Funding Acknowledgements Type of funding sources: None. Background Over the recent months, the scenery of the pharmacological treatment of heart failure has changed. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have become the protagonists, as trial after trial is revealing a prognostic benefit of their use for patients with heart failure (HF). While their clear advantage in heart failure with reduced ejection fraction (HFrEF) has resulted in the addition of SGLT2i in the most recent treatment guidelines 1, the magnitude of their impact in heart failure with preserved ejection fraction (HFpEF) is still debated. With the recent results of EMPEROR-Preserved trial shedding more light into this matter 2, concrete evidence is needed now more than ever to ascertain the role of SGLT2i in the management of HFpEF. Aims We performed a systematic review and meta-analysis to evaluate the role of SLGT2i in the management of patients with HF. More specifically, we performed a pre-specified subgroup analysis to assess the impact of this drug class in heart failure with reduced and preserved ejection fraction separately. Methods We conducted a systematic search of PubMed, Embase, Cochrane and Web of Science databases from inception to 15th of September. With the primary endpoint being hospitalisation for heart failure (HHF) or cardiovascular death (CVD), we identified 9,493 articles out of which 8 randomised controlled trials and 20,758 patients were included in the meta-analysis 2–9. The hazard ratios (HR) and 95% CI given in each study were used for the meta-analysis. A random-effects model with inverse-variance weights was used to combine the effect measures from all studies on a logarithmic scale. Statistical heterogeneity was assessed using the I² statistic. The statistical analyses were conducted using the Review Manager (RevMan) software (version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Results The use of SGLT2i was associated with a significant reduction in HHF or CVD both for the patients with heart failure and EF>40% (HR=0.78, 95%CI: 0.69, 0.87; I2 0%) and for the patients with heart failure and EF<40% (HR=0.74, 95%CI: 0.68, 0.81; I2 0%), while for the total population SGLT2i reduced the risk of HHF or CV death by 25% (HR=0.75, 95%CI: 0.70, 0.81; I2 0%) (figure 1). Additionally, a prespecified subanalysis showed that in the specific cohort of patients with heart failure and EF>50%, SGLT2i resulted in 23% lower risk of HHF or CV death (HR=0.77, 95%CI: 0.66, 0.91; I2 22%) (figure 2). Conclusion This meta-analysis provides robust evidence that SGLT2i appear to have a prognostic benefit across the spectrum of heart failure subgroups in terms of HHF or CV death. Further large-scale randomised trials examining the role of this drug class in the management of HFpEF would be extremely valuable and might transform the field of therapeutic strategies in this challenging clinical entity.

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Objectives We sought to answer whether 1‐month duration of dual antiplatelet therapy (DAPT) is safe after elective drug‐coated balloon only (DCB) angioplasty. Background The duration of DAPT after elective DCB was called into question after the ESC Focused DAPT Update of 2017. Until then, a 1‐month duration of DAPT was considered safe by national consensus groups (German, Italian, and Chinese) supported by data from prospective worldwide registries. The ESC Guidelines recommended a 6‐month duration of DAPT based on evidence from in‐stent restenosis randomized controlled trials only. Methods Retrospective, real‐world population, single‐center analysis conducted from January 1, 2012 to March 31, 2017 in a high‐volume, tertiary PCI center. Consecutive patients receiving 1‐month duration of DAPT after elective DCB angioplasty were included. We identified a primary composite outcome of cardiac death, myocardial infarction and target lesion revascularization at 6‐months. Results A total of 303 patients (78.5% male) with mean age of 67 ± 12.5 were included. This incorporated 86.1% de novo lesions and 56.5% nonsmall (≥3 mm diameter) coronary arteries treated. There were no reported outcomes of lesion thrombosis, target vessel MI, target lesion revascularization or cardiac death at 6‐months. There were two (0.6%) nontarget vessel MIs and one (0.3%) noncardiac death. Conclusion One‐month duration of DAPT appears safe after elective DCB‐only angioplasty, highlighting this strategy for patients at high‐risk of bleeding. These results also show favorable clinical outcomes for de novo coronary artery disease and nonsmall coronary arteries treated with DCB‐only angioplasty. A 1‐month duration of DAPT appears a safe and attractive option.

No abstract