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Behind the headlines: Clinical trialists deserve praise

from Cardiovascular News - Issue 69 - May 2023 - (OUS)

from Cardiovascular News - Issue 69 - May 2023 - (OUS), page 30

Conference calendar

Welcome to the May 2022 edition of Cardiovascular News, bringing you the latest news and updates from the fields of cardiovascular health, encompassing interventional cardiology and cardiac surgery.

Regular readers of this publication will already be aware of the results from the REVIVED trial, which were initially presented at the European Society of Cardiology (ESC) congress last August (26–29 August, Barcelona, Spain) with a simultaneous publication in the New England Journal of Medicine. The results, which were covered in detail in the November 2022 issue of Cardiovascular News, surprisingly showed no clear benefit of percutaneous revascularisation in patients with severe left ventricular impairment and severe coronary artery disease. In this edition, our editorial team report on more data from the trial, which suggested that viability testing, long been thought to be a useful clinical tool, does not clearly identify which patients may benefit from revascularisation.

When we read these headline results, we often fail to think about the huge amount of work that goes on behind the scenes, succeeding in delivering a trial such as this. As Divaka Perera—the trial’s lead investigator—is one of my colleagues at St Thomas’ Hospital in London, I had a glimpse into this process. The concept for the trial went back to well before 2010, with funding obtained from National Institute for Health and Care Research (NIHR) in 2013 (having been rejected by the British Heart Foundation [BHF] in 2011) and the first patient enrolled in August 2013, completing enrolment over six years later in March 2020. The phenomenal amount of work by Divaka and colleagues, as well as the London School of Hygiene and Tropical Medicine, needs to be recognised.

Also highlighted in this issue is the importance of intracoronary imaging to guide percutaneous revascularisation. There is now very good evidence for improved outcomes when routine intravascular imaging is performed. This is emphasised by the recently reported and published Renovate-Complex-PCI trial which showed a significant reduction in events associated with intravascular imaging for complex PCI. There is also growing evidence that it may benefit all patients undergoing PCI, not just those with complex lesions, which is summarised in a state-of-the-art review published in the Journal of the American College of Cardiology (JACC)

Transcatheter aortic valve implantation (TAVI) continues to expand across the globe, with a rapid movement to lower-risk, and younger, patients. As this occurs, the importance of durability and the potential for repeat procedures assumes greater importance, as highlighted in an interview with Nicolas Van Mieghem. He highlights that TAVI appears to show less valve dysfunction than surgical aortic valve replacement. Although these are sub-group analyses and more data are accumulating, it does appear to throw into debate the long-held belief that conventional surgery remains the gold standard. A further important consideration, which is likely to increase in significance as we treat younger patients, is the issue of future coronary access, which may be an important factor in initial valve selection. Guiseppe Tarantini gives an in-depth interview on the factors which need to be taken into consideration as we plan for re-do TAVI procedures, again a topic likely to assume greater importance in the years to come. We eagerly await longer-term followup of the many trials and registries highlighted. Finally, there is a detailed section on the importance and role of renal denervation for the management of hypertension, and an interview with Ruggero de Paulis, the inventor of the Valsalva graft, together with the usual sections on industry news.