Hot Line VI Coronary Artery Disease
Hot Line VI Coronary Artery Disease
Mark Creager, MD, president of the American Heart Association, and Elliott Antman, MD discuss trials presented at Hot Line VI on Coronary Artery Disease at the European Society of Cardiology Congress 2015, including PRESERVATION I, ABSORB STEMI TROFI II, and ABSORB Japan.
Content
1.83 -> CREAMER: Hi. I'm Mark Creager, president of the American Heart Association and with me
6.83 -> is Dr. Elliott Antman, past president of
the American Heart Association, and we're
11.33 -> in London at the European Society of
Cardiology Congress where it's been a
15.269 -> terrific week. A lot of new information
is coming out, particularly at their late
20.27 -> breaking clinical trial sessions, which
they call a Hot Line session here.
24.51 -> Today's Hot Line session dealt with
coronary artery disease with new
28.64 -> approaches using biotechnology, and there were several very interesting studies,
34.32 -> one using a bioabsorbable cardiac matrix to prevent left ventricular
40.66 -> remodeling and others using a
bioresorbable vascular scaffold for
46.56 -> treating coronary artery disease. Elliott, you were there. ANTMAN: Yes it was a very
50.81 -> interesting session, Mark, and we're going to go through a little bit of this
55.79 -> technology, this biotechnology. We have to explain some terms here. So the study
61.78 -> that we want to discuss first is
the one that used a bioabsorbable
65.339 -> cardiac matrix. So since the session
dealt with patients with coronary artery
70.73 -> disease the study enrolled about 300
patients who have an ST-elevation
75.62 -> myocardial infarction, and they were
treated with a substance which initially
82.12 -> is in liquid form. It's injected down the
coronary, and then it
87.2 -> complexes with calcium and becomes this bioabsorbable cardiac matrix. And the
92.42 -> attempt here was to strengthen the left
ventricular myocardium and prevent left
96.84 -> ventricular remodeling, and the endpoint
was left ventricular end-diastolic
101.32 -> volume index. Despite all this wonderful
biotechnology,
106.99 -> this did not show any difference
compared to a control group with respect
111.759 -> to the left ventricular end-diastolic
volume index. It's not clear why this
116.439 -> didn't work in this clinical trial when
it did seem to work in some animal
121.07 -> models. Perhaps the patients just simply
had such a large in truck that it was
125.92 -> not possible to actually make any dent
in the left ventricular remodeling that
131.09 -> was occurring in them, but it was a very
interesting example of using
135.88 -> biotechnology in patients with coronary
artery disease. There were two other
141.08 -> studies that also used by technology and
here's where the term is a little bit
146.519 -> different. These are bioresorbable
vascular scaffolds. Essentially it's an
151.29 -> absorbable stent, and when I first
heard about these, I said well that
157.53 -> doesn't make sense because I had always
been taught that the metal stent that
162.43 -> we're accustomed to is a scaffold and
prevents the vessel from collapsing and
167.14 -> I thought it ought to stay there, but,
you know, that's necessarily true, so
171.829 -> these are bioresorbable vascular
scaffolds, studied in one instance in
177.329 -> the ABSORB STEMI study, about 200
patients there, and the other in ABSORB
183.22 -> Japan, where there were about 400 patients studied. And it was the same approach
187.489 -> basically to use these bioresorbable
vascular scaffolds to see whether
193.47 -> the intermediate and somewhat longer-term follow-up indicated that these are safe
199.23 -> to use. And they used measures of
restenosis, apposition of the new
207.9 -> to type of scalpel to the wall of the
coronary artery. It turned out these were
214.159 -> noninferior to the standard metal stents,
so this is a quite an interesting
219.18 -> observation. So as opposed to the
bioabsorbable cardiac matrix which was
224.599 -> not a positive study, these two
bioresorbable vascular scaffold studies
231.01 -> show they were noninferior compared
to the metal stents, and I think more
235.079 -> needs to be done with this. We may see
these types of vascular scaffolds used
241.379 -> more and more in the future. CREAGER: So very important studies, one unfortunately negative,
246.109 -> but important nonetheless, testing a
technology that looks favorable in
250.349 -> pre-clinical trials and these other two
trials also important showing at least
255.81 -> safety and comparable efficacy
to, over the short term... [ANTMAN: Yes.] ...to more
263.229 -> traditional treatment of coronary artery
disease, but we don't know long-term yet,
267.27 -> and obviously outcome studies will have
to take place. ANTMAN: Absolutely, and Mark, there's
271.32 -> something we really need to emphasize
here. You know, with all this excitement about the
275.289 -> new approaches with biotechnology, we
must not lose sight of the importance of
280.31 -> what we know works, the guideline-directed medical therapy which has now
284.56 -> been shown to save lives and prevent
recurrent events in patients with
289.47 -> coronary artery disease. All of these
studies kept that guideline-directed
293.849 -> medical therapy in the background, so
these are evaluations of new biotechnology on
298.76 -> top of that. CREAGER: Right. So we're making advances, we're learning new things, and this field
303.849 -> is moving on, and it's certainly going
to continue to inform how we take care
307.84 -> of patients. ANTMAN: Absolutely, it was an exciting day. CREAGER: Right. And it's an exciting meeting,
311.449 -> and it's terrific to be here in London
this week.
Source: https://www.youtube.com/watch?v=EQQNZVhgH1A