ACC Preview: Regenerative medicine, robotics, game-changing trials and reform
American College of Cardiology
A telebriefing by American College of Cardiology officials emphasized several aspects of ACC.10, including thought-provoking keynote addresses, late-breaking clinical trials that could hold important significance and a potentially robust discussion of healthcare reform straight from Capitol Hill.

Meeting Chair James B. McClurken, MD, assistant director for cardiothoracic surgery at Temple University Medical School in Philadelphia, stressed the importance of the Sunday keynote lecture: “Regenerative Medicine: New Approaches to Health Care for the 21st Century” (11:00 AM -11:30 AM).

The address will be given by Anthony Atala, MD, director of the Institute for Regenerative Medicine at Wake Forest University Baptist Medical Center in Winston-Salem, N.C. Atala’s work focuses on growing new human tissues and organs to repair those that are diseased. Using cells from the patient’s own body, he has created lab-grown prototype blood vessels, bladders, wombs, muscle, and cartilage.

The Bishop Lecture on Monday (2:10 PM - 3:00 PM) will be delivered by Richard Satava, MD, a professor of surgery at the University of Washington in Seattle. Titled: “Beyond the Possible: Advanced Technologies and the Future of Healthcare,” the lecture will touch on robotic surgery, virtual reality, surgical simulation and other high-tech applications. McClurken said that there will be “some controversial topics discussed,” so stay tuned.

The session titled “Health System Reform: Where Are We Headed?” (Sunday, 12:15 PM - 1:45 PM) promises to be very enlightening. One keynote address of this ACC/i2 Joint Session will be given by Chris Jennings, a 20-year health policy veteran of the White House, Congress and the private sector. A second keynote lecture will be given by Rep. Paul D. Ryan, Jr., R-Wis. Panelists will respond to the lectures and then will open it up for audience comments and questions. “The session will prove most interesting,” McClurken intoned.

Late-breaking clinical trials

A large focus at ACC.10 will be the late-breaking clinical trials. Meeting planners selected 30 abstracts out of 108 that were submitted. McClurken said that most of the trials focused on comparative therapies, “a very important feature going forward in healthcare.”

He singled out “Effect of Genotyping Warfarin Patients on Outcomes: Results from The National Community-based Medco-Mayo Warfarin Effectiveness Study (MM-WES)” as being potentially the first genomic prediction of medication response study (Tuesday, 8:00 AM - 8:12 AM). “There has been much written about personalizing medical management and this will probably be the first trial to get answers how that can be utilized,” he said.

McClurken also highlighted EVEREST, the first transcatheter mitral valve repair trial being reported. This international multicenter study compared mitral valve surgery with the transcatheter technique. “It’s a very highly awaited trial,” he said.

A large percentage of trials being presented Sunday morning (beginning at 8:00 AM) revolve around various strategies for diabetics. The NAVIGATOR trial examined ways to reduce cardiovascular events by managing patients with diabetic issues. One arm looked at the progression of diabetic issues, while the other looked at the progression of cardiovascular issues.

The ACCORD Lipid Study looked at the effects of combination lipid therapy on cardiovascular events in diabetics, while the ACCORD Blood Pressure Trial reviewed effects of intensive blood pressure control on cardiovascular events in diabetics. The INVEST study was about rethinking lower blood pressure goals for diabetics with known coronary artery disease.

“We will find on Tuesday’s wrap up session which therapies work best to decrease the rate of disease progression in diabetics,” McClurken said.

He also pointed out the RACE II study, which compares lenient versus strict heart rate in patients with permanent atrial fibrillation.

George Dengas, MD, associate professor of medicine at Columbia University College of Physicians and Surgeons in New York and chair of the i2 Summit, which is being held jointly with ACC.10, highlighted many of the trials in session No. 3016 (Monday, 10:30 AM -12:00 PM). Two different drug-eluting stents (DES) were compared in the “all comer” SORT OUT III Trial. Another trial will report results of a comparison of a polymer-free DES versus Cypher and Endeavor, both polymer-based DES.

Investigators will report on the PERSEUS trial, which compared a new Taxus Element DES that has thinner struts with the older-generation Taxus Express stent. The CILON-T study could reveal that triple-antiplatelet therapy works well in certain patient populations.

Finally, the meeting will host two carotid artery intervention sessions, both on Tuesday. The first (10:30 AM -12:00 PM) will review several aspects of carotid disease including diagnostic options and medical therapy, predictors of outcome for asymptomatic patients, complication management and surgery versus stenting in high-risk patients.

The session will wrap up with “Lessons from CREST,” an important trial presented in February at the International Stroke Conference in San Antonio. “This will be the first cardiology meeting that CREST will be presented and discussed,” said Alfred Bove, MD, president of ACC and chief of cardiology at Temple University Hospital in Philadelphia. CREST found that stenting and endarterectomy were equally efficacious.

Later in the afternoon (12:15 PM - 1:45 PM), carotid stenting case reviews and lectures will be presented in collaboration with the Society for Vascular Medicine.