Monday, September 28, 2009


TCT 2009 had just concluded in San Francisco. I must begin by stating for the record that I did not attend, and that my observations are all from the internet. Looking at the program, I did not see anything outstanding or revolutionary. I see evolution of better stents and more data on the established stents especially the DES ( drug-eluting stents ). The new kid on the block is the Biomatrix DES by Biosensor ( initially a Singapore base company ), which has released very good two year followup results. This DES looks promising. Otherwise, a quick review of the meeting showed that the first generation DES ( namely stainless steel Cypher and Taxus ), has been easily surpassed by the second generation thin strut, cobalt chromium DES like the Endeavor and Endeavor Resolute and also the Xience V. In all the trials which compared second generation DES against first generation DES, the second generation wins easily. BUT this brings me to my next point. It would seem that although initial 12-24 months data would favour the second generation DES, after 5-7 years, the curve seem to merge back again, and they are almost equivalent. This has thought us a valuable lesson. That with DES, we need to observe short term, and also medium and long term. In other words, we must be vigilant all the time. Do not just take the initial results as gospel truth. " Old may still be gold ".
The meeting also saw some new pharmacological agent that may prove useful, including " Ticagrelor ", but this certainly need more studies. It was unfortunate that they decided to re-hatch the " COGENT study", a study that was prematurely halted for lack of funding. The authors now claim that Plavix + PPI does no harm. I will take it with a large pinch of salt for the simple reason that the study was abandoned.
Perhaps TCT 2009 will be remembered for what was not presented at SanFrancisco. And that is, that senators are investigating the star of all previous TCT, namely Dr M Leon , for alleged conflict of interest and non-declaration. This is a serious matter. I have not noted Dr Leon's reply to the accusation. Perhaps, he has replied to Columbia University, I do not know. But this accusation, coming on the second day of TCT 2009, must certainly have change the mood in San Francisco. Maybe there was less bounce in his step, as he stepped to the podium.
Is this the end of our cardiac intervention version of Hollywood?

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