PARIS, May 20, 2011: EuroPCR 2011 bids farewell to all 12,567 participants from the interventional cardiology community, industry partners and journalists, and thanks them for their contribution to a highly successful week, rich in educational activities, interactive discussions, information sharing and networking - fulfilling the goal of "Innovation in education at work".

Winner of the Ethica Award: Dr. Run-Lin Gao

The Board of EuroPCR bestows the Ethica award upon one remarkable individual who has significantly contributed to the field of Cardiovascular Intervention as being a teacher, a scientist, a care provider and a pioneer.
Dr. Run-Lin Gao is Professor of Medicine and Chairman of China Interventional Therapeutics. He graduated from the Beijing Medical University in 1965 and became a staff cardiologist at the Fu Wai Cardiovascular Hospital, Beijing in 1980. He obtained his Master Degree of Sciences from Peking Union Medical College in 1981. Already trained in cardiovascular laboratory procedures for congenital and valvular heart disease, he went to Loma-Linda University School of Medicine, California to train for his fellowship in coronary angiography and interventions under the tutorship of Dr. Francis Lau between 1985 and 1986. After returning to China, he began to promote the education and training of colleagues and to disseminate the use of percutaneous intervention in China. He was the first to perform emergency PTCA for acute myocardial infarction and the first to report coronary stenting and the use of drug-eluting stents in China.
He has received nine academic awards, has over 76 publications in English language journals, has more than 209 original publications and 19 editorials/reviews in peer-reviewed Chinese journals. He has taken an active role in clinical trials as a principal and co-principal investigator and in multinational studies as a regional lead investigator.
He has been described as "the father of interventional cardiology in China" and is considered not only as an excellent and compassionate practitioner but also as an enthusiastic and meticulous scientist. Our congratulations and thanks to Dr. Run-Lin Gao.

Winner of the Innovation Award: Fractional Flow Reserve-CT (HeartFlowTM)

Previous winners of this award have progressed to have a "disruptive" impact on the way cardiovascular disease is managed and the winner this year, Fractional Flow Resereve-CT (HeartFlowTM), is very likely to follow. Founded in 2007 and located in Silicon Valley, this innovative company with 40 employees has considerable experience clinically and in biomedical engineering, high-performance scientific computing and medical software.
Following the advent of fractional flow reserve (FFR) and coronary computed tomography (CT), now welcome FFR-CT, a non-invasive method of assessing of FFR. This is a marriage of the anatomical information derived from static coronary CT angiography (CCTA) and the functional information derived from FFR - but the latter no longer obtained invasively. From a CCTA investigation, the computational technology incorporates myocardial mass, aortic pressure, coronary microcirculatory resistance and the viscosity and density of blood. Underpinned by physiologic models and using proprietary algorithms, a 3D patient-specific epicardial model is
extracted from CCTA, and equations are solved to calculate blood flow, from which velocity and pressure is measured. The output is a combined functional and anatomic assessment in the form of a colour coded map able to show the location of functionally critical points.
There is a good linear relationship between invasive FFR and FFR-CT. Whilst the two techniques have similar sensitivity, the specificity and positive predictive value of FFR-CT are much better. In practice, a CCTA file will be uploaded onto a secured website, quality assessed, analysed and a report returned to the physician. The strengths of this technique far outweigh any weaknesses, being a low risk, accurate, non-invasive, lesion-specific, functional assessment of coronary artery disease severity. The better diagnostic performance compared with CCTA alone may improve patient selection for invasive evaluation.
This innovative technique was therefore chosen because it is potentially disruptive to the diagnosis and treatment of patients with stable ischemic heart disease (IHD). Pending confirmation of the early validation by the ongoing De Facto multicentre trial, it may challenge traditional non-invasive assessment of patients with stable IHD and may change the practice of invasive cardiology and cardiac surgery.

