July 2020 News Roundup

Cath Lab Dispatch is TCTMD’s monthly roundup of recent news tidbits from journals and medical meetings around the globe.

The recently published STOP Persistent AF trial, in HeartRhythm, demonstrates that cryoballoon ablation is safe and effective in patients with drug-refractory, symptomatic, persistent A-fib. The primary safety event rate was 0.6%, and 54.8% of treated patients remained free from ≥ 30-second episodes of A-fib, atrial flutter, or atrial tachycardia at 12 months.

In the Lancet, new data from the multicenter PORTICO IDE RCT demonstrate similar rates of all-cause mortality or disabling stroke at 2 years with the self-expanding Portico transcatheter aortic valve system (Abbott Structural Heart) compared to six other commercially available valves.

An opinion piece published in Structural Heart encourages heart valve centers to work on streamlining patient selection, procedure execution, postprocedural care, and discharge policy to keep pace with expanding indications for TAVR and increasing volume.

In the European Heart Journal, a multidisciplinary heart team explains how they used immersive virtual reality to review anatomy and plan for minimally invasive direct coronary artery bypass (MIDCAB) in an 18-year-old patient with a history of Kawasaki disease and associated left anterior descending and right coronary artery aneurysms.

A different use of virtual reality is described in EuroIntervention by investigators who found it to be a helpful method for reducing periprocedural anxiety among a small group of elderly patients undergoing TAVR with conscious sedation.

As reported by TCTMD, a meta-analysis of 10 RCTs published in JACC: Cardiovascular Interventions has shown a 31% lower risk for reinfarction with multivessel versus culprit vessel-only PCI in patients with STEMI and multivessel CAD. There was no significant mortality difference between treatment groups.

A new consensus document from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) provides a definition of ischemia with nonobstructive coronary arteries (INOCA), as well as guidance on diagnosis and management strategies based on existing evidence and clinical practice experience.

Exactly how cath labs will resume elective procedures will no doubt differ across regions based on COVID-19 infection rates—still, complex coordination will be required to plan and implement safe and successful essential cardiovascular care, researchers write in JACC: Cardiovascular Interventions.

From the Journal of the American College of Cardiology: a pooled analysis of four multicenter RCTs (APPRAISE-2, PLATO, TRACER, and TRILOGY ACS) indicates that in patients with ACS, all-cause mortality was consistently higher in those who experienced postdischarge bleeding, regardless of whether they were treated with or without PCI for the index ACS. Check out TCTMD’s coverage here.

A look-back at early clinical experience with TAVR in high-risk, elderly patients shows that the 10-year cumulative incidence of structural valve deterioration/bioprosthetic valve failure was low at 6.5%. Among the 10-year survivors, 62.5% were walking without a mobility aid and more than 40% reported sustained improvement in activities of daily living.

Compared with failed procedures, technically successful PCI for chronic total occlusions is associated with improved angina symptoms and lower incidence of MACE at 1 year, researchers write in the Journal of Invasive Cardiology.