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Dear readers,
In 2020, we have a year to remember — and for many, a year that they cannot wait to forget. We have been preoccupied with the pandemic, the politics, and the fight for equity in our society. Some people have lost loved ones, and others have had their lives thrown into turmoil. Many of our readers have served heroically through harrowing times and at risk to themselves. The next months are certain to hold challenges, but we have the prospect of vaccines and more effective treatments to sustain us.
In the health sphere, the top story for 2020 has been COVID, COVID, COVID. But here we focus on our cardiovascular world and present to you the top stories in our field.
Our top story is the same as last year's, the ISCHEMIA trial. Last year, we felt compelled to choose it, even as we awaited publication of the study. With its publication this year, we are again ranking it at the top. This trial is indeed game-changing, even as some people debate it around the edges. Its main finding was that an invasive strategy for patients with stable ischemic heart disease did not improve survival or reduce the risk for myocardial infarction (MI). We also have selected the substudy focusing on patients with chronic kidney disease, in whom the invasive strategy did not confer a benefit in clinical outcomes or health status.
Also in the top rank are several atrial fibrillation (AF) studies. In the EAST-AFNET 4 trial, involving minimally symptomatic or asymptomatic patients with AF, early rhythm control had better outcomes than rate control. The EARLY-AF and STOP AF trials showed that early treatment with cryoablation led to better short-term outcomes. In the RIVER trial, rivaroxaban was a safe and effective alternative to warfarin for patients with AF and a bioprosthetic mitral valve.
Another top story is a prevention trial, conducted almost entirely in South Asian and Southeast Asian countries, that showed that a polypill (statin, beta-blocker, thiazide diuretic, and angiotensin-converting–enzyme inhibitor) plus aspirin could reduce cardiovascular risk. The study is promising, though a quarter of participants dropped out during the run-in phase.
Another selected trial assessed mavacamten for symptomatic obstructive hypertrophic cardiomyopathy. Mavacamten significantly improved exercise capacity, symptoms, and quality of life — and may be on its way to approval relatively soon.
It is always nice to see that doing less can be better for patients. According to the POPular TAVI trial, aspirin was better than dual antiplatelet therapy after transcatheter aortic-valve implantation, with aspirin recipients experiencing less bleeding but no increased risk for thrombotic complications.
As in 2019 (NEJM JW Cardiol Jan 2020 and N Engl J Med 2019; 381:2497), colchicine has received some attention this year, but some uncertainty persists. One 2020 study showed benefit for patients with chronic coronary artery disease. However, a small study in patients with an acute coronary syndrome (ACS) found no benefit with colchicine and a suggestion of increased noncardiac deaths.
Finally, we have indeed chosen a study about COVID, but it focused on a dramatic drop in admissions for ACS in the first half of 2020. Many of us have been concerned that patients are avoiding needed care because they fear catching COVID-19.
Our best wishes to you, and let's hope for a 2021 that is full of good news, including progress against the pandemic, and more science that translates into benefit for our patients. And again, we are grateful to all of you for being part of our community — and for all you do every day for patients. On behalf of our wonderful editors and editorial team . . . thank you.
The NEJM Journal Watch Cardiology top stories for 2020 are:
Medical Therapy vs. Invasive Strategy in Stable Ischemic Heart Disease
Early Rhythm Control for Atrial Fibrillation
A Combination “Polypill” Reduces CVD Risk in Primary Prevention Patients
Mavacamten Shows Promise for Symptomatic Obstructive Hypertrophic Cardiomyopathy
Single or Dual Antiplatelet Therapy After Transcatheter Aortic Valve Implantation?
Acute Coronary Syndromes During the COVID-19 Pandemic
Rethinking Coronary Angiography in Advanced Kidney Disease