The 22nd Transcatheter Cardiovascular Therapeutics, or TCT, Annual Scientific Symposium was held from September 21 to 25 in Washington, DC, showcasing the latest advances in current therapies and clinical research in interventional cardiovascular medicine. The features below highlight just some of the studies that emerged from the symposium.
Transcatheter Valves for Aortic Stenosis
The Particulars: Patients with severe aortic stenosis and coexisting conditions are not candidates for surgical replacement of the aortic valve. The Placement of AoRTic TraNscathetER Valve Trial (PARTNER) was a randomized controlled trial that compared transcatheter aortic-valve implantation (TAVI) with standard therapy in people with severe aortic disease who were unable to undergo surgery.
Data Breakdown: At 1 year in the PARTNER study, the rate of death from any cause was significantly lower with TAVI when compared with standard therapy (30.7% vs 50.7%, respectively). The rate of the composite endpoint of death from any cause or repeat hospitalization was also significantly lower with TAVI when compared with standard therapy (42.5% vs 71.6%, comparatively). Among survivors at 1 year, the rate of cardiac symptoms was lower among patients who had undergone TAVI than among those who had received standard therapy.
Take Home Pearls: Patients with severe aortic stenosis who are not suitable candidates for surgery appear to benefit significantly from TAVI. The procedure reduces the rates of death from any cause, death from any cause or repeat hospitalization, and cardiac symptoms.
Robotically-Assisted PCI Safe & Feasible
The Particulars: Concerns of interventional cardiology include occupational injuries for clinicians, including sore backs, shoulders, hips and knees, as well as cumulative risks of long-term radiation exposure. A robotically-assisted PCI (CorPath 200, Corindus) was created to optimize angioplasty procedures and decrease risks to operators and other personnel.
Data Breakdown: Investigators tested a robotic remote-control system that consisted of an articulating robotic arm attached to the cath-lab patient table. The operator is located within a “shielded interventional cockpit,” from which the PCI device can be manipulated. The feasibility of robotically-assisted PCI in eight stable patients undergoing PCI for ischemia was evaluated. Performance success was high, with operators successfully placing a balloon or stent in the target lesion in all patients. The device was safely extracted without any adverse events, and procedure times were similar to standard PCI. Importantly, operator exposure to radiation was 97% lower than conventional PCI when compared with historical controls. Average contrast use was also lower.
Take Home Pearl: A robotically-assisted PCI system appears to be technically feasible and significantly reduces operator exposure to radiation.
Cost Savings Observed With Sirolimus-Eluting Stent
The Particulars: Patients with diabetes are a population that is considered at increased risk of requiring repeat coronary procedures. This patient group also poses a significant cost burden to the healthcare system.
Data Breakdown: The rates of target lesion revascularization (TLR) at 1 year were analyzed among 4,853 patients with diabetes. The use of sirolimus-eluting coronary stent (Cypher, Cordis Corporation) led to a highly significant 54% relative risk reduction in the rate of 1-year TLR (3.2%) when compared with paclitaxel-eluting stents (6.9%). The use of either everolimus-eluting or zotarolimus-eluting stents was not associated with a significant relative risk reduction in 1-year TLR when compared with paclitaxel-eluting stents. The cost reduction per diabetic patient treated with the sirolimus-eluting coronary stent would range between $733 and $937.
Take Home Pearl: Using a sirolimus-eluting coronary stent in patients with diabetes appears to result in substantial cost savings when compared with the use of everolimus-eluting, paclitaxel-eluting, or zotarolimus-eluting stents.