TCT.16 Preview: Program Directors Expect Answers About PCI vs. CABG for Treating Left Main CAD

In the months leading up to TCT.16, two of the conference’s directors, Gregg Stone, MD, and Ajay Kirtane, MD, SM, predicted clinical and programmatic highlights.

With TCT.16 coming, what excites you about the meeting? 

Stone: I get excited about TCT every year. It’s really the interventional cardiology’s one opportunity to gather all of the stakeholders from around the world: interventionalists, surgeons, general cardiologists, primary researchers, media, regulators, innovators. The list goes on and includes everyone who cares about interventional cardiology and vascular medicine. We put it all on the table and bring everybody up to date on where we are with managing complex patients with cardiovascular disorders.

Are you expecting practice-changing data?

Stone: Over the last 12 months, there has been tremendous progress made in the treatment of coronary artery disease, vascular heart disease and peripheral vascular disease and in structural heart interventions. Much of it is iterative, but some of it will be ground breaking, as will be reflected in the late-breaking trials. We are looking forward to late-breaking trials on left main PCI vs. CABG that will have the potential to define the contemporary management of patients with unprotected left main disease.

Those would be the NOBLE and EXCEL trials?

Kirtane: Yes. Left main disease is likely to be an important theme this year. I’m excited about it personally.

Stone: It’s also an exciting time for structural interventions in general. We expect new data on TAVR [transcatheter aortic valve replacement], including the leading devices, in terms of outcomes, quality of life and cost effectiveness. Mitral therapies are really exploding and will be in full force. Of course, the MitraClip, which has now been used in more than 30,000 patients, but also a whole host of new devices. Five devices in total have received CE mark, and several pivotal U.S. trials are likely to start this year. With the FDA Advisory Board panel’s vote this year for CTO closure in patients with iatrogenic stroke, there will be hot discussion about its use. 

Kirtane: Structural heart disease has been a major theme for the past three years. I expect that will continue, but I also anticipate renewed interest in the coronary space, building on the [Cardiovascular Research Foundation’s] CHIP [complex high-ris and indicated PCI] initiative and the growth of CTO [chronic total occlusion] procedures.

Stone: TCT.16 will be content-rich as well as reflective of what can be accomplished right now in interventional cardiology and less invasive surgery, with cases representing both. 

The program indicates live cases from 20 sites?

Kirtane: Right. The live cases will be great, showing a combination of coronary, structural and some endovascular content. Because of our many collaborations with colleagues abroad, we’ll be able to share some of the things they can do with new innovations and new devices. It will provide a preview of clinical cases and strategies we might not see here initially in the U.S.

Will FDA Commissioner Robert Califf, MD, participate in this year’s Town Hall session?

Stone: We’re working with the FDA on this year’s session and do expect the commissioner to speak in the TCT main arena. Being a cardiologist, he obviously offers invaluable perspectives not only for the future of drug and device regulation in our country but also how to work closely with the FDA to improve outcomes for patients with cardiology disorders.

TCT.16 will convene in Washington, D.C., Oct. 29-Nov. 2, just days before the country will elect a new president. Will the program include discussion about health policy issues?

Stone: It’s inevitable that the upcoming election will infuse itself into TCT. We always have discussion about the administration of healthcare, cost effectiveness, how different healthcare systems are doing, not only in the United States but also from Europe, Asia, South America and so on, reflecting that TCT is a global meeting where approximately 70 percent of physician attendees come from outside the United States. That being said, with the election I’m sure there will be a lot of discussion about the effect that an administration run by Hillary Clinton or Donald Trump would have on the delivery of healthcare in the United States.

How will the new Virtual TCT program work?

Stone: That’s a major innovation this year that we hope will advance medical education. Our specialty has grown so much that TCT could be a 14 days long. Most people can’t take two weeks out of their practice, and even the current five-day meeting is a stretch for some attendees. We want to provide a year-round learning opportunity. So, with Virtual TCT, some of the sessions will be taped at TCT without an audience. The speakers and moderators will film the whole session, which will then be rolled out in the weeks after the meeting, each with a live moderator who will take questions from the viewing audience. All of this will be archived for long-term learning.