Wednesday, April 06, 2011


I was away doing PCI yesterday. When I got to review the presentations made at 4th April 2011 sessions, there were many papers in my area of interest that is worth highlighting.

1. Looks like the second generation DES has arrived, and they are all better then the first generation DES. For example, Dr Greg Stone presented data comparing the new Promus Element stent against the Promus ( actually a carbon copy of Xience V ) stent, and showed that the Promus Element was non-inferior at 1 year. Results were good. The Promus Element stent is on a platinum chromium platform, making it thinner and much more deliverable. It is also easier to see on flouro. Dr Martin Leon presented the Resolute US 1 year results and showed that the Endeavor Resolute was non-inferior to historical controls, namely the Endeavor Driver ( or the old ABT 578 ).
Dr Patrick Serruys presented the Resolute All Comers 2 years results and showed that at 2 years, there was no catchup. That Endeavor Resolute was still as good as Xience V. The numbers look good.
Looks like now, the benchmark gold standard for the moment is Xience V, and everyone is comparing their stents with Xience V.
There are a whole host of stents not mentioned in ACC 2011. Well lets not go there.

2. 4 th April also showed papers on the non-superiority of Transradial versus Transfemoral PCI, in the RIVAL study. These 7,000 or so patients had ACS. They were across 32 international sites. They were both equivalent. There was no difference in MACE, but there seemed to be some difference in major access site bleeding. I could not find details of which site participated. Obviously with transradials, familiarity and skill is important, working through a smaller artery. Of course, the issue of patient comfort was not measured.

3. The 4th April also saw some results from the RAP ( Radial Artery Patency ) study. 561 patients across 13 sites in North America, followed for 5 years. The RAP study showed that Radial artery Grafts were slightly superior to Saphenous Vein Grafts, in terms of 5 year patency rates. The patients all had Radial and Saphenous Vein grafts and so act as their own control. About half had 5 year angiographic follow up. Some of the saphenous veins were harvested by junior trainees, some were harvested endoscopically, while the Radial Grafts were all harvested by the senior man. How much difference these made, we will never know.

4. Before I finish, there is one study on the 3rd April, which I miss writing on. PRECOMBAT. This is a study on PCI for unprotected left main stem disease, comparing the sirolimus eluting stent ( Cypher ) with conventional CABG. This study was led by Dr SJ Park from Asan Medical Center, Korea. It showed that DES ( Cypher ) was non-inferior to CABG. What impressed me most was that in both arms, the event rates were so low. Well for those of us who do unprotected left mains, take heart. Your are OK.

I suppose, tomorrow, I should try and post some medical developments coming out of ACC 2011. I think the summit ends today, in New Orleans.

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