Late-breaking science in interventional cardiology is alive and well despite the COVID-19 pandemic. That was the conclusion drawn after the first virtual edition of the Cardiovascular Research Foundation (CRF) annual scientific symposium—TCT Connect 2020 (14–18 October, virtual)—which continues to be an important fixture in the interventional cardiology calendar, despite being the latest in a long line of virtual meetings to take place throughout 2020.
In the aftermath of the symposium, Cardiovascular News spoke to TCT faculty and attendees to gather their views on the key highlights from the meeting.
“At the beginning we were a little bit concerned that people are digitally tired, and because of this perhaps people would not really be interested in digital platforms,” said Juan Granada, president and chief executive officer of CRF. “But, I have to tell you that the response was overwhelming, it was a very positive response.”
According to Granada, although the data are still being analysed, the digital platform enabled many attendees to join the meeting who may have been unable to attend in its physical format. He said: “Thanks to the digital platform, a big proportion of the attendees were people that never actually participated in TCT before, which is something extremely exciting for us because it removes the limitation of coming to these meetings.”
Picking out the important messages from the research presented across the four-day event, Granada commented that the “concept of vulnerable plaque is back”, referring to several late-breaking studies presented on the first day of the conference, including the PROSPECT II and PROSPECT ABSORB studies. Granada said: “The concept of having some plaques that are not recognised by angiography and actually are going to cause events, that concept is back and I really think that is going to reignite the field of vulnerable plaque research—a field that has been dormant since PROSPECT.”
Granada also pointed to head-to-head studies comparing transcatheter aortic valve implantation (TAVI) platforms, including the SCOPE II and SOLVE TAVI trials. “I really think these trials are necessary, as happened with stents, to be able to pick up the technical and outcome difference between these different technological platforms,” Granada said. In terms of data on drug-eluting stents, Granada noted the significance of the XIENCE 28/90 study, presented on day two of the symposium by Roxana Mehran (Icahn School of Medicine, New York, USA).
Furthermore, Granada highlighted two proof of principle studies involving the Mitraclip (Abbott) device, one on the viability of treating patients with cardiogenic shock in acute mitral regurgitation— “the fact that we have a technology that could potentially help those patients is very encouraging”—and a second on the use of Mitraclip in patients with end stage heart failure undergoing transplant.
According to Granada’s fellow TCT course director Ajay Kirtane (Columbia University Vagelos College of Physicians and Surgeons, New York, USA), “first and foremost, it was just so great to be able to see new science and to connect with colleagues around the globe. So much has been missed—in life—during the pandemic, and while our focus should always be on COVID-19, we know that we can help people in so many ways through the diagnosis and treatment of cardiovascular disease. So in this way, it was great to feel invigorated with our field again.”
Turning to the scientific programme, Kirtane said: “On the coronary side, I really felt that the emphasis on adjunctive imaging and physiology guidance was palpable. We want to optimise outcomes for our patients and more and more data are emerging that this is the way to ensure it.”
Speaking to Cardiovascular News, Davide Capodanno (University of Catania and G Rodolico-San Marco, Catania, Italy), commented that the wealth of research exhibited at TCT Connect is proof that, despite the pandemic, research in cardiovascular medicine remains strong.
“The first take-home message for me is that late-breaking science is alive and well despite the pandemic ,” he said. “One would have expected a major impact on the number of trial submissions, which did not happen: good news.”
He also sought to explain an emerging trend of trials returning neutral results, as witnessed in late-breaking trials of coronary devices. “Event rates are so low in control arms that it is difficult for an investigational arm to improve: this explains why we are seeing more and more non-inferiority designs and neutral results. There is a need for some breakthrough concepts and technologies in the quest for improvement, but for me these results speak also for the great achievements of medical therapy in secondary prevention nowadays, and the benefit of appropriate revascularisation according to the heart team principle.”
Mamas A Mamas (Keele Cardiovascular Research Group, Keele University, Stroke-on-Trent, UK) described the FORECAST randomised clinical trial, investigating the use of fractional flow reserve management derived from computed tomography (FFRCT) as “big news”. Describing the study, he said: “CT FFR was compared to routine algorithms for assessment of stable coronary disease with resource utilisation as a primary endpoint. The study showed no differences in this outcome, or angina, or clinical endpoints such as major adverse cardiac and cerebrovascular events (MACCE) . It is still an important study in that it showed a 20% reduction of coronary angiography for patients, thereby potentially reducing radiation dose to patients, but also procedural risks from an angiogram, which may be low but are still significantly higher than a non-invasive test.”
Mamas also highlighted the PROSPECT II and PROSPECT-ABSORB studies as opening “an important avenue of focus”, adding that future trials in targeting high-risk lesion phenotypes “must be in the wings”. Elsewhere, he also pointed the ULTIMATE trial, which compared intravascular ultrasound (IVUS)-guided versus angiography-guided implantation of drug-eluting stents.
Summing up his thoughts following the meeting, he commented: “Finally, to my mind the take-home message is that interventional meetings will never be the same again. We had late-breaking trials, live cases, state of the art technology, and scientific contents and CPD all delivered in a virtual environment, available to anyone across the globe in real-time but also on demand. This meeting will change how we deliver educational content down the line.”