EuroPCR 2019: What you need to know

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May 21, 2019 – May 24, 2019 (Paris, France)

Percutaneous coronary interventions

BIO-RESORT trial¹: Among a total of 1506 patients with small vessel disease, patients receiving ultrathin-strut sirolimus-eluting stents were less likely to undergo repeat revascularization within 3 years, as compared to those who received earlier generation thin-strut zotarolimus-eluting devices.

REVELATION trial²: In 120 STEMI patients undergoing primary PCI, drug-coated balloon (DCB) was shown to be a safe therapeutic strategy and to be non-inferior to drug-eluting stent (DES) treatment with respect to FFR values at 9 months.

An angiographic substudy of the BASKET-SMALL 2 trial³ showed that in patients with small-vessel coronary disease, a DCB (n = 47) strategy was safe and comparable to DES (n = 64) at up to 1-year follow-up, with no complete thrombotic vessel occlusion occurring in the DCB group versus 8 events occurring in the DES group.

TARGET All Comers trial⁴: In 1653 coronary artery disease patients randomized to revascularization treatment with Firehawk, a biodegradable-polymer sirolimus-eluting stent, and XIENCE 2, a durable-polymer everolimus-eluting stent, comparable target lesion failure rates (a composite of cardiac death, target-vessel myocardial infarction and ischemia-driven target lesion revascularization) were obtained at 2-years follow-up.

A substudy of the GLOBAL LEADERS trial⁵ showed that in 4570 patients undergoing complex PCI, long-term ticagrelor monotherapy following one-month dual antiplatelet therapy (DAPT) reduced the risk of bleeding without an increase in ischemic events at 2-years as compared to standard DAPT.

Heart valve replacement and repair

TRILUMINATE trial⁶: In 85 patients with moderate or greater tricuspid regurgitation, transcatheter edge-to-edge tricuspid valve repair with a clip device improved regurgitation by at least one grade in 86.6% of patients at 30 days, with associated significant improvements in patients’ quality of life.

A meta-analysis⁷ including a total of 8020 low-risk patients with severe aortic stenosis randomized to transcatheter (TAVR) or surgical (SAVR) aortic valve replacement showed a reduction in all-cause mortality and stroke in the TAVR group up to 2 years after treatment, regardless of the type of valve used and of baseline surgical risk.

Five-year results of the CHOICE trial⁸ (n = 241 patients) comparing the performance of balloon-expandable and self-expandable aortic valve prosthesis implanted via transcatheter procedures (TAVI) have shown similar rates of mortality, stroke and re-hospitalization for the two groups. However, with the self-expandable device, forward flow hemodynamic parameters were superior at all time points and especially at 5 years, as compared to the balloon-expandable device.

A new COAPT trial substudy⁹ has shown that in 614 patients a lower degree of residual mitral regurgitation at 30-days (2+ or less), was associated with lower rates of all-cause mortality and heart failure hospitalization, along with improved quality of life at 2-years follow-up, regardless of the treatment received. Of note, mitral regurgitation reduction achieved at 30-days was significantly more durable when treatment consisted of MitraClip as compared to medical therapy alone.

Intracoronary imaging

A new expert consensus on the use of intracoronary imaging¹⁰ has been released in order to support a larger use of intracoronary imaging and provide recommendations in the setting of acute coronary syndromes, for guiding interventional decision-making based on plaque characteristics and in cases when angiographic results are ambiguous.

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