February 2023 | Issue 68
Featured in this issue:
www.cardiovascularnews.com
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Judith Hochman: ISCHEMIAEXTEND
Profile:
Ourania Preventza Multidisciplinary teams are the future of aortic care
Nieves Gonzalo
page 18
page 12
Tricuspid valve intervention and intravascular imaging studies among “trials to watch” in 2023
STS 2023
Jim Lennon
Medicare study reopens guideline debate around surgery and PCI in patients with multivessel coronary artery disease
An analysis of Medicare claims data from more than 100,000 patients with multivessel coronary artery disease undergoing coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) has reopened debate on controversial guidelines concerning coronary revascularisation.
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nalysis findings, involving data from the US Centers conservative approach in patients with stable coronary for Medicare and Medicaid Services, were presented artery disease. However, STS claims that the majority of by cardiac surgeon J Hunter Mehaffey (West Virginia patients in the ISCHEMIA trial were not representative of University, Morgantown, USA) at the 59th annual meeting US patients undergoing CABG, and therefore the study of The Society of Thoracic Surgeons (STS 2023; 21–23 did not fully represent the comparative benefits for patients January, San Diego, USA). who had multiple blockages in their coronary arteries. The research was instigated following the publication The latest analysis, which was performed by a team of of guidelines from the American College of Cardiology (ACC), the American Heart Association (AHA) and the Society for Cardiovascular Angiography and Interventions (SCAI) in December 2021, which downgraded the indications for CABG from a class 1 recommendation to a class 2B in three-vessel coronary disease, a recommendation that left the cardiothoracic surgery world “shocked”, according to Mehaffey. In a press release promoting the findings of the study, the STS—which pointedly declined to endorse the guidelines upon their publication in 2021—said that the guidelines rely heavily on data from the ISCHEMIA trial, ai16690416847_CX 2023 Ad Inhouse-225x54.pdf 1 21/11/2022 14:41:24 which compared an initial invasive approach versus a Continued on page 2
CABG was associated with significantly improved longitudinal survival, with a nearly 60% reduction in all-cause mortality”
TRIALS IN CORONARY IMAGING, transcatheter tricuspid valve interventions, transcatheter aortic valve implantation (TAVI) in small annuli, and further insights from the REVIVED-BCIS2 study are among the top trailed research coming in 2023 in the interventional cardiology space. This is according to Mirvat Alasnag (King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia) and Roxana Mehran (Mount Sinai Hospital, New York, USA), who spoke to Cardiovascular News about the trials they are expecting to have the most impact throughout the year. Of the major cardiovascular society meetings coming up in 2023, the American College of Cardiology (ACC) annual meeting (4–6 March, New Orleans, USA) is the first out of the gate, with a programme that features several latebreaking trials namechecked by both Mehran and Alasnag. Mehran highlights the release of results from the TRILUMINATE pivotal trial, the first major randomised trial evaluating the safety and efficacy of transcatheter tricuspid valve edgeto-edge repair (TEER) for severe tricuspid regurgitation (TR) as one to watch at the meeting. Trials in tricuspid interventions are of “pivotal” importance, Mehran comments, after significant previous focus has been placed on the aortic and mitral valves in the past. “New technologies are emerging that could take care of tricuspid valve regurgitation”, Mehran observed of the field in general. TRILUMINATE is exploring the use of the Triclip (Abbott) system in patients in North America and Canada, and Mehran commented Continued on page 4
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