Interventional Cardiology
The COMPLETE Timing Substudy: A Randomized Trial of Complete Staged Revascularization Vs. Infarct Artery PCI Alone in Patients With Acute Myocardial Infarction and Multivessel Disease – Importance of Revascularization Timing
The results of a substudy of the COMPLETE Trial were presented at TCT 2019 by Dr. David Wood, an interventional cardiologist, and Professor of Medicine at the University of British Columbia, Canada. The analyses revealed that compared with culprit-lesion only PCI, the timing of complete revascularization, whether performed early during the index hospitalization or after discharge have similar benefits on major cardiovascular events.
New 1,500 Patient Study Demonstrates Favorable 1-Year Mortality Rate in Mitral Valve-In-Valve Implantation in Patients With Failed Mitral Valve Surgery
The results of a combined analysis of the STS/ACC/TVT Registry and the Centers for Medicare and Medicare Services (CMS) were presented by Dr. Mayra Guerrero, an interventional cardiologist and Professor of Medicine at Mayo Clinic Hospital, at TCT 2019. The analysis suggests that a transcatheter mitral valve-in-valve implantation may be preferable to repeat mitral surgery and should be the standard of care in patients with favorable anatomy.
SCOPE I: ACURATE Neo (Self-Expanding TAVR System) Struggles to Have An Edge On SAPIEN 3 (Balloon-Expandable TAVR System)
Results of a randomized trial presented at TCT 2019 and simultaneously published in The Lancet, showed that TAVR with the self-expanding ACURATE neo (Boston Scientific) did not meet non-inferiority compared to the balloon-expandable SAPIEN 3 (Edwards Lifesciences) in terms of early safety and clinical efficacy outcomes.
Meta-analysis Shows Reduced 1-Year Mortality with TAVR in Low-Risk Severe AS Patients
In a meta-analysis of RCTs comparing TAVR (Transcatheter Aortic Valve Replacement) versus SAVR (Surgical Aortic Valve Replacement) in low-risk patients with severe AS, TAVR was associated with a significantly lower risk of all-cause and cardiovascular mortality at 1 year follow up. The study conducted by Kolte et.al was recently published in the Journal of American College of Cardiology.
REVELATION Trial: Paclitaxel-Coated Balloon Angioplasty is Non-Inferior To The Routinely Conducted Drug-Eluting Stenting in STEMI Patients A 9 months follow-up Single-Centered Randomized Clinical Trial
According to a recent study based on the REVELATION Trial, conducted by Nicola S. Vos et al. and published in JACC, Paclitaxel-coated balloon angioplasty was documented to be non-inferior to the routine drug-eluting stenting (DES) in ST-segment elevation myocardial infarction (STEMI) patients.
Dual Anti-thrombotic Therapy Safe For Patients with Atrial Fibrillation and Recent PCI:ENTRUST-AF PCI Results of the ENTRUST-AF PCI trial presented at the ESC Congress 2019
Results from a phase-IIIb, open-label, multi-center, randomized clinical trial comparing the safety of dual anti-thrombotic therapy (DAT) with triple anti-thrombotic therapy (TAT) for patients with atrial fibrillation who have undergone recent (4 hours – 5 days) percutaneous coronary intervention (PCI), have shown that the DAT regimen (Edoxaban plus a P2Y12 inhibitor) is non-inferior to Vitamin K antagonist(VKA) plus a P2Y12 inhibitor and aspirin or TAT regimen.
SYNTAXES Study: No Significant Difference In All-Cause Death At 10 Years Between PCI and CABG Results of a 10-year Follow-up Study presented at the European Society of Cardiology (ESC) Congress 2019
A follow-up of a multicenter, randomized controlled trial, the results of which were debuted at the European Society of Cardiology (ESC) Congress 2019, has shown that at 10 years, no statistically significant difference existed in all-cause mortality between percutaneous coronary intevention (PCI) using first-generation paclitaxel-eluting stents and coronary artery bypass grafting (CABG). However, CABG was shown to provide significant survival benefit in patients with three-vessel disease, but not in patients with left main coronary artery disease.
Novel Physiology-Based Method of Estimating Myocardial Ischemic Burden
Murai et al. devised a novel physiology-based method of estimating the amount of myocardium subtended by coronary stenosis, which is feasible and can be performed in the catheterization laboratory with a Doppler sensor-equipped guidewire. The study was published in the recent issue of Circulation: Cardiovascular Interventions.
Fractional Flow Reserve Aids Decision Making for Intermediate Coronary Lesions: 1-Month Data from FORZA Study
Compared with optical coherence tomography (OCT), fractional flow reserve (FFR) was associated with a higher percentage of medical therapy, lower risk of acute kidney injury, shorter hospital stay, and reduced costs at one month among patients with intermediate coronary lesions. The study by Leone et al., recently published in the Journal of American Heart Association, revealed.
TSR1 Gene Associated with Coronary Dissection in A Chinese Cohort
TSR1 gene, encoding a ribosome biogenesis factor required for the maturation of 40S subunit, was identified as a potential cause of spontaneous coronary artery dissection (SCAD) in the study by Sun et al., published in the Journal of the American College of Cardiology.