Cardiovascular interventions and intercontinental "crossfire"

A key session this year sought to highlight the contribution of the Asia-Pacific region to the present and future of the field, to comprehend worldwide variations in the delivery of life-saving PCI and to understand how the future of cardiovascular interventions worldwide will be influenced by intercontinental cross-talk.
There are important differences between East and West in the practice of PCI and CABG. Most hospitals in the Asia-Pacific region (AP) provide a full PCI service without on-site availability of CABG. When CABG is available, there is no consistency in the use of PCI and CABG. Lack of surgical expertise and resources in developing countries and a cultural aversion to invasive surgery is driving the more widespread use of PCI, yet coronary revascularisation is not available or too expensive for most patients. Mortality rates for PCI and CABG are difficult to interpret, vary considerably and databases are incomplete. Public awareness of heart disease is poorer, and there is a paucity of good quality research and training facilities. The guidelines and clinical risk scores that dictate management in the West may not be applicable in the East. For economic reasons, pharmaceutical products and medical devices (particularly stents) are often manufactured locally and often not in accordance with international standards.
Primary PCI is the ‘gold standard’ treatment for STEMI in AP, but a number of factors prevent this from being widely applicable including diversity in the availability of cathlabs and in the training of interventionists and support staff. Key to improving success and minimising delays in bringing patients to the cathlab are an understanding of geographical constraints, better organisation of cathlab teams and better public education.
The substantial differences between East and West provide the opportunity for mutual benefit. Western strengths include clinical and surgical expertise, great educational programs and courses which use live demonstrations, robust databases and clinical trials, good manufacturing practice and industrial support. Strengths in the East include bench research, large populations for clinical trials, experience in complicated and high risk interventional procedures and low manufacturing costs. If we concentrate on our relative strengths, herein lie the ingredients for synergy between the regions. Yean Leng Lim concluded, "Turn 'Cross-fire' into 'Co-evolution' of a 'Pacific PCI Community' for the East and West that will benefit ultimate patient care."
The discussion surrounding PCI or CABG from a global perspective highlighted a number of issues. The US perspective of left main treatment remains firmly in the surgical camp with evidence- and guideline-based management likely to remain strictly adhered to, particularly by low volume operators. The evidence for PCI cannot predict the course of disease beyond 2-3 years and there is concern for patients who receive PCI and then run in to trouble in the future. Hopefully sufficient "warning" signs will present, enabling appropriate further action to be taken in time. From an AP perspective, cultural preference for PCI has a profound influence on practice and is reflected in the predominance of PCI in the region. This theme recurred throughout discussions. It will require a Heart Team approach, sensitive to such cultural preferences, to help shift to a balance that delivers more patients the optimum therapy. But it is not just culture driving the diverse balance of PCI and CABG across the globe because development of CABG expertise is a universal problem due to a lack of leadership to educate and train in this specialty.
Discussion on the future of percutanous intervention on a global scale was didactic. Owing to the large populations in need, there is enormous potential for techniques such as renal denervation for hypertension and the percutaneous treatment of structural heart disease. Rheumatic heart disease is the commonest cause of acquired heart disease in children and young people in developing countries. Is it realistic to make percutaneous valve technology, which is now available for very elderly western patients, accessible to the large numbers of younger patients with rheumatic heart disease in these areas? In principle the goal must be to make the best treatments available to all, but realistically treatments such as TAVI will not reach everyone and basic preventative medicine which impacts the many is at least as important as technology reaching the few.
The issue of medical device cost, quality, intellectual property and local manufacture was considered. For innovative treatments (very costly in the West) to become more available to AP, it is likely that local innovation and economical local production will be required to minimise costs whilst ensuring international copyright law is respected. Of course this is with the caveat that the quality of devices must not compromised.
Interventionalists often rely solely on the training, techniques and strategies used in their own country or region. Martin Leon reflected that PCI could have advanced faster had there been better communication not just between ‘local’ colleagues but also between continents. With more crosstalk the pace of progress in PCI should advance more quickly. Percutaneous treatment of structural heart disease - TAVI, closure of PFO and even catheter-based treatment of congestive heart failure - is an emerging field and maybe this area can develop more quickly with better intercontinental communication. Meetings such as those under the PCR Family umbrella will play a major part in that progression.
Better eastern communications technology, a thirst for knowledge and hunger for improvement will drive intercontinental crosstalk. "We are thinking globally, YOU are acting locally", affirmed Jean Marco.

The PCR spirit continues throughout the year

PCR London Valves: 16-18 October 2011, London
GulfPCR-GIM: 15-16 December 2011, Dubai
AsiaPCR/SingLIVE: 12-14 January 2012, Singapore
... and then of course EuroPCR: 15-18 May 2012, Paris