry with intermediate risk pulmonary embolism who had cardiac index measured pre- and post-thrombectomy (a procedure to remove blood clots) and compared using paired data.
Out of the 384 intermediate-risk patients, the study found that more than one-third (34.1 percent) were in normotensive shock at baseline, indicating that they were much sicker than what their stable blood pressure otherwise indicated.
Significant predictors of shock included increased heart rate, residual deep vein thrombosis (clot in the lower legs), reduced RV function (reduced right-sided heart function), and saddle pulmonary embolism (a blood clot in the main pulmonary artery). The normotensive shock group showed significant improvement in heart function and mean pulmonary artery pressure post-procedure. In addition, percutaneous mechanical thrombectomy (removing clots mechanically) was safe with low rates of major adverse events and mortality through 30 days.
“Our study highlights important findings that can change the way we triage and manage patients who have intermediate-risk pulmonary embolism,” says Sripal Bangalore, MD, professor of medicine and director of research at NYU Langone’s Cardiac Catheterization Laboratory. “First, it shows that the prevalence of shock state is high despite the normal/stable blood pressure, which highlights the need to closely monitor these patients. Second, we showed that a novel shock index can effectively further risk-stratify these patients and identify those who are in the normotensive shock state. Finally, percutaneous mechanical thrombectomy can be a game changer in these patients.”