CAD Does Not Modify Effect of Vericiguat on Heart Failure Outcomes

The following article is a part of conference coverage from the American College of Cardiology’s 70th Annual Scientific Session & Expo is being held virtually from May 15 to 17, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by clinicians and scientists in the field. Check back for more from the ACC 2021 .

Although individuals with coronary artery disease (CAD) have worse outcomes in heart failure, the presence of CAD does not appear to modify the effect of vericiguat. These findings were presented during the American College of Cardiology Annual Meeting, held virtually from May 15 to 17, 2021.

Researchers assessed the results of the VICTORIA trial, which included 5048 patients with worsening heart failure, 53.6% (n=2704) of whom had CAD. The median follow-up time for this population was 10.8 months. The primary composite endpoint was cardiovascular death or hospitalization for heart failure.

Individuals with CAD in the study population were more likely to have diabetes, to smoke, to be men, to be older, and to have a lower estimated glomerular filtration rate (53.5 mL/min/1.73 m2) than those without CAD (63.3 mL/min/1.73 m2; P <.0001). Compared with patients who did not have CAD, more of those with CAD used implantable cardioverter defibrillators (33.5% vs 21.1%; P <.0001) and cardiac resynchronization therapy (16.3% vs 12.8%; P =.0006).

The primary composite endpoint was significantly higher among those with CAD than those without CAD (adjusted hazard ratio [aHR], 1.23; 52.7% vs 45.0%). Differential rates of cardiovascular disease were also higher in patients with CAD (aHR, 1.44; 30.2% vs 21.9%; P <.001), as were heart failure hospitalizations (aHR, 1.17; 42.1% vs 36.7%; P =.01) and sudden death (8.6% vs 5.5%; P <.02) despite greater use of devices.

CAD did not significantly modify the treatment effect of vericiguat on these outcomes (P =.78).

The study researchers concluded that those with CAD have “higher composite [cardiovascular] outcomes in [heart failure], including the proportion of [cardiovascular] deaths relative to [heart failure] hospitalizations.” Investigators indicated that, in this population, “the effect of vericiguat was similar irrespective of CAD.”

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Armstrong PW, Saldarriaga Giraldo CI, Atar D, et al. Coronary artery disease and cardiovascular outcomes in heart failure: Insights from the Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction (VICTORIA) trial. Presented at: American College of Cardiology (ACC) Annual Meeting; May 15-17, 2021.