Off to EuroPCR 2019? Expect Mitral and Tricuspid Updates, Thin-Strut Stent Surprises, and ‘Strong’ Statements

PARIS, France—Preparations are underway to mark the 30th anniversary of EuroPCR, which kicks off in the City of Light on Tuesday, May 21. But the focus of this year’s meeting, known for its gleaming gadgets and live-case action, is looking forward, not back, says course director William Wijns, MD (Lambe Institute for Translational Medicine and CÚRAM, Galway, Ireland).

“We really are not looking to the past but projecting ourselves into the future,” Wijns told TCTMD. “We spent some time with the interventional community . . . reflecting on what makes us stick together after all these years, when we have so many other new tools, e-learning, webinars, websites of all kind, etc, etc—really trying to understand what’s unique about the face-to-face interaction.”

What grew out of those discussions, says Wijns, was the decision that this year’s conference should make “a rather strong statement about the fact that meetings, where physicians can exchange and share know-how, experience, practice, and discuss cases, will always be needed.”

At EuroPCR this year, that translates into the standard mix of new trial results, registry updates, and abstract presentations—most of which are focused on emerging technology or new drug and device indications—but offset by live-case sessions, an “imaging learning center,” and beefed-up simulation sessions.

Late-Breaking Abstracts

A full 15 sessions, distributed across the first 3 days of the 4-day meeting, are designated as “late-breaking trial submissions,” although these contain a mix of first-in-man studies, early clinical studies, and updates or new analyses from trials that debuted at previous meetings. Only one “hot line” grouping gets the main-arena treatment, scheduled after the opening ceremony on Tuesday. This particular set of studies includes an analysis of mitral regurgitation reduction and outcomes from COAPT, a GLOBAL LEADERS substudy focused on complex patients, 3-year results from BIO-RESORT, and a SCAAR registry snapshot of outcomes with thin-strut stents in Sweden.

A second grouping of late-breaking trials is also worth noting: a special Lancet session on Thursday allows time for a deeper dive into five talks presented earlier in the meeting and selected by Lancet editors to be explored further in this session. These include the TRILUMINATE trial of percutaneous edge-to-edge repair for tricuspid regurgitation; the Global EXPAND study tracking early results with the next-generation MitraClip (NTR/XTR) system; a randomized trial comparing paclitaxel-coated balloon angioplasty with drug-eluting stenting in acute MI; and lastly, a trial of shorter-duration, triple antithrombotic therapy in A-fib patients undergoing coronary stenting.

Late-breaking abstract sessions elsewhere in the program are dedicated to aortic valve innovation, drug-coated balloons, mitral and tricuspid devices, bioresorbable scaffolds, renal and pulmonary artery denervation, pharmacotherapy, and thin-strut DES.

Of this mixed bag, Wijns suggested that the TRILUMINATE trial, evaluating a transcatheter clip repair system in tricuspid regurgitation, will “draw a lot of attention,” and that the thin-strut stent trials may have some surprises in store. He has “not seen the results,” he clarified, but was rather making a prediction. “After so many trials, one after another, showing noninferiority versus everolimus, we were sort of getting used to the fact that this was it, we’re not going to improve beyond [current-generation drug-eluting stents]. But I think this story is continuing and we may have underestimated the importance of strut thickness.”

Drugs, Plus Devices

“Drug and device synergy” is a key theme of this year’s program, Wijns noted. A larger number of talks this year than in the past are devoted to cardiovascular medications and their selection, combination, dosing, and duration. Included in this year’s program are sessions devoted to new diabetes drugs, options for patients at high risk of bleeding, and management of patients taking oral anticoagulants undergoing PCI.

To help attendees make sense of the existing and sometimes conflicting pharmacotherapy data, this year’s EuroPCR program offers four “PCR algorithm sessions” intended to address strategies for optimal dual antiplatelet therapy after stenting, reperfusion in STEMI, peri- and postprocedural antiplatelet therapy in patients on anticoagulation, and de-escalation of P2Y12 inhibitors following ACS.

Five Strong Positions

To TCTMD, Wijns hypothesized that one of the reasons interventional cardiology meetings like EuroPCR remain popular is that face-to-face discussion is essential in a field where evidence is not fully fleshed out for all of the tools and split-second decisions that operators have to make in a given patient. Guidelines notoriously lag behind. Perhaps in part to fill that gap, this year’s program is dotted with five formal PCR “position statements.” Some will be simultaneously published, Wijns noted, but all cover topics that represent areas of novelty or controversy which could benefit from a “strong message.”

The first, delivered by Bernard Prendergast, MD (St Thomas' Hospital, London, England), immediately following the COAPT late-breaker on Tuesday, addresses the use of percutaneous edge-to-edge repair in patients with heart failure and secondary mitral regurgitation.

Later that day, Alexandra Lansky, MD (Yale University School of Medicine, New Haven, CT), will present the PCR position statement on drug-coated balloons (DCBs) at the start of a late-breaking abstract session examining clinical outcomes after DCB use. As reported by TCTMD, the safety of paclitaxel-coated balloons for peripheral vascular disease has been a hot topic in the wake of the now famous Katsanos meta-analysis and subsequent FDA action. Of note, Lansky is delivering the PCR statement in a session dedicated to DCBs in the coronaries, although studies of peripheral DCB interventions are found elsewhere in the program.

Also Tuesday afternoon, Tom Johnson, MD (University Hospitals Bristol, England), will summarize the European Association of Percutaneous Cardiovascular Interventions expert consensus position on the clinical use of intracoronary imaging—a document slated for simultaneous publication, Wijns noted.

The fourth PCR position statement deals with patients at high risk for bleeding and will be presented as a keynote lecture by Philip Urban, MD (Hôpital de la Tour, Geneva, Switzerland), on Wednesday in the main arena; it is being simultaneously published as an Academic Research Consortium consensus document.

The fifth and final statement is a position paper on evolving indications for TAVR, which Stephan Windecker, MD (University of Bern, Switzerland), will present via a keynote lecture Thursday in the main arena.

Watch, Learn, Try

Live-case sessions have always been a core part of interventional cardiology meetings and there are a range to choose from in this year’s EuroPCR program. In a new twist, facilitators of the live cases will be able to pause the live feed to “sketch over” the paused images in order to illustrate their comments about the ongoing procedure. Wijns also stressed that this year’s programming had considered the need to allow some cases to run longer, rather than have the transmissions cut before the case is done.

The simulation sessions have also been expanded, Wijns noted. The idea for these small-group sessions was originally to teach operators the manual skills to deal with rare complications, such as stent dislodgement or balloon dysfunction. The rationale, said Wijns, is that these events might happen just once in an operator’s career, but having trained on the simulator might make the difference of life and death for the patient. This year’s simulation sessions also offer the chance to learn MitraClip deployment and transseptal puncture.

And the 30-year track record of the meeting will not be overlooked entirely. This year’s Ethica award will be given to Jean Marco, MD (University of Toulouse, France), credited with launching the first EuroPCR back in 1989. The inaugural meeting, known as the “Course on Complex Coronary Angioplasty and New Techniques in Interventional Cardiology,” took place in Toulouse, and involved just a few dozen participants. Organizers of this year’s meeting in Paris anticipate upwards of 11,000 people to attend.