TCT 2009 - San Francisco, CA

Heartwire

Interventional/Surgery
Kissing-balloon dilatation of side branch not needed with one-stent bifurcation approach
Sep 29, 2009 16:15 EDT
With the one-stent technique for the treatment of bifurcation lesions, the use of routine kissing-balloon dilatation of the side branch does not improve six-month clinical outcomes.
BCIS-1 trial:
Interventional/Surgery
BCIS-1 trial: "Bailout" intra-aortic balloon pump beats elective use in low EF/high-risk patients
1 COMMENT - Sep 29, 2009 10:45 EDT
The study provides an important answer to a question that has divided some interventionalists. Those who "swear" by IABP use for all high-risk, low-EF patients should rethink their practice. In hypotensive patients and those with cardiogenic shock, IABPs play a key role.
Interventional/Surgery
FAUST: Ultrasound guidance improves femoral access in cases of high bifurcation, reduces risk of complication
3 COMMENTS - Sep 29, 2009 09:45 EDT
CORRECTED // A study has found that although ultrasound imaging doesn't seem to improve upon the overall success rate of fluoroscopy-assisted femoral-access PCI, it does seem to facilitate the procedure, reducing the risk of access complications by 59% and doubling the first-pass success rate.
Acute Coronary Syndromes
CHARISMA Genomics Substudy links loss-of-function allele and bleeding
Sep 28, 2009 14:15 EDT
Patients who are homozygous for the CYP2C19*2 allele are at increased risk of ischemia but less likely to bleed. Routine genotyping for the variant still isn't recommended.
Interventional/Surgery
Reduced bleeding and comparable stent thrombosis with DES and bare-metal stents: HORIZONS-AMI at two years
1 COMMENT - Sep 25, 2009 17:55 EDT
Two-year data showed significant reductions in bleeding and cardiac mortality in patients treated with bivalirudin when compared with those treated with heparin plus a GP IIb/IIIa inhibitor. In the stent arm of the trial, researchers showed that stent thrombosis rates were equivalent between DES and bare-metal stents, although both rates were high, at 4.1%.
PLATO-Invasive: Impressive ticagrelor results mirror overall trial findings
Interventional/Surgery
PLATO-Invasive: Impressive ticagrelor results mirror overall trial findings
7 COMMENTS - Sep 25, 2009 17:30 EDT
The prespecified subset analysis helps clarify the performance of the drug in patients managed invasively, including adding new insights into its benefits over both the 300-mg and 600-mg loading doses of clopidogrel.
PROSPECT: Vulnerable lesions lead to unstable angina rather than MI or death
Interventional/Surgery
PROSPECT: Vulnerable lesions lead to unstable angina rather than MI or death
4 COMMENTS - Sep 25, 2009 14:15 EDT
After successful PCI, 20% of patients go on to have a MACE at three years and 12% of patients develop events from nonculprit lesions. PROSPECT investigators say, however, that events from these nonculprit lesions are more likely to be unstable angina or progressive angina, rather than harder events such as MI or cardiac death.
Interventional/Surgery
COMPARE: "Real-world" randomized trial favors Xience V over Taxus Liberté
3 COMMENTS - Sep 25, 2009 08:30 EDT
COMPARE is the second of two large randomized controlled trials comparing a Taxus stent with Xience V to show a clear benefit of the newer stent.
Interventional/Surgery
Doubling dose of clopidogrel benefits STEMI patients without risk of bleeding
2 COMMENTS - Sep 24, 2009 17:45 EDT
Doubling the dose of clopidogrel reduced the risk of MI and stent thrombosis in STEMI patients without increasing the risk of bleeding. The benefit extended to patients who received a bare-metal stent or a drug-eluting stent.
COGENT: No CV events but significant GI benefits of PPI omeprazole
Clinical cardiology
COGENT: No CV events but significant GI benefits of PPI omeprazole
14 COMMENTS - Sep 24, 2009 16:30 EDT
The randomized controlled trial results should put a stop to alarmist headlines about PPIs blunting efficacy of antiplatelet drugs, experts say. By withholding PPIs, physicians are doing more harm than good, the results suggest.
Interventional/Surgery
FAME lives on: FFR results durable at two years
