Several studies (some of them recent, some of them not so much so) have compared left main coronary artery angioplasty and myocardial revascularization surgery. Combined, these works compose a large corpus of evidence, but follow-up has not gone beyond 5 years in any case. The main aim of this study (presented at TCT 2018 and published simultaneously…
TCT 2018 | BIONYX: Durable Polymer-Coated vs. Ultrathin-Strut, Bioresorbable Polymer-Coated DES
This work, presented at TCT 2018 and published simultaneously in The Lancet, is the first randomized study comparing a zotarolimus-eluting stent with a new thin-strut structure and limited radiographic visibility (Onyx), and a bioresorbable polymer-coated sirolimus-eluting stent (Orsiro). Onyx was developed to improve visibility while reducing strut thickness. To that end, a dense platinum–iridium core and…
TCT 2018 | RESET: Everolimus DES vs. Sirolimus First Generation DES at Long Term
This study had published thrombosis and revascularization rates at one year after stenting, but today one year seems rather short, which is why this cohort was followed up for 5 to 7 years more, to be able to properly assess the differences between first and second generation DES. There were no significant differences a t…
TCT 2018 | ULTIMATE: IVUS Guided DES Implantation for All Vessels, for All Lesions
Intravascular Ultrasound (IVUS) guided drug eluting stent (DES) implantation is associated with less adverse events compared against angiography guided stenting. This is especially clear for certain populations (with left main PCI as paradigmatic) but not so clear when dealing with all comers. 1448 all comer patients requiring DES stenting were randomized 1:1 to IVUS guided…
TCT 2018 | SYNTAXES: 10 Year Follow Up is ‘Trendy’
The SYNTAX trial had a 5-year follow-up, but the SYNTAXES (“ES” for extended survival) was specifically designed to find out comparative mortality of both treatments (PCI or surgery) at 10 years in patients with three vessel and/or left main lesions. This study retrospectively compared survival data at long term of 897 patients randomized to surgery…
TCT 2018 | PREPARE-CALC: Rotational Atherectomy vs. Cutting Balloon in Calcified Lesions
Compared against conventional predilation with balloon, rotational atherectomy is associated with higher procedural success rate in severely classified lesions. Balloons capable of modifying plaque such as the Flextome Cutting Balloon or the AngioSculpt Scoring Balloon -among others- could reach similar results to that of rotational atherectomy, though this has not been tested so far. 200…
TCT 2018 | TALENT: Ultrathin Struts and Bioresorbable Polymer at the Lowest Possible Cost
This study assessed the Ultra-thin Strut Bioresorbable Polymer-based Coronary DES (Supraflex) against the Xience, with special emphasis in the cost-benefit ratio. It included a population of 1435 all-comers from 23 centers in 7 European countries, randomized 1:1 (720 Supraflex and 715 Xience). Primary end point was a composite of cardiac death, target vessel myocardial…
TCT 2018 | SORT OUT IX: Polymer-Free DES with Ultra-Thin Struts vs. Bioresorbable Polymer- Based DES
Polymer persistence in 1st and 2nd generation DES meant to allow drug release has been associated with a chronic inflammatory response that might be associated to restenosis, neo atherosclerosis and stent thrombosis. This is the rationale behind the development of polymer free and bioresorbable polymer-based DES. They have both been compared against permanent polymer DES,…
TCT 2018 | LEADERS FREE II: Polymer-Free DES in Patients at High Risk for Bleeding with 1 Month of Antiplatelet Therapy
This study was aimed at gaining device registration from the US Food and Drug Administration (FDA) for a polymer-free biolimus A9 drug-coated stent (BioFreedom, Biosensors). The study had two purposes: on the one hand, it meant to reproduce the results of the LEADERS FREE trial (published in 2015) in terms of safety and efficacy with…
High-Sensitivity Troponins Turned All Events into Infarctions; the 4th Universal Definition Clarifies Things
Myocardial infarction or myocardial injury? The Fourth Universal Definition of Myocardial Infarction (an update of the 2012 version) is here to clarify that not all cases of elevated cardiac troponin values are acute myocardial infarctions. This document was presented a few days ago at the European Society of Cardiology (ESC) Congress in Munich and simultaneously…
Direct Stenting vs. Conventional Angioplasty and Their Interaction with Thrombus Aspiration
The rates of direct stenting are higher among patients randomized to thrombus aspiration. The rates of clinical events and myocardial reperfusion did not differ significantly between a direct stenting strategy vs. predilation and stenting, and no interaction was observed as regards thrombus aspiration. Several preliminary studies have emerged from the hypothesis that a direct stenting…