Highlights from the first ever virtual American College of Cardiology World Congress of Cardiology 2020 (ACC.20/WCC).

I would like to begin with expressing my gratitude and appreciation for healthcare workers around the world caring for patients in need and all their efforts to overcome the COVID-19 pandemic. As lives around the globe are moving online, cardiovascular professionals from more than 135 countries took advantage of the vital science and education that made up ACC.20/WCC Virtual. I want to congratulate Program Chair Dr Andrew M. Kates and the organizing committee for creating a virtual experience that delivered cutting edge science, emerging technologies, and novel educational formats directly to cardiovascular clinicians, scientists, and other key stakeholders worldwide. The virtual meeting was free of charge for all participants from 28 to 30 March, and unlimited online access for 90 days after the meeting is available. While the ACC.20/WCC meeting went virtual, the original conference location in Chicago, McCormick Place, was converted into Illinois’ first field hospital to handle 3000 COVID-19 patients. ACC President Dr Richard J. Kovacs said in his opening remarks: ‘The ACC.20/WCC Virtual meeting is an opportunity for all of us to connect as a global community and emphasize the fact that none of us are in this crisis alone’. The kick-off of ACC.20/WCC Virtual on Saturday was the first LateBreaking Clinical Trial Session featuring the VICTORIA trial testing vericiguat an oral soluble guanylate cyclase (sGC) stimulator in patients with heart failure with reduced ejection fraction (HFrEF). The trial met its primary endpoint and showed that vericiguat vs. placebo was able to reduce cardiovascular death or hospitalization for HFrEF with a hazard ratio, 0.90 (0.82–0.98; P = 0.02). However, the benefit was really driven by reduction in hospitalization rather than cardiovascular (CV)or all-cause mortality. CV mortality was numerically lower, but this did not reach statistically significance. The incidence for symptomatic hypotension and syncope were numerically but not statistically higher in the treatment group. Vericiguat emerges as yet another medicine to reduce heart failure hospitalization with a modest effect, and it remains to be seen how this will impact the treatment landscape of HFrEF in light of recent advances with sacubitril/valsartan, SGLT2 inhibitors, or GLP-1 receptor agonists. Manipulating the sGC pathway is a novel and potentially important pathway in HFrEF. The ACC.20/WCC meeting was the big virtual stage for several studies evaluating the efficacy of direct oral anticoagulants (DOAC) in different clinical scenarios, including the VOYAGER PAD, COMPASS, PRONOMOS, AUGUSTUS, and Caravaggio Study. I want to highlight three of these studies starting with the COMPASS and COMPASS Diabetes sub-analysis. COMPASS showed that rivaroxaban plus aspirin was associated with fewer adverse atherosclerotic cardiovascular disease (ASCVD) events, but more major bleeding events compared to aspirin alone in patients with stable ASCVD. The COMPASS diabetes sub-analysis provided further insight that the combination of aspirin 100 mg daily plus rivaroxaban 2.5 mg twice daily provided a similar relative degree of benefit on ASCVD endpoints compared to patients without diabetes. However, given the significantly higher baseline risk of diabetics, the absolute benefit appeared greater in those with diabetes, including a three-fold larger reduction in all-cause mortality. Similar to the parent study, overall bleeding risk was increased in the rivaroxaban/ aspirin group, however, not in fatalor intracranial-bleeding. The second DOAC highlight was a secondary analysis from the previously reported, practice changing AUGUSTUS trial, which studied the risk of increased bleeding and benefit of reduction in ischaemic events with apixaban vs. warfarin and aspirin vs. placebo in patients with atrial fibrillation and a recent acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI). This secondary analysis now suggested the use of aspirin for up to 30 days results in an equal balance between an increase in significant bleeding and reduction in severe ischaemic events. The take home message from this study was that in selected patients with a high risk for recurring ischaemic events and lowbleeding risk, triple therapy for 1 month followed by a P2Y12 inhibitor and apixaban was a reasonable and safe strategy. The results from the Caravaggio study were widely anticipated in the vascular community. The Caravaggio study assessed whether oral apixaban was non-inferior to subcutaneous low molecular weight heparin (dalteparin) for the treatment of acute proximal deep vein thrombosis and/or pulmonary embolism in patients with active or previously treated cancer (excluding brain malignancies or metastasis). The results showed overall non-inferiority for the apixaban strategy and the P-value for