Judith S. Hochman, MD

RESEARCH SUMMARY

Over the past several decades, clinical research activities in the Division of Cardiology have contributed substantially to the cardiovascular literature and have greatly influenced the practice of clinical cardiology. In 2003 the Cardiovascular Clinical Research Center (CCRC) was established under the direction of Dr. Judith Hochman. Considered one of the world's leading cardiovascular clinical trialists, Dr. Hochman's studies in the areas of cardiogenic shock and coronary artery disease have transformed the guidelines for treating patients with heart disease. The CCRC serves as the clinical coordinating center for international and national multi-center trials and as the organizing entity for numerous local trials as well. The CCRC has helped support participant enrollment in a wide range of clinical trials and has helped administer the division's expanding portfolio of clinical research.

Dr. Hochman is Senior Associate Dean for Clinical Sciences, Co-Director of the NYU-HHC Clinical and Translational Science Institute, Harold Snyder Family Professor and Associate Director of the Leon Charney Division of Cardiology, and Director of the Cardiovascular Clinical Research Center (CCRC) [http://medicine.med.nyu.edu/cardiology/cardiovascular-clinical-research-center-ccrc] at the New York University Grossman School of Medicine. Her particular areas of interest include the management of ischemic heart disease, both acute and chronic, with a special interest in the role of revascularization with either PCI or CABG, the pathophysiology and management of cardiogenic shock, and optimized management of stable coronary disease, including based on sex differences. She is currently the Study Chair of ISCHEMIA EXTEND, an NHLBI/NIH-funded extended follow-up of the ISCHEMIA multicenter international randomized clinical trial. This trial compared two strategies for the management of patients with stable coronary artery disease: routine invasive management with the intent to revascularize using contemporary PCI or CABG plus optimal medical therapy, versus routine optimal medical therapy alone, with cardiac catheterization reserved for refractory symptoms or an acute ischemic event. The trial demonstrated no net difference in the primary outcome, which included major cardiovascular events; there was early risk with PCI and CABG procedures, with subsequent reduction in myocardial infarction.  Longer-term follow-up demonstrated a reduction in CV death, but this was offset by an increase in non-CV death with the invasive strategy; all-cause mortality was similar. An   initial invasive strategy improved quality of life in those with baseline angina.  The findings resulted in new recommendations in the American College of Cardiology/American Heart Association and the European Society of Cardiology Practice Guidelines.

Dr. Hochman was the Study Chair of the NHLBI-funded Occluded Artery Trial (OAT), which tested the hypothesis that late opening of the infarct related artery (PCI/stent) will reduce the risk of death, MI and Class IV HF. OAT demonstrated no benefit for late angioplasty for persistent total occlusion late post MI and a trend toward excess reinfarction and led to new recommendations against performing this procedure in the ACC/AHA Guidelines (NSTEMI and STEMI, PCI) and the  European Society of Cardiology Guidelines. These findings proved durable over the long- term (>6 years). In a subset of patients in the NHLBI-funded angiographic OAT ancillary study (TOSCA 2) less LV remodeling was seen with PCI. However, the NHLBI-funded myocardial viability ancillary study did not confirm that and importantly, the presence of retained viability in the zone supplied by the infarct-related artery did not correlate with improvement in EF or LV size with PCI. Patients in both the PCI and medical therapy only groups had significant improvement in EF over one year, with no difference between the groups.

She was the Study Chair of the NHLBI-funded SHOCK Trial, which demonstrated a one year and long-term durable survival benefit for emergency PCI or CABG and led to a change in the US and European guidelines. Translation of this trial and the recommendations led to increased use of revascularization in community-based studies with associated reduced mortality. She has investigated the role of systemic inflammation and excess nitric oxide in the genesis and persistence of cardiogenic shock and was Study Chair for phase 2 and phase 3 studies of nitric oxide synthase inhibition in refractory cardiogenic shock- SHOCK 2 and TRIUMPH. SHOCK 2 was an NHLBI Small Business Innovation Research program–funded trial; that phase 2 study and TRIUMPH were the first randomized trials to test a pharmacologic agent for cardiogenic shock. These trials demonstrated a dissociation between improvement in blood pressure and clinical outcomes, eg death. There was reduction in death despite a significant increase in BP with the NOS inhibitor. Dr. Hochman has served on numerous steering and executive committees for multi-center acute and chronic ischemic heart disease clinical trials.

During COVID-19 pandemic, she developed and led, as Study Chair, ACTIV-4A (Accelerating COVID-19 Therapeutic Interventions and Vaccines 4 ACUTE (ACTIV-4A) trial and oversaw CONTAIN and COMPILE studies.

She has served as a member of the FDA Cardiorenal Advisory Panel and chair and member of numerous Data and Safety Monitoring Boards (DSMBs) on trials sponsored by NIH and industry. In recognition of her scientific contributions she was awarded the 2014 AHA Clinical Research Prize and the 2016 ACC Distinguished Scientist Award (Clinical Domain), and the 2023 AHA Distinguished Scientist Award.