Nationwide Study Shows New-onset Left Bundle Branch Block After Transcatheter Aortic Valve Replacement Occurred in 15% of Intermediate Risk Patients and Is Associated with Worse 2 Year Outcomes
According to a new nationwide study, new onset left bundle branch block (LBBB) post transcatheter aortic valve replacement (TAVR), a recently established therapy for intermediate risk surgical candidates with symptomatic, severe aortic stenosis, is associated with adverse long term clinical outcomes in patients without baseline conduction disturbances or pacemaker. Based on the findings published in the European Heart Journal, these outcomes include cardiovascular mortality, re-hospitalization, new pacemaker implantation, and worsened left ventricular systolic function in intermediate risk patients.
STS/ACC TVT Registry: Higher Volume Associated with Better TAVR Outcomes
Recent updates from the Centers for Medicare & Medicaid Services (CMS) maintain the volume requirements of the transcatheter aortic-valve replacement (TAVR) programs to qualify for reimbursement. In corroborate with the CMS updates, the latest data from the Society of Thoracic Surgeons/American College of Cardiology (STS/ACC) Transcatheter Valve Therapy (TVT) Registry by Dr. Sreekanth Vemulapalli et al., published in the New England Journal of Medicine, revealed lower 30-day mortality at hospitals with a high procedural volume.
MR-INFORM: Myocardial Perfusion Based Strategy to Determine Need for Revascularization Shown to be Non-Inferior to Invasive Angiography in Reducing the Occurrence of Major Adverse Cardiovascular Events in Patients with Stable Angina
A trial led by Dr. Eike Nagel published in the New England Journal of Medicine showed that among patients with stable angina and risk factors for coronary artery disease, a myocardial-perfusion cardiovascular MRI based strategy to determine eligibility for revascularization was associated with a lower incidence of coronary revascularization than invasive angiography with fractional flow reserve (FFR) and was non-inferior to FFR in terms of the occurrence of major adverse cardiovascular outcomes.
LRT Trial: Transcatheter Aortic Valve Replacement In Low Risk Patients with Symptomatic Severe Aortic Stenosis Appears To Be Safe At 1 Year
A study led by Dr. Ronald Waksman showed that in low-risk patients with symptomatic severe aortic stenosis, transcatheter aortic valve replacement (TAVR) appears to be safe at 1 year. This study, which was published in JACC Cardiovascular Interventions, provides evidence to support the use of TAVR in low-risk patients.
BIO-RESORT TRIAL: Lower Stent Strut Thickness Associated with Lower Rates of Repeat Revascularization
A prespecified analysis of the BIO-RESORT trial demonstrated that patients stent in small coronary vessels were less likely to need repeat revascularization if ultrathin-strut sirolimus-eluting stents were used as compared to the previous generation thin strut zotarolimus-eluting stent. Dr. Rosaly Buiten, the lead authors of this study published in JAMA cardiology, highlights the need to further evaluate the potential benefit of thin stent struts.
REVELATION: Drug-Coated Balloon Is Non-Inferior to Drug-Eluting Stent in Terms of Functional Outcome by 9 Months In Patients with STEMI
A randomized controlled trial led by Dr. Nicola Vos published in JACC: Cardiovascular Interventions showed that a treatment strategy involving the use of a drug-coated balloon (DCB) was non-inferior to drug-eluting stents (DES) for patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI). The data here suggest that using DCB could be both safe and feasible.
New Study Involving 95,000 Stents Shows Outcomes of Bioabsorbable Polymer Drug-Eluting Stents Not Better than Permanent Drug-Eluting Stents in Reducing Stent Thrombosis and Restenosis
In a study published in the European Heart Journal, Dr. Sergio Buccheri showed that patients with bioabsorbable polymer drug-eluting stents (BP-DES) did not have a better outcome when compared to patients who receive permanent polymers (PP-DES) during percutaneous coronary intervention (PCI).
COAPT Trial: Transcatheter Mitral Valve Repair Leads to Early and Sustained Health Improvements in Patients with Secondary Mitral Regurgitation
A study led by Dr. Suzanne Arnold published in the Journal of American College of Cardiology showed that in patients with heart failure secondary to mitral regurgitation, transcatheter mitral valve repair resulted in early and sustained health status improvement compared with medical therapy alone.
PARTNER 3 Trial: Lower Risk of Death, Stroke and Rehospitalization in Patients with Severe Aortic Stenosis and Low Surgical Risk Treated with TAVR
A randomized controlled trial led by Dr. M.J. Mack, published in the New England Journal of Medicine, showed that in patients with severe aortic stenosis and a low surgical risk, treatment with transcatheter aortic valve replacement (TAVR) with a balloon expandable valve was associated with a lower risk of stroke, death or rehospitalization by 1 year when compared to surgery.
VANISH Trial: 3 Year Follow Up Data Shows No Difference in Myocardial Blood Perfusion With Bioresorbable Stents Compared to Drug-Eluting Stents After Sympathetic Stimulation
A clinical trial led by Dr. Wijnand J. Stuijfzand published in JACC Cardiovascular Interventions showed that when compared to drug-eluting stents, bioresorbable everolimus-eluting stents (BVS) did not lead to improved myocardial blood flow after sympathetic stimulation.
