Live from TCT – September 17, 2022

Seth Bilazarian, MD, with Chuck Simonton, MD, recap highlights from day one of the 2022 Transcatheter Cardiovascular Therapeutics (TCT) conference in Boston, MA.

Late-breaking clinical trials (LBCT): Day one’s focus was structural heart disease with data presented on the SENTINEL™ cerebral protection system (Boston Scientific). While the trial examining whether cerebral embolic protection reduces stroke in patients undergoing TAVR missed its primary endpoint, there was a trend toward improvement. Another presentation demonstrated equivalence of the PASCAL repair system (Edwards Lifesciences) and MitraClip™ (Abbott) in transcatheter edge-to-edge repair (TEER).

World-renowned cardiologist Valentin Fuster, MD, PhD, received the TCT Career Achievement Award, which he adds to the highest awards for research he’s received from the AHA, the ACC and the European Society of Cardiology (ESC).

Presentation of REVIVED-BCIS2 data, which showed no significant difference between multivessel PCI and optimal medical therapy in stable patients with low ejection fraction (EF), prompted discussion on the implications for the PROTECT IV RCT. In an interview with Gregg Stone, MD, co-PI for the PROTECT IV RCT, he emphasized, “What’s really important is you’ve got to look at the patients who were enrolled in the study.” A majority of REVIVED-BCIS2 patients were stable and not experiencing angina or heart failure symptoms. “We’re doing a different study,” Dr. Stone explained. PROTECT IV is examining a large, complex patient population presenting with MI or severe HF, who require acute revascularization and have been turned down for surgery. The question being addressed in PROTECT IV is whether to revascularize these patients with standard therapy or with mechanical circulatory support and Impella CP® during the procedure. 

Live cases on day one included a complex Protected PCI case presented by Jonathan Hill, MD from the Royal Brompton Hospital in London, UK, which highlighted best practices of optimizing outcomes.

Highlights from Saturday's symposium included:

• Katherine Kunkel, MD, summarized data on AMI cardiogenic shock (AMICS) best practices for improving outcomes
• Junya Ako, MD, presented impressive survival data from Japan’s J-PVAD study
• Jay Giri, MD, MPH, discussed real-world outcomes from payer databases, providing a useful perspective on these types of published papers
• Navin Kapur, MD, provided an update from the Cardiogenic Shock Working Group and discussed the stages of cardiogenic shock

In a live interview, Alaide Chieffo, MD, FESC, president-elect of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), discussed high-risk PCI and MCS support in ACS, emphasizing that routine use of IABP for AMICS is not recommended in the European guidelines. She also highlighted data from the Italian IMP-IT registry on the use of Impella®  heart pumps pre-PCI. 

The day’s recap concluded with an invitation to remotely join a symposium by Adam Salisbury, MD, MSc, offering an update from the OPTIMUM study on the use of MCS in surgically ineligible patients receiving high-risk PCI.