Top 10 interventional cardiology stories in 2014

The past year has been one of major developments in the field of interventional cardiology, with hot topics including FDA device approvals and key outcomes from various clinical trials.

The following are the 10 most popular articles on Healio.com/Intervention during 2014:

1. Brain, neck tumors reported in 3 dozen cath lab operators

Ariel Roguin

New findings presented at the SOLACI-CACI 2014 annual meeting corroborated previously observed associations between development of brain and neck tumors and working in a cath lab. While protective equipment is currently available for the trunk, thyroid and eyes of cath lab operators during interventional procedures, the head and neck region remains exposed to radiation. The new data, which reported development of brain and neck tumors among 36 interventional cardiologists, electrophysiologists and interventional radiologists, were presented by Ariel Roguin, MD, PhD, of the Rambam Medical Center and the Technion, Haifa, Israel. Read more

2. SYMPLICITY HTN-3 fails to meet primary efficacy endpoint

In what was for many an unexpected outcome, the highly anticipated results from the SYMPLICITY HTN-3 trial, which evaluated the Symplicity renal denervation system (Medtronic) in patients with treatment-resistant hypertension, did not achieve the primary efficacy endpoint of change in office systolic BP at 6 months. However, the study did achieve its primary safety endpoint.

Krishna J. Rocha-Sing

“In time, I think, we will look back upon the SYMPLICITY HTN-3 trial as another example of failing forward: The trial may have failed, but as we learn from this, we will move the field forward,” Krishna J. Rocha-Sing, MD, FACC, FAHA, of the Prairie Vascular Institute at St. John’s Hospital in Springfield, Ill., told Cardiology Today. Read more

3. ACC changes recommendations on complete revascularization

New data prompted the American College of Cardiology to rescind the recommendation from its Choosing Wisely campaign that caregivers and patients should consider whether complete coronary revascularization is necessary during MI. This change was the result of data from the CvLPRIT and PRAMI trials, presented at the European Society of Cardiology Congress in 2014 and 2013, respectively, which suggested that complete revascularization improved outcomes, even for major stenoses in nonculprit lesions. Read more

4. HEAT-PPCI: Heparin superior to bivalirudin in 28-day outcomes after primary PCI

This single-center study evaluated patients with STEMI undergoing primary PCI. Researchers found that heparin yielded decreased rates of MACE and stent thrombosis at 28 days compared with bivalirudin (Angiomax, The Medicines Company) in this population.

Rod Stables, MD, from Liverpool Heart and Chest Hospital in Liverpool, U.K., and colleagues randomly assigned 1,830 consecutive patients with STEMI to receive 70 U/kg body weight of heparin pre-PCI or a 0.75 mg/kg/hour bolus of bivalirudin followed by 1.75 mg/kg bivalirudin per hour for the duration of the procedure. Read more

5. ATLANTIC: Pre-hospital ticagrelor did not benefit reperfusion but had lowered stent thrombosis in STEMI

Gilles Montalescot

Results from this study, presented at the ESC Congress 2014, indicated that while pre-hospital administration of ticagrelor (Brilinta, AstraZeneca) is safe, it does not appear to improve pre-PCI coronary reperfusion among patients with acute STEMI compared with in-hospital treatment with the drug.

“[Pre-hospital ticagrelor administration] may, however, reduce the risk of stent thrombosis after PCI,” Gilles Montalescot, MD, PhD, of the Centre Hospitalier Universitaire Piitié-Salpêtrière, Paris, and Cardiology Today’s Intervention Editorial Board member, said during a press conference. Read more

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6. RESOLUTE: Low stent thrombosis rates reported with DAPT interruption

David Kandzari

Findings presented at the ACC Scientific Sessions 2014 indicated that interruption of dual antiplatelet therapy between 1 month and 1 year after PCI was associated with low rates of stent thrombosis. The pooled patient data, which were presented by David Kandzari, MD, of the Piedmont Heart Institute, Atlanta, and colleagues, were collected from eight clinical trials associated with the RESOLUTE Global Clinical Program. Read more

7. FDA approves CoreValve for patients with severe aortic stenosis

In January 2014, Medtronic announced that the FDA approved the self-expanding transcatheter CoreValve System for patients with severe aortic stenosis who are not candidates for traditional aortic valve replacement surgery. The FDA approved the device without an advisory panel review due to strong clinical outcomes from the Extreme Risk Study of the CoreValve US pivotal trial, according to a company press release. Read more

8. SCAI consensus document provides best practices for renal artery stenting

Sahlil A. Parikh

In August, the Society for Cardiovascular Angiography and Interventions published an expert consensus statement on the best practices for renal artery stenting. In the document, SCAI provided guidance for clinicians on the identification of patients who may benefit most from renal artery stenting. The five-member panel was led by Sahlil A. Parikh, MD, assistant professor of medicine at Case Western Reserve University School of Medicine and director of the Interventional Cardiology Fellowship Program at University Hospitals Case Medical Center.

In the document, the panel suggested that recent research, including the CORAL trial, failed to demonstrate that stenting of atherosclerotic renal artery stenosis improves on medical therapy. However, they also recognized the possibility that the design of CORAL and other similar trials may have excluded patients who could have benefited from the procedure. Read more

9. Hybrid coronary revascularization reduced morbidity vs. CABG

Results from a systematic review and meta-analysis supported the effectiveness of hybrid approaches to coronary revascularization. The analysis indicated that hybrid revascularization yields lower morbidity than CABG, but similar rates of death and MI. Researchers also observed an association between hybrid revascularization and a lower need for in-hospital blood transfusions, as well as a shorter length of hospital stay. Read more

10. VERIFY-2: FFR remains gold standard for determining severity of stenosis

Stuart Watkins

According to results of the VERIFY-2 study, presented at the SCAI Scientific Sessions, measurement of Pd/Pa or instantaneous wave-free ratio, whether used in binary algorithms or hybrid strategies encompassing fractional flow reserve, are not as accurate as FFR alone for ascertaining stenosis severity.

“FFR remains the gold standard,” Stuart Watkins, MD, consultant cardiologist at the Golden Jubilee National Hospital in Glasgow, Scotland, said a press release. “Although these measures aren’t accurate enough to replace FFR, this study adds to our body of knowledge as we work to identify the most effective ways to measure lesion severity.” Read more