Major Highlights in Coronary Artery Disease for 2024

ABYSS Trial

• The ABYSS trial showed that discontinuing beta-blocker therapy in stable patients years after a myocardial infarction (MI) increased the risk of adverse events.
• The findings emphasized the long-term benefits of beta-blockers in reducing mortality and recurrent cardiovascular events in stable post-MI patients.

AGENT IDE Trial

• The AGENT IDE trial led to the approval of Boston Scientific’s Agent balloon, a drug-coated balloon (DCB), for treating in-stent restenosis, with a significant reduction in target lesion failure at 12 months compared to uncoated balloons.
• The REC-CAGEFREE I trial found that DCBs were inferior to drug-eluting stents in noncomplex coronary lesions, limiting their broader application.
• Reimbursement for DCBs, expected in 2025, may increase their use, particularly in small-vessel disease, where placing stents is less desirable.

CLEAR SYNERGY (OASIS 9) Study

• The CLEAR SYNERGY study showed that routine use of colchicine after PCI for acute myocardial infarction (AMI) failed to reduce major adverse cardiovascular events.
• The study revealed that spironolactone reduced heart failure events, suggesting it may benefit high-risk post-MI patients despite not achieving its primary endpoints.

DanGer Shock Trial

• The DanGer Shock trial demonstrated that the Impella CP microaxial flow pump reduced 180-day mortality in patients with STEMI complicated by cardiogenic shock compared to standard care.
• Experts highlighted the importance of patient selection, as indiscriminate use of Impella might not yield similar benefits.
• The positive results from DanGer Shock led to the early termination of the RECOVER IV trial, which lacked clinical equipoise between Impella and standard care.

ECLIPSE Trial

• The ECLIPSE trial found no significant difference between orbital atherectomy and balloon angioplasty for treating calcified lesions, questioning the routine use of atherectomy.
• The results supported a balloon-first strategy, using atherectomy as a bailout option, emphasizing safety and cost-effectiveness in managing calcified lesions.

REDUCE-AMI Trial

• The REDUCE-AMI trial showed that long-term beta-blocker therapy did not reduce mortality or recurrent MI in patients with acute MI and preserved ejection fraction, challenging their routine use in the modern era of MI care.

                    Comparison of ABYSS and REDUCE-AMI

• The ABYSS trial highlighted the harm of discontinuing beta-blockers in stable post-MI patients, reinforcing their long-term benefits.
• The REDUCE-AMI trial found no mortality benefit from beta-blockers in patients with acute MI and preserved ejection fraction, reflecting the evolving understanding of post-MI care.

New Guidelines for Left Main Disease

• Updated guidelines recommended coronary artery bypass surgery (CABG) over PCI for most patients with left main coronary artery disease, emphasizing CABG's superiority in reducing long-term adverse events.
• These guidelines resolved prior disagreements between surgeons and interventionalists, including controversies from the EXCEL trial, which in 2019 raised concerns over the outcomes of PCI for left main CAD.
• The EXCEL trial had contributed to divisions in the cardiovascular community, but the new guidelines gained support from the European Association for Cardio-Thoracic Surgery (EACTS), signifying a consensus.