3 COMMENTS - Sep 24, 2009 14:45 EDT
The past few cardiology meetings have included data on the FAME study, and TCT 2009 was no exception. Investigators showed that the one-year and 18-month results were durable out to two years, although some researchers would like to see the study replicated to conclusively prove the added value of fractional flow reserve testing.
Interventional/Surgery
SIRTAX LATE: No differences in MACE for first-generation stents at five years
2 COMMENTS - Sep 24, 2009 08:30 EDT
After one year, Cypher had lower rates of death, MI, or repeat PCIs than Taxus in the SIRTAX trial. But four years later, investigators say all differences between the two have disappeared, in part due to more late "catch-up" with the Cypher.
Interventional/Surgery
Stent sandwich: First-generation stents equal for Cypher in-stent restenosis
1 COMMENT - Sep 24, 2009 07:45 EDT
Late lumen loss at one year, the primary end point, was equivalent between the Cypher and Taxus stent at one year among patients with restenosis after initial treatment with the Cypher stent.
SPIRIT IV: Xience V trumps Taxus for clinically driven end points, although diabetic questions linger
Interventional/Surgery
SPIRIT IV: Xience V trumps Taxus for clinically driven end points, although diabetic questions linger
Sep 23, 2009 16:15 EDT
UPDATED // Rates of target lesion failure were significantly lower for the everolimus-eluting Xience V stent for the trial as a whole. In diabetic patients only, however, no differences were seen between the two stents.
Interventional/Surgery
Should patients go directly to a PCI-capable hospital? Two studies, different results
Sep 23, 2009 10:45 EDT
One trial showed that despite a mean treatment delay of 67 minutes, STEMI patients undergoing primary PCI taken first to an emergency department before transfer had equivalent rates of major adverse cardiac events when compared with those who presented directly to a PCI facility. A smaller study showed that taking patients directly to the cardiac center resulted in significantly better survival when compared with patients who were transported to an emergency department.
Interventional/Surgery
Changing PARTNER: Program tweaks overshadow updates from transcatheter-valve studies
Sep 23, 2009 09:15 EDT
A packed session of interventionalists eager to hear more about long-term safety and efficacy were caught off-guard by news that a new co-primary end point has been added to cohort B.
Murmurs
Senators question Dr Martin Leon's financial links to industry
5 COMMENTS - Sep 22, 2009 17:15 EDT
UPDATED // The letter, from Sens Herb Kohl and Charles Grassley, states that Leon did not fully disclose much of the money he has received from outside companies.
Should left main PCI be a class IIa indication?
Interventional/Surgery
Should left main PCI be a class IIa indication?
5 COMMENTS - Sep 22, 2009 13:15 EDT
TCT 2009 kicked off with a discussion on revascularization strategies for left main PCI. Interventionalist Dr Paul Teirstein argues the data are sufficient for left main PCI to be a class IIa indication, upgrading it from the current class III recommendation, but surgeon Dr David Taggart says that CABG is still the preferred revascularization option in the majority of left main patients.
Interventional/Surgery
Three-year SPIRIT III results show enduring edge for Xience V over Taxus
Sep 22, 2009 11:45 EDT
Three-year target vessel failure remained statistically lower for the everolimus-eluting Xience V stent (which is also marketed as the Promus) than for the paclitaxel-eluting Taxus stent.
ENDEAVOR IV: Revascularization rates similar for Endeavor and Taxus at three years, with Endeavor
Interventional/Surgery
ENDEAVOR IV: Revascularization rates similar for Endeavor and Taxus at three years, with Endeavor "pulling ahead" for safety
Sep 22, 2009 09:45 EDT
Rates of cardiac death and MI actually statistically favor the Endeavor stent at three years, new data show. Stent thrombosis occurred just once after one year for Endeavor, as compared with 11 cases after the one-year mark in the Taxus-treated patients.

Discussion and opinions