A quarter century ago, stents were on the periphery as planners for the first Transcatheter Cardiovascular Therapeutics (TCT) conference put together their inaugural program. Now third-generation stents share the stage with transcatheter aortic valve replacement (TAVR) devices.
“Twenty-five years ago it was never envisioned that TCT would evolve as it has,” TCT co-director Gregg W. Stone, MD, told Cardiovascular Business. “It was envisioned at that time as a relatively small boutique meeting to discuss the implementation of new device angioplasty, beyond balloon angioplasty. At the first TCT, stents were mentioned as an afterthought.”
Stents have come a long way since then. This year’s TCT scientific session included a late-breaking clinical trial on third-generation devices such as the Resolute Integrity zotarolimus-eluting stents (Medtronic) and the Promus Element everolimus-eluting stents (Boston Scientific). Results from DUTCH PEERS (TWENTE II), an all-comers trial that compared the two flexible-design stents, showed they performed comparably in patients who required PCI.
Lead investigator Clemens von Birgelen, MD, PhD, explained that, as clinicians, he and his colleagues wanted to evaluate their safety and efficacy in a head-to-head comparison. When asked at a press conference if it matters, he replied, “When you are standing there in the middle of the night fighting with a right coronary artery that is tortuous and calcified, it matters.”
Results from OPTIMIZE, a noninferiority clinical trial designed to compare two different durations of aspirin plus clopidogrel (Plavix, Bristol Myers-Squibb/Sanofi Aventis), also offered physicians findings that inform practice. The study found that some patients implanted with newer generation drug-eluting stents may safely discontinue dual antiplatelet therapy at three months, good news in cases where the patient may need surgery within a year of PCI.
“We are not saying stop at three months, but if you need to do that, you can do that safely,” lead investigator Fausto Feres, MD, of the Instituto Dante Pazzanese de Cardiologia in São Paulo, Brazil, told Cardiovascular Business.
Judging by the crowded conference rooms, TAVR wins for buzz and excitement. The CoreValve (Medtronic) device received a thumbs up for safety and efficacy in the pivotal CoreValve Extreme Risk Iliofemoral study. Results were presented as a late-breaking clinical trial, and attendees flocked the follow-up events. For instance, they stood four-deep outside the doorway to listen in on the packed presentations at a special session that drilled into components such as echocardiographic results and quality of life findings.
What were your favorite presentations and which will change your practice? Please let us know.
Cardiovascular Business, editor