Sunday, April 30, 2006

Angioplasty Summit 2006: TCT Asia Pacific 26th-28th April 2006

TCT ASia Pacific was just held in Korea. This is arguably the largest Interventional cardiology meeting, live live case demonstration, in Asia. It started humbly about 10 years ago as a Asan medical center meeting, led by a very capable interventional cardiologist at Asan medical center, Dr SJ Park.

We were all starting angioplasty programs in our respective countries, in the early to late 1980's. In Asia, the Japanese and Indians were ahead, namely Dr M.Noboyashi in Japan and Dr M Samuels in India. Dr Arthur Tan and Dr Richard Ng led the work in Singapore (and also started the Asian Pacific Society of Interventional Cardiology), Dr Damras in Thailand, Dr Gao Rulin in China, Dr SJ Park in Korea and our group in Malaysia.

After two decades, the Japanese, Chinese and Koreans are way ahead, rivalling the Americans and Europeans, while we are still in our humble beginnings. This Angioplasty Summit is held in close collaboration with the American TCT organisiation. In fact, Dr Park has formed a Cardiovascular Research Foundation, in collaboration with the Cardiovascular Research Foundation of USA, to run this meeting and also fund cardiovascular research in Korea. They are indeed doing wonderful research, in many fields of cardiovascular medicine, including cholesterol metabolism, coronary artery disease, hypertension, various gene therapies and, of course, research in interventional cardiology. In this area, they are experts in angioplasty for unprotected left main stem coronary artery (ULMCA), outdoing even the Americans and the Europeans.

The results of angioplasty in ULMCA in the world, is probably best, in the hands of Dr SJ Park. Angioplasty of ULMCA is one of the last frontiers in angioplasty yet to be conquered, the rest being CTO (chronic total occlusion), and bifurcation CAD. These are the areas in interventional cardiology where the technique is still very much evolving, and the results variable. This barrier is being very ably conquered with the Koreans showing the way. It then is no surprise that at this Angioplasty Summit 2006, we saw demonstration after demonstration of angioplasty in ULMCA, bifurcation lesions and a few CTOs. Angioplasty of ULMCA carries a high risk as the LMCA controls more then half the circulation to the heart, and here we see the Koreans doing them with a rather casual approach and with impunity. Their results, immediate and longterm, have been very good. Coronary artery disease of the ULMCA is traditionally, and by practice guidelines, the territory of the cardiac surgeons, in view of the high risk (immediate and longterm) associated with angioplasty of ULMCA. The Koreans are shifting the borders here, extending the indications of angioplasty to include CAD of ULMCA. The 2,000 or so delegates were shown how good they are in this field. In fact Dr SJ Park has organise a clinical trial to study treatment of ULMCA, which is better, angioplasty or bypass surgery. The trial is called COMBAT (comparison of bypass surgery against angioplasty) in ULMCA coronary artery disease, with the use of the sirolimus eluting stent. This meeting is so well organised that we had live case demonstrations and lectures from New York, Paris, and Milan/Italy.

The rest of this big meeting had presentations on drug-eluting stents, the use of intravascular ultrasound, peripheral vascular and carotid interventions, percutaneous ASD repairs, and cholesterol therapies.

All in all, it was a very well organisied, big meeting, showcasing the best in Korean interventional cardiology. It was indeed, a privilege to be a faculty member in this august meeting.

Syabas Dr SJ Park.

*Syabas is a Malaysian term meaning congratulations

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