EuroPCR 2017: Fresh data on OCT management, FFR guidance and bioresorbable stents
Participants saw exciting results from a number of late-breaking trials during EuroPCR 2017, focusing on such topics as chronic total occlusions (CTO), neurological outcomes following TAVI in intermediate-risk patients, and bioresorbable vs. bare metal stents.
Gerald Werner presented the results of a randomised, multicentre trial to evaluate the utilisation of revascularisation or optimal medical therapy for the treatment of chronic total coronary occlusions (EuroCTO).
“This is the first randomised trial to compare the effects of percutaneous coronary intervention (PCI) vs. optimal medical therapy (OMT) on 12-month health status,” G. Werner told participants. “It is not on prognosis. It is on actual, clinical symptoms as self-assessed by the patients with a CTO.” Safety, he explained, will be assessed at three years’ follow-up.
The results of the trial demonstrated better results for PCI than OMT in terms of angina frequency, physical limitations and quality of life. However, problems with enrolment weaken the strength of the data. “This trial gives some evidence, even though we did not reach p<0.001,” said G. Werner. “It still shows that PCI of a CTO should be considered in these patients as a primary option. It is safe and effective in expert hands.”
A cost-analysis of fractional flow reserve (FFR)-guided revascularisation during primary angioplasty was presented by Elmir Omerovic, whose team found that “complete revascularisation in ST-elevation myocardial infarction PCI procedures with FFR guidance can result in lower cost for society in most countries.”
A. Pieter Kappetein presented an analysis of data from the SURTAVI (Surgical or transcatheter aortic valve replacement [TAVI] in intermediate-risk patients) trial comparing outcomes following TAVI using Medtronic’s CoreValve or Evolut R bioprostheses with surgical aortic valve replacement (SAVR). “The SURTAVI trial showed that TAVI with a self-expandable valve was non-inferior to surgical aortic valve replacement,” A.P. Kappetein explained. “But, as TAVI continues to be evaluated in other patient populations, it is also important to be able to look at other endpoints…especially when you move towards lower risk patients, you want to know what the stroke rate is, and how that affects quality of life.”
The data revealed that the incidence of early stroke (within 30 days) was significantly lower in TAVI patients than in SAVR patients. “This is the first time we have shown this,” A.P. Kappetein said. “Early stroke patients experience longer intensive care unit times, more days in hospital, and were more frequently discharged to an alternative care facility and not discharged home.”
The results also showed TAVI patients to recover faster than SAVR patients, whether they experienced stroke or not.Other results were less divided. “All-cause mortality at one year was similar for TAVI and SAVR for patients with stroke or encephalopathy at 30 days,” A.P. Kappetein explained. “There were no differences in early stroke rates among TAVI patients and SAVR patients for select subgroups.”
Joanna Wykrzykowska revealed data from the Amsterdam investigator-initiated Absorb strategy all-comers (AIDA) trial, the first randomised trial in a patient population reflecting routine clinical practice. Her team compared the Absorb bioresorbable vascular scaffold system and the Xience everolimus eluting coronary stent system (both Abbott). Their results demonstrated a significant difference in thrombosis throughout two years, with “a more than three-fold higher rate of device thrombosis” observed in patients treated with Absorb. Discussants were surprised that post-hoc analysis by procedural technique and vessel size was not associated with differences in event rates. Of note the target vessel failure rates at two years were low in both groups and not significantly different (11.7% with Xience vs. 10.7% with Absorb, p=0.43).