Author + information
- Spencer B. King III, MD, Editor-in-Chief, JACC: Cardiovascular Interventions⁎ ()
- ↵⁎Address correspondence to:
Spencer B. King III, MD, Editor-in-Chief, JACC: Cardiovascular Interventions, Saint Joseph's Heart and Vascular Institute, 5665 Peachtree Dunwoody Road, NE, Atlanta, Georgia 30342
There are many venues for reporting important research findings, and I am always interested in how much will be unveiled at the Annual Scientific Sessions of the American College of Cardiology (ACC). Because we had not inaugurated an interventional cardiologist as President of the ACC since my tenure in 1998 to 1999, I was especially interested in how big a splash intervention would make this year as we welcomed another interventional cardiologist, our own Associate Editor, Dr. David R. Holmes, Jr., to take the helm of the College. I was not disappointed. More than one-half of the late-breaking trials reported were on topics relevant to interventions. The big hitter was obviously the PARTNER (Placement of Aortic Transcatheter Valves) trial, a study of patients with high-risk aortic stenosis randomized to percutaneous valve implantation or surgical placement. The results were encouraging for further expansion of percutaneous valve implantation beyond the surgically inoperable group. In addition, the economic analysis of the inoperable group B patients showed a projected extension of life with the percutaneous valve of 1.9 years at a cost of $50,000 per life-year gained—quite a positive result for a medical intervention. Dr. Martyn Thomas opined that this might be attractive even to the “bean counters” in the United Kingdom. Among other late-breakers that interested me was the PRECOMBAT (Bypass Surgery Versus Angioplasty Using Sirolimus-Eluting Stent in Patients With Left Main Coronary Artery Disease) trial of patients with left main disease, which adds significant weight to the SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) left main subgroup findings. This randomized trial provided strong evidence that selected left main patients can be managed safely with stenting, and it will increase the discussion of what level of Class 2 indication (either A or B) left main intervention should fall into. The other structural heart disease trial with clinical impact was the 2-year follow-up of EVEREST-II (Endovascular Valve Edge-to-Edge Repair Study). Although annual follow-up of trials without significant interval change is usually frowned upon, that finding was what made this report so valuable. The 1-year results showing significantly more mitral regurgitation with a mitral clip raised the question of whether clinical deterioration would occur with further follow-up. The results were reassuring, as the degree of mitral regurgitation did not change between years 1 and 2, and neither did the clinically-equivalent outcomes. The RIVAL (Radial vs. Femoral Access for Coronary Intervention) trial, a comparison of radial and femoral access for interventions, was somewhat sobering in this era of marked enthusiasm for the radial approach in that it showed comparable results by either method, and the difference was driven only by groin hematomas in the femoral group. Of the many double-antiplatelet duration studies to come, the EXCELLENT trial, comparing 12- with 6-month double-antiplatelet therapy, showed that overall there were no excess events with the shorter-duration therapy, but a subgroup of diabetic patients did raise concerns for the abbreviated treatment plan. The ISAR-CABG (Is Drug-Eluting Stenting Associated With Improved Results in Coronary Artery Bypass Grafts) trial boosted drug-eluting stents (DES) for saphenous vein grafts disease over bare-metal stents, but only for target vessel revascularization, without a difference in hard endpoints. The delta was about 5 to 6 reinterventions per 100 cases avoided if DES were used.
Another one-half dozen late-breakers fell into the interventional camp. I took special pleasure, however, in hearing Dr. Patrick Serruys report the 1-year follow-up of the ABSORB (A Bioabsorbable Everolimus-Eluting Coronary Stent System) trial. This bioerodable stent seems to be performing its stenting assignments well (i.e., scaffolding and reducing neointimal proliferation) while beginning to actually resorb. The presentation by Dr. Serruys was of particular interest to me as I recalled conversations we had together more than 23 years ago about the dream of a stent that could do its job and then go away, leaving a functional artery behind. Despite our failures in the beginning (we worked on the polymeric biodegradable stent idea in the late 1980s), this development gave a new direction for vascular research. I foresee many careers perfecting endovascular scaffolds and solving the problems that may arise.
Thanks to all of the members of the editorial board who participated in the joint JACC, JACC: Cardiovascular Interventions, and JACC: Cardiovascular Imaging editorial meeting, and also enjoyed a bit of levity. Dr. Jagat Narula, Editor-in-Chief of JACC: Cardiovascular Imaging, stole the show by unveiling his latest issue with the cover showing the CT scans of a 3,500 year-old mummy with calcified coronary arteries. Trying not to be outdone, I joked that on close observation the images also revealed a stent in the LAD! Actually, imaging and interventions are virtually inseparable, as are our respective journals.
Despite our specialty reaching its middle age, the vitality evident in the work reported at ACC.11 and i2 Summit 2011, as well as the skillful organization of the interventional aspects of the program by Dr. David Moliterno (another Associate Editor of JACC: Cardiovascular Interventions) and his team bode well for the future of our specialty. As Dr. David Holmes said so passionately to the new fellows inducted at the Convocation, “The future is all about you.” We all must support this new generation of physicians and scientists who will develop the new, yet-to-be-imagined therapies that will justify our specialty by improving the lives of our patients.
- American College of Cardiology Foundation