EuroPCR 2015 news tips: Treatment delays, radial 'paradox,' transcatheter valves, and more
1. The "Radial Paradox": Higher Femoral Access Site Complications Offsets Radial Benefits
Growing acceptance of radial access during cardiac catheterisation to reduce access site complications may contribute to a loss of experience with femoral access, potentially increasing vascular complications when the femoral technique is used. Montreal Heart Institute researchers compared contemporary and historical patient cohorts (n=17,059) and found that vascular access complications today, using the femoral artery approach--used typically as a back-up method--are more common than before radial access was introduced. This, in turn, offsets the benefit of radial access at a population level since patients in the contemporary cohort (radial + femoral) suffered more vascular complications than those in the historical cohort. Trainees and default radial operators should acknowledge the "Campeau Radial Paradox" --named after radial pioneer Lucien Campeau--and take appropriate action, investigators say.
CONTACT: Dr. Lorenzo Azzalini, Montreal Heart Institute and Montreal Health Innovations Coordinating Center, CANADA azzalini@gmail.com
Abstract: EURO15A-OP203
Date: Wednesday May 20, 10:30, Room Ternes 1 AND Wednesday May 20, 11:08, Room 253*
*As one of the abstracts featured in "PCRs Got Talent," this presentation may also make it to the second round, Thursday May 16:50-18:20 and final round, Friday 9:00-10:00, both in Room 253.
2. Most Non-Culprit Vessels with Significant Stenosis Not Functionally Important: FFR Study
Controversy exists surrounding the benefits/risks of reopening all significantly blocked ("stenotic") vessels during primary angioplasty for heart attack, or simply reopening the "culprit" blocked artery responsible for the MI and treating the others at a later date, or leaving them be. An ongoing study, COMPARE-ACUTE, is using fractional flow reserve (FFR) technology to assess whether or not a vessel blockage seen on angiography has a functional effect on the heart (by impeding oxygen flow). Preliminary findings from the trial show that more than 50% of non-culprit arteries deemed to have significant stenosis are not functionally significant by FFR, a finding that will no doubt increase the debate as to whether and when to intervene on non-infarct-related arteries.
CONTACT: Dr. Elmir Omerovic, Sahlgrenska University Hospital, Gotheborg, SWEDEN elmir@wlab.gu.se (First author Dr. Peter Smits, Maasstad Hosptial, Rotterdam)
Abstract: EURO15A-OP024
Date: Wednesday May 20, 11:00, Room 253 AND Friday May 22, 9:39, Room 242B*
*As one of the abstracts featured in "PCRs Got Talent," this presentation may also make it to the second round, Thursday May 16:50-18:20 and final round, Friday 9:00-10:00, both in Room 253.
3. Drug-Eluting Stents Best Bare Metal in Elderly Patients, without Bleeding Trade-off
Despite the wide uptake of drug-eluting stents (DES), little research exists supporting their safety and efficacy in elderly patients (>75 years), who are typically excluded from randomised trials. A new study of 635 consecutive, elderly patients at two European centres compared "net" clinical benefits (both ischaemic and bleeding events) among patients who received a DES (170 patients) or a bare metal stent (BMS, 465 patients). Investigators found that duration of antiplatelet therapy, as per treatment guidelines, was longer among the DES-treated patients than the bare metal stent-treated patients, but this did not translate into higher rates of bleeding. Moreover, net benefit was higher in the DES group (40.5%) than in BMS-treated patients (55.7%; p=0.009), driven by a significant reduction in myocardial infarction (8.6 vs. 16.6%; p=0.038) and target vessel revascularisation rates (7.9 vs. 21.9%; p=0.003).
CONTACT: Dr. Fabio Mangiacapra, Campus Bio-Medico University, Rome, ITALY fabio.mangiacapra@gmail.com (Lead author: Dr. Giuseppe Di Gioia, Campus Bio-Medico University)
Abstract: EURO15A-MA005
Date: Wednesday May 20, 9:32, Room Arlequin AND Wednesday May 20, 11:04, Room 253*
*As one of the abstracts featured in "PCRs Got Talent," this presentation may also make it to the second round, Thursday May 16:50-18:20 and final round, Friday 9:00-10:00, both in Room 253.
4. Detailed Analysis of Door to Balloon Time Delays in STEMI Finds Key Areas for Improvement
A seven-year review of 797 STEMI patients at a Melbourne hospital addressing door-to-balloon times (DTBT) in heart attack patients suggest that certain timeframes are more critical than others in reducing the delays to angioplasty that lead to worse outcomes. Key areas for cutting DTBTs down to 90 minutes or less, according to Australian researchers led by nurse Lorelle Martin, include prompt or prehospital performance of the diagnostic ECG and expediting the assembly of the cathlab team, especially in high-risk patients. Specific procedural timeframes were also identified as areas for improvement. Door to ECG time, for example, was identified as a being particularly protracted in female patients. The data also confirmed that patients with DTBT >90 minutes died at nearly three times the rate of patients treated within the recommended 90 minutes.
Contact: Lorelle Martin (nurse), Austin Health, Melbourne, Australia, lorelle.martin@austin.org.au
Abstract: EURO15A-OP231
Date: Wednesday 20th, 11:34, Room 253 AND Thursday May 21, 11:30 Room 251.*
*As one of the abstracts featured in "PCRs Got Talent," this presentation may also make it to the second round, Thursday May 16:50-18:20 and final round, Friday 9:00-10:00, both in Room 253.
