Conversations with Dr Andrew Kates, vice chair of ACC.18
Pearl Toh spoke with Dr Andrew Kates, vice chair of ACC.18 Scientific Session about what’s new in cardiology and what ACC.18 has to offer.
What have been the most exciting developments in cardiology in the past few years?
Some of the most exciting developments relate to the advancement in prevention, valvular heart disease, heart failure, and interdisciplinary approach to delivery of health care.
In terms of prevention, we are looking at new agents for treating lipid disorders especially, such as PCSK9 inhibitors and small interfering RNA molecules. With regards to valvular heart disease, we are learning more and more in percutaneous aortic valve replacement, as well as repairs for mitral valve and tricuspid valve diseases. And not to forget about the advancement in ablation.
I like the slogan of “Don’t miss a beat” for this year’s meeting. So, what is the main theme of ACC.18?
Don’t miss a beat! Yes, the overarching theme for our annual scientific session relates to the four I’s: interactive, informative, interdisciplinary, and innovative.
Being informative, above all, is about providing education. Information comes in many different ways and learning formats, but the informative aspect that we have put in place is another model we called “less lecturing and more learning”. This means really involving the learners, which leads to the next “I” which is interactive.
We have done a lot to make this meeting as interactive as possible. In the late-breaking sessions, we had the audience participate by asking them questions and getting their opinions. It’s a great way of engaging the audience. Also, we actually put the panellists in the audience─we have five thought leaders who are actually the panellists embedded in the audience asking questions. And that’s also being innovative.
In terms of interdisciplinary, we engage all members of the cardiovascular team. Beyond cardiologists, we have cardiac surgeons, nurse practitioners, pharmacists, and dieticians involved in the planning process of the meeting, as well as attending the meeting and being a key part of it.
What are the studies in ACC.18 you would particularly like to highlight?
There are several from the late-breaking studies. The ODYSSEY trial on alirocumab in high-risk ACS patients showed a 15 percent risk reduction in MACE. Importantly, the higher-risk group with LDL-C ≥100 mg/dL seems to benefit the most. How that may inform practice is that it allows us to focus on the patient group that will benefit the most, especially when the treatment cost is so high.
The VEST trial is also important. Wearable defibrillator has never been proven to be helpful, and for many patients it is uncomfortable and represents a burden to wear. Now identifying that there is no clear benefit to those wearing it post-MI tells us that this is not the right thing to do. For some higher-risk or secondary prevention population, it may be appropriate but we need to be selective on who uses it.
Other exciting trials include MOMENTUM 3 on the left ventricular assist device (LVAD) HeartMate 3 which showed a significant reduction in pump thrombosis in patients with advance heart failure who use the system for long term. It’s really changing the paradigm from where the consideration for LVAD used to be either as a destination therapy or bridge to transplant, now we are changing the focus to short term and long term.
Another trial, POISE, is one to look out for. It showed no significant benefit with perioperative beta-blockade in patients undergoing noncardiac surgery, but a higher mortality rate driven by a higher stroke rate.
Regarding the ODYSSEY trial, do you see that changing the target LDL-C levels in guidelines?
I think it will help with the second large randomized trial showing benefits with low LDL-C levels. Where it is placed and what level of recommendation is given remain to be seen. Other considerations include cost and safety.
What are the challenges or gaps in knowledge that need to be addressed in cardiology?
One area that is continuing to evolve is in cardio-oncology, and we certainly are looking forward to see more data on this. Also, we are always looking for new pharmacological agents for treating acute coronary syndrome.
What advice do you have for medical resident aspiring to become a cardiologist?
By all means become cardiologist! It’s a wonderful profession to have. I would encourage them to get involved—in education, research, and the professional organizations in their respective countries. There are many wonderful aspects of cardiovascular medicine, so keep their mind open and there is a great deal to learn.
... And come to ACC.19?
Yes, of course. Come to ACC.19!