Thread by @aayshacader

#ACC21 late-breakers🧵
1/Antiplatelets: Let's start with #aspirin
❌ADAPTABLE :Aspirin 325 mg vs 81 mg in ASCVD pts
No difference in death/ MI/ stroke/major bleeding
💎pragmatic trial: EHR-identified pts
💎significant dose switching in 325 mg group
nejm.org/doi/full/10.10…

✅Host Exam: Aspirin vs Clopidogrel in chronic Maintenance monotherapy after #PCI w/ DES
#Clopidogrel monotherapy reduced composite of death, non-fatal MI, stroke, ACS re-admission, BARC >=3 bleeding, compared to #aspirin monotherapy.
❓East Asian paradox
thelancet.com/journals/lance…

✅TALOS- AMI: De-escalation ✅
In pts w/ no major events in 1st month after index PCI, de-escalation of DAPT from #ticagrelor to #clopidogrel is superior to tica-only DAPT in terms of net clinical benefit, with
⬇️decreased bleeding 🩸risk
- no increase in ischaemic risk
#ACC21

4/ Now onto NOACs
ATLANTIS❌
Full-dose #apixaban is NOT superior to SOC antithrombotic treatment among patients undergoing #TAVI despite a reduction in valve leaflet thrombosis.
💎safety (bleeding) of apixaban is similar to that of current SOC
#ACC21 @mirvatalasnag @ShrillaB

5/VOYAGER-PAD
✅#Rivaroxaban 2.5 mg bd with aspirin vs aspirin alone reduces first & subsequent adverse limb & cardiovascular events in patients with #PAD undergoing lower extremity revascularization.

@JACCJournals publication: bit.ly/33QBsRr

#ACC21 @taraloujones

6/ 🥀#FLOWERMI
❌FFR-guided PCI of non-IRA did not reduce composite outcome of death, MI or urgent revasc at 1 year, compared with angio-guided PCI in STEMI patients with MVD

@nejm simpub:
nejm.org/doi/full/10.10…

#ACC21 @ACCinTouch @ncurzen @SukhNijjer @tabaza @Julio_Farjat

7/ Negative trial for #ARNI
PARADISE-MI
❌Compared with ramipril, #sacubitril/valsartan did not reduce the primary endpoint of CV death, HF hospitalization or outpatient HF requiring Rx in a contemporary enriched acute MI population (EF≤40%).

acc.org/latest-in-card…

#ACC21

8/ Also #ARNi❌LIFE
Compared to Valsartan only, Sacubitril/valsartan did NOT⬇️NT-proBNP or clinical composite of no of days alive,out of hospital & free from HF events, in patients with advanced HFrEF & comorbidities

💊sicker pts, lower BP, worse renal function, ⬇️ LVEF, ⬆️AF

9/ Win for #soitagliflozin
✅SOLOIST-WHF and SCORED 

Pooled data showed benefit of sotagliflozin in reducing composite of total CV deaths, HF hospitalizations, & urgent HF visits in pts with both diabetes& HF
🌟across full range of EF, including HFpEF
🌟men &women

@DLBHATTMD

10/ negative #COVID-19 trials
❌INSPIRATION-S: atorvastatin 20mg/d failed to reduce venous or arterial thrombosis, Rx with ECMO, or all cause mortality in #COVID19 ICU pts

@bbikdeli @HeartOTXHeartMD @Umair2017 @VietHeartPA @torresviera @CardioNerds @cardiojaydoc02 @rahatheart1

11/
❌DARE-19
#dapagliflozin failed to reduce organ dysfunction or death, or improve recovery, compared with placebo among in noncritically ill hospitalized #COVID19 pts

#ACC21 @ACCinTouch @Sarah_Moharem @sarahhudsonuk @HeartOTXHeartMD @hvanspall @chiarabd @sabeedak1 @JGrapsa

12/
❌Coalition ACTION
In hospitalized #COVID19 pts w/⬆️D dimer levels, initial in-hospital therapeutic AC did NOT improve clinical outcomes& increased bleeding compared w/prophylactic AC
-stable pts: #rivaroxaban 20 mg OD
-unstable pts: enoxaparin, then rivaroxaban to 30 days

13/ #LAAOS-lll✅
On a background of anticoagulation, surgical left atrial appendage occlusion during cardiac surgery reduced ischaemic stroke in pts with AF

nejm.org/doi/full/10.10…

#ACC21 #EPeeps @m_tahakhan @KTamirisaMD @HafizaKMD @A_FelixOliveira @ovidiogarciav @pomyers

14/ ✅RADIANCE-HTN TRIO
-In hypertensive pts resistant to triple combination therapy, ultrasound #RDN showed 8mmHg ⬇️in daytime ambulatory SBP vs sham
-BP⬇️effect of RDN vs sham consistent for 24h,
nighttime &office SBP

@ACCinTouch @ajaykirtane @drandrewsharp @ShrillaB

15/ CAPITAL-CHILL🥶
❌Moderate hypothermia NOT superior to mild hypothermia in improving mortality or neurological outcomes at 6 months among comatose patients with out-of-hospital cardiac arrest

#ACC21 @ACCinTouch @DeepDastidar @DrAsifQasim @DrKeeble @AnnaKateBarton @avolgman

16/ FIDELIO-DKD✅