The Best of ACC 2014

Every year, cardiovascular physicians hope to leave the annual meeting of the American College of Cardiology (ACC) with information that improves their ability to provide optimal patient care. This year did not disappoint.

Amid the thousands of presentations, posters and discussions were clinical trial results that are game-changers. Some created excitement by confirming the value of new treatments and technologies, while helping define the populations that will benefit. Others disappointed by dashing hopes that certain medications, medical regimens or new techniques would solve long-standing problems.

Like other conference attendees, Steven Nissen, MD, chairman of Cardiovascular Medicine at Cleveland Clinic, felt certain topics are likely to have greater impact on patient care than others. His Top 5 picks from ACC 2014 include:

1. PCSK9 inhibitors. In multiple clinical trials, this new class of drugs safely lowered LDL cholesterol where statins and ezetimibe had failed.
2. Aspirin and clonidine prior to non-cardiac surgery failed to protect the heart. A real disappointment that puts researchers back to square one.
3. Renal denervation lowered systolic blood pressure, but only slightly more than a sham procedure. Although the procedure is approved in Europe, interest here has slowed down until key questions can be answered.
4. Transcatheter Aortic Valve Replacement (TAVR) appears to be effective in keeping patients alive and out of the hospital, while the patient factors that determine the success or failure of TAVR are becoming more clear.
5. A low-tech, three-minute memory test showed striking ability to predict which heart-failure patients are likely to be readmitted within 30 days and would benefit from assisted living.

The biggest surprise, says Dr. Nissen, was renal denervation. “It demonstrates the power of self-delusion in medicine. A technique everyone thought would work produced no benefit.”

So what was his Number One choice? PCSK9 inhibitors—“the most powerful LDL-lowering therapy ever discovered. They also seem safe and effective in patients who can’t tolerate statins,” he says.