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New Evidence, Ideas Abound at TCT 2017
The meeting offers the latest research in interventional cardiology and tackles technical and big-picture issues.
The Transcatheter Cardiovascular Therapeutics conference, being held Oct. 29 to Nov. 2 in Denver, will offer attendees the chance to hear the latest clinical research in interventional cardiology, as well as obtain the technical information they need to benefit patients.
The meeting will feature 12 Late-Breaking Clinical Trials and 16 First Report Investigations, as well as live cases, debates, town hall meetings and other educational opportunities.
“We are blessed with a very broad-based group of Late-Breaking Clinical Trials and First Report Investigations that cover the spectrum of what it means to be an interventional cardiologist,” Gregg W. Stone, MD, professor of medicine at Columbia University and director of cardiovascular research and education at the Center for Interventional Vascular Therapy at NewYork-Presbyterian Hospital/Columbia University Medical Center, told Cardiology Today’s Intervention. “We have a panoply of studies which address the multifaceted aspects of CAD and structural heart disease.”
Late-Breaking Clinical Trials
Stone, who is also co-director of medical research and education at the Cardiovascular Research Foundation, director of TCT and a member of the Cardiology Today’s Intervention Editorial Board, said several Late-Breaking Clinical Trials should have “a major impact on clinical practice and/or areas for investigation.”
He said the CULPRIT-SHOCK trial, the largest randomized trial of patients with cardiogenic shock randomly assigned to complete revascularization vs. culprit-only revascularization, “will have a major influence on how we view patients with cardiogenic shock, who have very poor prognosis even with PCI.”
Two late-breakers should “further affect our approach to the patient with left main CAD,” Stone said. EXCEL QOL is comparing quality of life in patients from the EXCEL trial of PCI vs. CABG in left main CAD. Attendees will also see full 3-year results from EXCEL, as every patient has now been followed up to 3 years.
The DKCRUSH-V randomized trial “is an important study because normally, the distal bifurcation of the left main is the most challenging area for interventionalists to effectively treat, and has been associated with a higher major adverse event rate compared with non-distal left main lesions,” he said. “We now have a large-scale randomized trial of provisional stenting vs. double-kissing crush stenting in the distal left main. This could affect how PCI is performed in patients with left main CAD.”
Also of note, Stone said, is a series of presentations on a bioresorbable vascular scaffold (Absorb, Abbott Vascular) vs. an everolimus-eluting metallic stent (Xience, Abbott Vascular), “which are still very important and relevant even though Abbott Vascular has [announced] that they are stopping commercialization of BVS,” Stone said. These include the 3-year results from ABSORB III and the 4-year results from ABSORB II, which could provide insight into any benefits with the technology after the bioresorption process is completed at 3 years, and 30-day results of ABSORB IV, the largest randomized trial of the technology, in which investigators “screened out patients that had very small vessels” and “more strongly recommended routine aggressive pre- and post-dilatation” in an effort to reduce early stent thrombosis, which was elevated in the BVS arm in earlier trials.
Attendees will also learn about the cost-effectiveness of transcatheter aortic valve replacement vs. surgical AVR in intermediate-risk patients from two trials, PARTNER 2A and SAPIEN 3, he said.
Five-year data from PREVAIL will shed light on the effectiveness of left atrial appendage closure (Watchman, Boston Scientific) vs. warfarin in patients with nonvalvular atrial fibrillation at risk for stroke. The presentation “will give a long-term perspective about this important question,” Stone said.
Focus on Access, Inclusion
Attendees will also come away with insights on “diversity, community and inclusiveness,” because sessions “will be discussing issues that either limit health care to certain demographic groups on a geographic or other basis or limit opportunities for certain groups to participate in the subspecialties of cardiology and interventional cardiology,” Stone said.
These themes will surface “in the main arena, in dedicated sessions, in the FDA Town Hall meetings, and even in the corridors,” he said.
Also of note, the 40th anniversary of PCI and the 15th anniversary of TAVR will be celebrated with a special exhibit and a discussion in the main arena at the meeting.
“We believe that attendees will learn and be exposed to the newest ways to most safely, effectively and intelligently approach patients with coronary, vascular and structural heart disease from both an evidence-based and a technique/experiential point of view,” Stone said. “That’s what makes TCT unique.”
Disclosure: Stone reports he has financial ties with various pharmaceutical and device companies. He is co-director of medical research and education at the Cardiovascular Research Foundation.