The main advances in interventional cardiology in 2018 include the new European guidelines on revascularization, new developments in the treatment of cardiogenic shock, novel stent technology from Asia and clinical trial data showing no benefit of dropping aspirin after stenting.
Key advances
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The 2018 ESC guidelines on myocardial revascularization provide the most up-to-date, evidence-based consensus recommendations1.
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For patients presenting with ST-segment elevation myocardial infarction, multivessel disease and cardiogenic shock, we now know that the acute intervention should be to treat the culprit vessel only2.
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New stent technologies with thin struts, absorbable polymers and reduced drug doses are proving to be equivalent to current technology in the first year after implantation and might show benefits with longer follow-up3.
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The first absorbable scaffolds have not met clinical expectations and have been removed from the market4.
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Ticagrelor monotherapy after stent implantation did not show a benefit at 2 years compared with standard dual antiplatelet therapy5.
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References
Neumann, F. J. et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur. Heart J. https://doi.org/10.1093/eurheartj/ehy394 (2018).
Thiele, H. et al. One-year outcomes after PCI strategies in cardiogenic shock. N. Engl. J. Med. 379, 1699–16710 (2018).
Lansky, A. et al. Targeted therapy with a localised abluminal groove, low-dose sirolimus-eluting, biodegradable polymer coronary stent (TARGET All Comers): a multicentre, open-label, randomised non-inferiority trial. Lancet 392, 1117–1126 (2018).
Stone, G. W. et al. Blinded outcomes and angina assessment of coronary bioresorbable scaffolds: 30-day and 1-year results from the ABSORB IV randomised trial. Lancet 392, P1530–P1540 (2018).
Vranckx, P. et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months versus aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet 392, 940–949 (2018).
Thiele, H. et al. PCI strategies in patients with acute cyocardial infarction and cardiogenic shock. N. Engl. J. Med. 377, 2419–2432 (2017).
Wald, D. S. et al. Preventive angioplasty in myocardial infarction. N. Engl. J. Med. 370, 283 (2014).
Serruys, P. W. et al. Comparison of zotarolimus-eluting and everolimus-eluting coronary stents. N. Engl. J. Med. 363, 136–146 (2010).
Byrne, R. A. et al. Report of a European Society of Cardiology-European Association of Percutaneous Cardiovascular Interventions task force on the evaluation of coronary stents in Europe: executive summary. Eur. Heart J. 36, 2608–2620 (2015).
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A.B. has received consulting fees from Abbott Vascular, Cardinal Health and Microport, and speaker fees from Astra Zeneca.
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Baumbach, A. Advancing the evidence base in interventional cardiology. Nat Rev Cardiol 16, 79–81 (2019). https://doi.org/10.1038/s41569-018-0142-5
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DOI: https://doi.org/10.1038/s41569-018-0142-5
