TCT.13: Moving from anecdotal to evidence-based medicine

Gregg W. Stone, MD, co-director of the Transcatheter Cardiovascular Therapeutics (TCT) conference, talked about the history of the 25-year-old event and new initiatives in the first part of a Q&A with Cardiovascular Business. In part two, below, he elaborates on upcoming late-breaking clinical trials and other research.

TCT.13 is scheduled to take place Oct. 27-Nov. 1 in San Francisco.

How have the late-breaking clinical trials changed over the years?

The late-breaking clinical trials have assumed increasing importance over the years along with the general recognition that evidence-based medicine is how we should make our treatment decisions.

Twenty-five years ago people were much more prone to practice anecdotal medicine.  You were only as good as your last case. If it was successful or unsuccessful would dictate how you treated your next 10 patients.

We’ve learned the fallacy of relying on anybody’s experience in terms of not being representative of outcomes even in that person’s own practice, let alone across a hospital or city or nation or world. It has really been a recognition that randomized trials sit at the pinnacle of the scientific process, and with some limitations, should guide how we practice, the types of devices we use, whether patients are treated with medications or angioplasty or surgery.

With that recognition has come the emergence and increasing importance of the late-breaking trials, which will change practice theoretically overnight; in practicality, sometimes over months or years. Certainly in all major conferences the late-breaking trials are seen as the most exciting and perhaps impactful segment of the meeting, given their ability to influence practice.

How many applications did you have for the late-breakers?

We had over 130 applications.

What is the difference between a late-breaking clinical trial and a first report investigation?

They are all really late-breaking clinical trials but the formal late-breaking clinical trials, of which there are nine, are the highest ranked trials. The first report investigations tend to be somewhat smaller or more novel devices with a more limited experience. While very important and deserving of late-breaking clinical trial status, they are not quite the same impact level as the other nine late-breaking clinical trials.

How many abstracts did the TCT receive?

I don’t recall off the top of my head but it was unprecedented. [Editor’s note: The TCT later provided those figures. There were 1,750 abstracts submitted; 851 were accepted, with 136 being oral abstracts and 715 posters.]

Is there anything you’d like to add?

There are a lot of special activities about the 25th year anniversary. We will be having special introductory opening videos looking back on 25 years of TCT. We’ll have sessions with many of the original pioneers of the subspecialty, including the original faculty from the first TCT 25 years ago. It will be a very exciting and celebratory environment while we grapple with all the complexities of modern interventional cardiology.

Dr. Stone is co-director of the division of medical research and education at the Cardiovascular Research Foundation, which organizes the TCT in partnership with the American College of Cardiology. He also is a professor at Columbia University College of Physicians and Surgeons and director of cardiovascular research and education at the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center, all in New York City.