5. Transcatheter Valve Outcomes in Patients with Paradoxical Low-Gradient Aortic Stenosis
Patients with severe aortic stenosis (AS) who have a mean transvalvular aortic gradient (MPG) END
Growing acceptance of radial access during cardiac catheterisation to reduce access site complications may contribute to a loss of experience with femoral access, potentially increasing vascular complications when the femoral technique is used. Montreal Heart Institute researchers compared contemporary and historical patient cohorts (n=17,059) and found that vascular access complications today, using the femoral artery approach--used typically as a back-up method--are more common than before radial access was introduced. This, in turn, offsets the benefit of radial access at a population level since patients in the contemporary cohort (radial + femoral) suffered more vascular complications than those in the historical cohort. Trainees and default radial operators should acknowledge the "Campeau Radial Paradox" --named after radial pioneer Lucien Campeau--and take appropriate action, investigators say.
CONTACT: Dr. Lorenzo Azzalini, Montreal Heart Institute and Montreal Health Innovations Coordinating Center, CANADA azzalini@gmail.com
Abstract: EURO15A-OP203
Date: Wednesday May 20, 10:30, Room Ternes 1 AND Wednesday May 20, 11:08, Room 253*
*As one of the abstracts featured in "PCRs Got Talent," this presentation may also make it to the second round, Thursday May 16:50-18:20 and final round, Friday 9:00-10:00, both in Room 253.
2. Most Non-Culprit Vessels with Significant Stenosis Not Functionally Important: FFR Study
Controversy exists surrounding the benefits/risks of reopening all significantly blocked ("stenotic") vessels during primary angioplasty for heart attack, or simply reopening the "culprit" blocked artery responsible for the MI and treating the others at a later date, or leaving them be. An ongoing study, COMPARE-ACUTE, is using fractional flow reserve (FFR) technology to assess whether or not a vessel blockage seen on angiography has a functional effect on the heart (by impeding oxygen flow). Preliminary findings from the trial show that more than 50% of non-culprit arteries deemed to have significant stenosis are not functionally significant by FFR, a finding that will no doubt increase the debate as to whether and when to intervene on non-infarct-related arteries.
CONTACT: Dr. Elmir Omerovic, Sahlgrenska University Hospital, Gotheborg, SWEDEN elmir@wlab.gu.se (First author Dr. Peter Smits, Maasstad Hosptial, Rotterdam)
Abstract: EURO15A-OP024
Date: Wednesday May 20, 11:00, Room 253 AND Friday May 22, 9:39, Room 242B*
*As one of the abstracts featured in "PCRs Got Talent," this presentation may also make it to the second round, Thursday May 16:50-18:20 and final round, Friday 9:00-10:00, both in Room 253.
3. Drug-Eluting Stents Best Bare Metal in Elderly Patients, without Bleeding Trade-off
Despite the wide uptake of drug-eluting stents (DES), little research exists supporting their safety and efficacy in elderly patients (>75 years), who are typically excluded from randomised trials. A new study of 635 consecutive, elderly patients at two European centres compared "net" clinical benefits (both ischaemic and bleeding events) among patients who received a DES (170 patients) or a bare metal stent (BMS, 465 patients). Investigators found that duration of antiplatelet therapy, as per treatment guidelines, was longer among the DES-treated patients than the bare metal stent-treated patients, but this did not translate into higher rates of bleeding. Moreover, net benefit was higher in the DES group (40.5%) than in BMS-treated patients (55.7%; p=0.009), driven by a significant reduction in myocardial infarction (8.6 vs. 16.6%; p=0.038) and target vessel revascularisation rates (7.9 vs. 21.9%; p=0.003).
CONTACT: Dr. Fabio Mangiacapra, Campus Bio-Medico University, Rome, ITALY fabio.mangiacapra@gmail.com (Lead author: Dr. Giuseppe Di Gioia, Campus Bio-Medico University)
Abstract: EURO15A-MA005
Date: Wednesday May 20, 9:32, Room Arlequin AND Wednesday May 20, 11:04, Room 253*
*As one of the abstracts featured in "PCRs Got Talent," this presentation may also make it to the second round, Thursday May 16:50-18:20 and final round, Friday 9:00-10:00, both in Room 253.
4. Detailed Analysis of Door to Balloon Time Delays in STEMI Finds Key Areas for Improvement
A seven-year review of 797 STEMI patients at a Melbourne hospital addressing door-to-balloon times (DTBT) in heart attack patients suggest that certain timeframes are more critical than others in reducing the delays to angioplasty that lead to worse outcomes. Key areas for cutting DTBTs down to 90 minutes or less, according to Australian researchers led by nurse Lorelle Martin, include prompt or prehospital performance of the diagnostic ECG and expediting the assembly of the cathlab team, especially in high-risk patients. Specific procedural timeframes were also identified as areas for improvement. Door to ECG time, for example, was identified as a being particularly protracted in female patients. The data also confirmed that patients with DTBT >90 minutes died at nearly three times the rate of patients treated within the recommended 90 minutes.
Contact: Lorelle Martin (nurse), Austin Health, Melbourne, Australia, lorelle.martin@austin.org.au
Abstract: EURO15A-OP231
Date: Wednesday 20th, 11:34, Room 253 AND Thursday May 21, 11:30 Room 251.*
*As one of the abstracts featured in "PCRs Got Talent," this presentation may also make it to the second round, Thursday May 16:50-18:20 and final round, Friday 9:00-10:00, both in Room 253.
5. Transcatheter Valve Outcomes in Patients with Paradoxical Low-Gradient Aortic Stenosis
Patients with severe aortic stenosis (AS) who have a mean transvalvular aortic gradient (MPG) END