NEW ORLEANS — Besides the major low-risk transcatheter aortic valve replacement trials presented this week, a radial versus femoral showdown was a highlight for interventionalists at this year’s meeting of the American College of Cardiology.
In SAFARI-STEMI, operators trained in both radial and femoral access had similar 30-day mortality rates with either approach (1.5% vs 1.3%, P=0.69) when stenting in ST-elevation MI (STEMI). The radial approach was consistently associated with numerically less bleeding, albeit without achieving statistical significance.
Notably, investigators stopped this 2,292-person trial early after declaring futility in showing a survival difference between radial and femoral groups.
Other notable studies in interventional cardiology included:
STEMI patients who had received fibrinolytic therapy had the same major bleeding rates whether they were subsequently randomized to ticagrelor (Brilinta) or clopidogrel (Plavix) in the TREAT trial.
The incidence of ischemic events over 12 months was similar between ticagrelor and clopidogrel recipients. More than half of study participants — nearly 3,800 patients from several continents — had gotten percutaneous coronary intervention (PCI) as part of their treatment.
Ticagrelor alone was noninferior to standard 12-month dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) placement for rates of death, MI, stroke, and urgent target vessel revascularization at 2 years.
However, urgent revascularization and later stent thrombosis were both down with ticagrelor alone, according to the GLASSY substudy of the large GLOBAL LEADERS trial with independent central adjudication of events.
Sonothrombolysis with IV infusion of microbubbles added to PCI was deemed safe and feasible in a randomized trial of 100 STEMI patients in Brazil.
“Sonothrombolysis is efficacious in achieving early infarct vessel patency, microvascular flow, reducing infarct size and consequently restoring left ventricular systolic function,” researchers reported in MRUSMI.
Nearly one in four patients left the cardiac cath lab with residual ischemia (iFR 0.89 or below) despite good angiographic results after PCI in this observational study.
Remaining pressure gradients were largely focal, leading investigators to hypothesize that additional PCI of residual focal lesions could bring down the rate of residual ischemia. The study was conducted at 15 centers in North America and Europe.
In cases of suspected coronary artery disease, fractional flow reserve (FFR) derived from coronary CT angiography added enough functional information to have an impact on revascularization decisions in an international registry.
Patients with CT-derived FFR values over 0.80 tended to be managed conservatively and have lower rates of revascularization and clinical events at 1 year.