TCTMD’s Top 10 Most Popular Stories for October 2019

Controversy surrounding the 5-year results of EXCEL—sparked when the chairman of the surgical committee during the design and recruitment phase of the trial accused his fellow investigators of manipulating the study in PCI’s favor—garnered the most attention from TCTMD’s readers this month.

News out of TCT 2019 dominated the rest of the list, with stories on adverse events with the Watchman left atrial appendage occlusion device (Boston Scientific), the TWILIGHT and Onyx ONE trials evaluating different durations of dual antiplatelet therapy after stenting, TAVR valve positioning, long-term PARTNER 2A trial results, and techniques for assessing intermediate coronary lesions.

Other topics to make the Top 10 list for October 2019 were the impact of cuts to office-based noninvasive cardiac tests by the Centers for Medicare & Medicaid Services, a countdown to the release of the long-awaited and much-anticipated ISCHEMIA trial results, and the benefits of a diabetes drug in patients with heart failure.

1. Former EXCEL Investigator Alleges Trial Manipulation, Prompting Vehement Denials

Surgeon David Taggart set the EACTS meeting ablaze when he accused EXCEL researchers of stacking the deck in PCI’s favor.

2. Watchman Adverse Events: Analysis Digs Into What’s Been Reported to the FDA

Operators can use this information to become better prepared to prevent and manage these issues, a researcher says.

3. CMS Cuts to Office-Based Noninvasive Cardiac Tests Are Driving Costs Higher

An unintended upshot of CMS payment cuts in 2005 is more tests being done in hospitals, with CMS and patients footing the bill.

4. TWILIGHT: Ticagrelor Monotherapy Lowers Bleeding Without Increasing Ischemic Events

Experts agree the findings suggest that aspirin can be dropped in practice 3 months after PCI in this high-risk patient cohort.

5. ISCHEMIA Countdown Begins, but a ‘Black-and-White’ Answer Is Uncertain

After 12 years, numerous trial tweaks, and vocal debate about the trial’s ability to deliver an answer, ISCHEMIA cometh.

6. Predicting Final Valve Position After TAVR: Different Devices, Different Success

Operators placing these valves should leave as good a result as possible for future interventions, such as PCI, says one expert.

7. Long-term PARTNER 2A Results Put Spotlight on Paravalvular Leak in TAVR

Patients with moderate-to-severe leaks—less frequently seen now with newer technology—had a greater risk of late mortality.

8. Onyx ONE: Shorter DAPT Plus ZES Noninferior to Polymer-Free Stent in High-Bleeding-Risk Patients

While the study adds needed data, it does not fully answer the question of whether 1-month therapy strikes the perfect balance.

9. DAPA-HF Details: Dapagliflozin Slashes HF Outcomes, Even in Nondiabetics

Investigators saw benefits with the SGLT2 inhibitor across all subgroups. One observer predicts a new era of heart failure care.

10. FORZA: For Intermediate Lesions, OCT-Guided PCI Costs More, Yields Better Outcomes vs FFR

“These techniques are complementary and each offer different, important information,” William Fearon says.