Diamonds in the Rough
Clinical trialing has consistently provided support for the technology-driven field, to the point where interventional cardiologists “probably have more publications and more randomized trials than any other subspecialty,” according to Roxana Mehran, MD, joint chief scientific officer of the Clinical Trials Center at the Cardiovascular Research Foundation (CRF), which sponsors TCT.
A constant theme among trials at this year’s conference was dual-antiplatelet therapy—studies evaluated proper dosing, compared prasugrel to Plavix and assessed the benefit of adding another medication. In five separate clinical studies, triple-antiplatelet therapy, which adds cilostazol to the aspirin/Plavix regimen, found that it achieves greater platelet inhibition than conventional dual-antiplatelet therapy in patients undergoing PCI with drug-eluting stents (DES).
The much-anticipated HORIZONS AMI trial, which has provided the largest data-set at one-year in a comparison of stent types, found that DES in heart attack patients demonstrated significantly reduced rates of target lesion revascularization and binary angiographic restenosis compared to bare-metal stents. Another component of the study found that bivalirudin significantly lowers rates of all-cause death, death from cardiac causes, and major bleeding, compared to the standard drug therapy of heparin and glycoprotein IIb/IIIa inhibitors.
Many experts at TCT speculated that the HORIZONS AMI results will serve to continue to assuage fears of using DES, and predicted a much wider adoption rate of bivalirudin.
Reducing door-to-balloon (D2B) times continued to be a hot topic of sessions, and many TCT presenters parsed out different methods of a successful decline, including keeping personnel in the hospital 24/365. Regardless of the specific method, most presenters stressed the need for wider acceptance of a fiscally responsible, effective D2B method.
Please continue to follow our TCT coverage that will restart in Thursday’s newsletter. As Mehran suggests, being privy to the TCT sessions, is “like being a kid in a candy store. You can see it all, including things you’ve never envisioned. It’s all there.”
Justine Cadet, News Editor