TCT 2020: Short DAPT, Longer TAVR Outcomes, Intravascular Imaging, and More

The 2020 virtual TCT meeting kicks off next week, dubbed TCT Connect, and program chairs are promising a mix of science, technology, and debate in a streamlined yet comprehensive online experience.

“The TCT meeting is usually so large and intense that it makes it difficult for you to navigate through your all your educational needs,” Juan Granada, MD, president and chief executive officer of the Cardiovascular Research Foundation (New York, NY), explained to TCTMD. “This platform, for the first time, is going to allow people to really learn what they want to learn in an organized and predictable fashion. If you really spend the time to explore the different channels and topics, you will really be getting the best in science, innovation, and research.”

TCT Connect will be broadcast over 5 days, October 14-18, 2020, across three channels: the “Main Arena,” World Connect/e-Satellites, and Innovation/e-Training. In a telebriefing for journalists earlier this week, Granada, along with other course directors Ajay Kirtane, MD (NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY), Roxana Mehran, MD, and Gregg Stone, MD (both Icahn School of Medicine at Mount Sinai, New York, NY), walked through some of the highlights.

The Main Arena channel is home to the live cases—22 from nine sites—as well as the late breakers and spotlight abstract sessions. More than 30 presentations, broken down as Late-Breaking Clinical Trials or Late-Breaking Clinical Science, will be released over the course of the meeting in sessions starting at 11 AM EDT each day. The Journal of the American College of Cardiology, Journal of the American Medical Association, the Lancet, and the European Heart Journal are each co-hosting one of the Late-Breaking Clinical Trials sessions.

• Wednesday, the Trials deal with vulnerable plaque imaging and plaque progression, while the Science presentations cover drug therapies in STEMI, as well as the lone COVID-19 late breaker—NACMI, covering STEMI outcomes from the North American COVID-19 Registry.
• Thursday’s Trials pivot to structural interventions and include SCOPE II (head-to-head TAVR comparison), REFLECT II (cerebral protection in TAVR), and MITHRAS (randomized trial of atrial septal defect closure after transcatheter mitral valve repair). The Science presentations include the DISRUPT CAD III trial of lithotripsy for severe coronary calcification, and a range of other coronary intervention studies, among them DEFINE-PCI, which addresses the significance of residual ischemia post-PCI.
• On Friday, all three Trials—FORECAST, TARGET FFR, and DEFINE-FLOW—involve intravascular imaging, both invasive and noninvasive, for decision-making and stent optimization. The Science grouping switches back to structural interventions, including 1-year outcomes from SOLVE-TAVI; MITRABRIDGE, exploring the use of the MitraClip as a bridge to transplant; a cerebral protection analysis from the Society of Thoracic Surgeons/American College of Cardiology TVT Registry; and GLOBAL EXPAND, tracking 12-month outcomes with newer-generation MitraClip devices.
• Saturday’s program features three coronary Trials investigating new stent technology or reduced DAPT in high-bleeding-risk patients (HOST-REDUCE, COBRA-REDUCE, and OPTIMIZE). The Science presentations examine the MitraClip in the setting of cardiogenic shock, 1-year results from SCOPE I, TRANSIT (TAVR for failed TAVR), and 5-year follow-up in the PARTNER 2 Valve-in-Valve registry.
• Sunday departs from the other days by combining the Trial and Science talks in a single setting under the umbrella of endovascular interventions. Drug-coated balloons above and below the knee (BTK) are featured, including longer-term results from VOYAGER PAD, IN.PACT BTK, and ILLUMENATE. Another trial, TANGO, looks at the adventitial delivery of temsirolimus in BTK. The FLASH registry details results with a percutaneous technology for pulmonary embolism, while the final trial in this batch tackles renal denervation of the periarterial renal sympathetic nerve.

“We had so many trials sent to us, we went through a very difficult process of actually choosing the ones that would have important practice-changing and important novel findings, and certainly the ones that have been chosen in the Late-Breaking Trials would fit that category,” Mehran said. “Every day there's something that I believe will have an important impact on clinical practice.”

COVID-19 and Top Abstracts

Also on the Main Arena channel for TCT Connect are special sessions devoted to COVID-19 abstracts, on Wednesday, and the top abstracts, on Thursday. Speaking during the call, Stone stressed that COVID-19-related sessions can also be found among the complex cases, a MedTech innovation session on Wednesday, as well as a special US Food and Drug Administration session on Thursday. “Obviously [COVID-19] has affected everything we do in these patients, how we do STEMI and non-STEMI, general elective procedures, etc,” said Stone. “And of course in about 20 states, we have increasing numbers of COVID again, so this isn't going to go away for a while.”

The World Connect/e-Satellite channel, said Granada, showcases topical and controversial topics across different areas of interventional cardiology, explicitly seeking the involvement of diverse geographical regions. Satellite sessions and sponsored programming can also be found on this channel, he noted. The third channel, Innovation and e-Training, is the place for new tech and early stage research. In addition to the COVID-19 program, two additional FDA sessions are found on the Innovation channel tackling the “postpandemic future” and a “regulatory cycle reimagined,” plus a specific look at some of the thornier areas of device approval, including devices for mechanical circulatory support and mitral repair/replacement, as well as shorter duration DAPT.

In all, said Granada, more than 110 countries are represented among the faculty and registered “attendees” so far, with more than 110 hours of programming, including 288 lectures and 203 challenging cases in addition to the 22 live cases. A total of 475 abstracts were accepted for this year’s TCT and will be published simultaneously in JACC. While only a handful of the top abstracts were selected for the virtual Main Arena, the remaining talks will be published on TCTMD, Stone noted.

And indeed, Kirtane pointed out that TCT has always had a strong online component by virtue of archiving a huge amount of content on TCTMD. This year, he said, an “extraordinary effort” was made by the program chairs to bring the meeting fully online in a novel way. “One thing that's been very difficult for many physicians, in addition to not being able to see their colleagues, is not being refreshed on new data,” Kirtane explained. “And one of the things that's nice about meetings is that you sort of get a reset in a sense and reassess your own practice, how other people are practicing, and the cases are involved in that, as well. In many respects having new data allows us to do that.”

Note: The Cardiovascular Research Foundation is the published of TCTMD.