Transcatheter Cardiovascular Therapeutics Congress, September 25–29, 2019 (San Francisco, USA) TCT is the annual scientific symposium of the Cardiovascular Research Foundation (CRF) and the world’s premier educational meeting specializing in interventional cardiovascular medicine.
COAPT 3-year outcomes1: 614 patients with heart failure and secondary mitral regurgitation underwent transcatheter mitral valve repair using MitraClip®. Improvements relative to optimal medical treatment only were even greater at 3 years than after 2 years. Benefits were also seen in 58 cross-over patients previously treated with guideline-directed medical therapy only. See more from COAPT at EuroPCR 2019, ACC 2019 and NEJM 2018.
SCOPE I2 compared the ACURATE neo valve with the SAPIEN 3 valve in 739 patients with severe aortic stenosis. In this first RCT, the ACURATE device failed to meet non-inferiority for its primary composite safety and efficacy endpoint at 30 days.
The PARTNER 3 trial has previously shown clinical benefit of transcatheter atrial valve replacement (AVR) versus surgical AVR at 1 year. Patients had severe AS and low surgical risk. This new study analyzed health status data at 12 months3 and found quality of life at 1 year to be higher in TAVR patients than in surgical AVR patients.
The Mitral Valve-in-Valve4(ViV) study in real-world high-surgical-risk patients with failing mitral prosthetic valves reported on acute and long-term outcomes. Patients underwent a ViV procedure via one of two routes: transseptal (n=1,326) or transapical (n=203). The transseptal route had clear benefits for mortality, duration of procedure and hospitalization.
Percutaneous coronary intervention (PCI)
In the IDEAL-LM study5, patients with left main coronary artery disease (CAD) were given a new drug-eluting stent (DES) thought to favor shorter dual antiplatelet therapy (DAPT) duration. At 2 years, the bioabsorbable polymer DES with 4-month DAPT was non-inferior to a durable polymer DES with 12-month DAPT.
EXCEL at 5 Years6: this trial included 1,905 patients with left main CAD undergoing PCI with a DES or coronary-artery bypass grafting (CABG). The composite outcome of death, stroke or myocardial infarction (MI) at 5 years was similar for patients undergoing PCI or CABG. See more from EXCEL sub-study analysis.
A sub-study of the COMPLETE trial7 analyzed the timing of complete revascularization of non-culprit lesions after PCI. Patients had ST-segment elevation MI and multivessel disease. The positive impact on outcome was not affected by the timing of the staged procedure i.e. during either initial hospitalization or after discharge.
Meta-analysis of PCI for stable CAD8: this analysis included 5,188 patients with both CAD and aortic stenosis and found that PCI had no additional clinical advantage in terms of key clinical outcomes. The authors concluded that patients may not need to undergo PCI prior to or alongside TAVR.
The TWILIGHT trial9 assessed ticagrelor monotherapy in 7,116 patients who had undergone PCI. After 3 months’ DAPT with ticagrelor and aspirin, half the patients were switched to placebo instead of aspirin. At 12 months, ticagrelor monotherapy reduced bleeding relative to DAPT, with no increase in ischemic events.
An update from the AUGUSTUS trial10 that tested an antithrombotic regimen in 4,614 patients with AF looked at three distinct patient subgroups: patients with acute coronary syndrome (ACS) treated medically, patients with ACS undergoing PCI, and those with stable CAD undergoing elective PCI. Dual therapy with apixaban and a P2Y12 inhibitor without aspirin was equally safe and effective in these groups of patients.
Author: Sally Hill