TCT 2002 Meeting Coverage

Summaries of important articles from major peer-reviewed journals

TCT 2002 Debates - Expert Presentations

Is There an Optimal Revascularization Strategy for Diabetics and Nondiabetics with Multivessel Disease?

• Surgery is Still the "Gold Standard" for Optimal Revascularization of Diabetics and Nondiabetics With Multivessel Disease, by D. M. Cosgrove
• PCI With Stents is the Preferred Alternative for Optimal Revascularization Strategy for Most Diabetics and Nondiabetics With Multivessel Disease, by J. W. Moses

Surgery or stent? Gap is narrowing
O'Neill Wand Grines CL. 
Lancet 2002;360:961-962. [ Sep 26, 2002 ]
The results of the Surgery or Stent trial published in the Lancet come just as everyone is starting to digest the data from the landmark SIRIUS study, which many feel will strengthen the argument for angioplasty using drug-eluting stents as an alternative to CABG for a number of patients with multivessel disease. 
The SoS Investigators. Lancet 2002;360:965-970; 
See also: http://www.medscape.com/viewarticle/443185 

Minimally invasive bypass equal to PCI . . . at least for the time being
Diegeler A et al. 
N Engl J Med 2002;347:561-566. [ Aug 21, 2002 ]
A study of 220 patients with isolated LAD artery stenosis fared similarly after PCI with stenting or MIDCAB surgery, but experts say that the advent of drug-eluting stents may tip the balance in favor of a percutaneous approach. 

Full text journal article Jan 2002
Stenting in Patients With Multivessel Disease: The New Eon?
Results from several trials show that percutaneous treatment of multivessel CAD has similar success rates to surgery.

Full text journal article Jun 2002
Staged Versus 1 Step Approach for Multivessel Percutaneous Coronary Interventions
Read about the benefits of staging multivessel percutaneous coronary interventions.

Full text journal article Jun 2002
Triple Vessel Stenting for Triple Vessel Coronary Disease
This prospective study evaluates 115 patients with multivessel CAD who underwent percutaneous coronary intervention.

Usefulness of fractional flow reserve for risk stratification of patients with multivessel coronary artery disease and an intermediate stenosis
Chamuleau SA, et al.
Am J Cardiol 2002;89:377-80.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11835914
Deferral of angioplasty of intermediate coronary narrowings is safe based on FFR > or = 0.75 in this patient cohort; this coincides with previous reports in patients with 1-vessel CAD. Furthermore, these results suggest that FFR is more useful than single-photon emission computed tomography for clinical decision-making and risk stratification in patients with multivessel CAD

Prognostic value of coronary blood flow velocity and myocardial perfusion in intermediate coronary narrowings and multivessel disease
Chamuleau SA, et al.
J Am Coll Cardiol 2002;39:852-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11869852
Deferral of PTCA of intermediate lesions in multivessel disease is safe when CFVR greater-than-or-equal 2.0 (event rate 6%). This selective evaluation of coronary lesion severity during cardiac catheterization allows a more accurate risk stratification than does SPECT, which is important for clinical decision making in this patient cohort.

Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina
de Feyter PJ, et al.
Circulation 2002;105:2367-72.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12021222
http://www.circulationaha.org/cgi/content/full/105/20/2367
http://www.circulationaha.org/cgi/content/abstract/105/20/2367
There was no difference in rates of death, myocardial infarction, and cerebrovascular event at 1 year in patients with unstable angina and multivessel disease treated with either stented angioplasty or bypass surgery compared with patients with stable angina. The rate of repeat revascularization of both unstable and stable angina was significantly higher in patients with stents

The effect of completeness of revascularization on event-free survival at one year in the ARTS trial
van den Brand MJ, et al.
J Am Coll Cardiol 2002;39:559-64.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=1184985
Complete revascularization was more frequently accomplished by bypass surgery than by stent implantation. One year after bypass, there was no significant difference in event-free survival between surgically treated patients with complete revascularization and those with incomplete revascularization, but patients randomized to stenting with incomplete revascularization had a greater need for subsequent bypass surgery.