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VIDEO: Roxana Mehran, MD, highlights four important trials presented at AHA

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NEW ORLEANS — In this video exclusive, Roxana Mehran, MD, associate medical editor of Cardiology Today's Intervention, provides perspective on the PIONEER AF-PCI, FUTURE, ART and GARY trials, which were presented at the American Heart Association Scientific Sessions.

“This has been a great meeting for amazing trials and, for me as an interventionalist, specifically, interventional cardiology trials,” Mehran, professor of medicine at the Icahn School of Medicine at Mount Sinai, said.

PIONEER AF-PCI, which evaluated patients with atrial fibrillation undergoing PCI who received rivaroxaban-based strategies (Xarelto, Janssen) and demonstrated reduced bleeding vs. warfarin, suggests “a new way to deal with patients with AF undergoing PCI with a novel anticoagulant,” she said.

The FUTURE trial looked at the impact of therapeutic management guided by fractional flow reserve or conventional angiography. “Unfortunately, [the investigators] stopped the trial about 900 patients into the study ... due to increased mortality. When [the investigators] presented the trial, there was no increased mortality; that didn’t reach statistical significance. So, unfortunately, we [don’t] know whether angiography-guided vs. FFR-guided [PCI] is any different. ... I still believe that FFR-guided PCI is the right way to assess lesions when you’re not sure of the significant narrowing of that lesion,” Mehran said.

In the ART trial, patients with symptomatic multivessel CAD undergoing CABG received single or bilateral internal-thoracic-artery grafting.

“You would imagine that you’re going to do a lot better with total arterial revascularization [but] that was not the case,” she said.

Finally, new data from the GERMANY study of the GARY registry provided insight on patients who underwent transcatheter aortic valve replacement or surgical AVR, and showed higher mortality with TAVR at 1 year. Mehran encouraged physicians to take these results “with a grain of salt.” She added, “I would still say that the randomized trials stand — that TAVR is really the future of AVR.”