Daily News 1，   CIT2010，   April 1st
Contemporary Therapy for Coronary Artery Disease
Invited Lecture 1， Plenary Hall A， 10.00-11.00

    As an overview of contemporary therapy for coronary artery disease， a contingent of invited speakers presented brief lectures and discussion on the topic in this morning’s session. The pros and cons of revascularization processes were the major themes and the latest updates from the ACC/AHA Guidelines for STEMI and PCI were outlined.

    Professor Donald Cutlip of the Harvard Clinical Research Institute， Boston， spoke on lessons learnt from recent clinical trials on the influence of diabetes on procedure outcome. Patients with diabetes have significantly increased risk of CV events due to restenosis. He presented evidence also that drug-eluting stents had fewer complications， comparing Paclitaxel-eluting， and Paclitaxel and Everolimus DES. Aggressive risk factor management to control dyslipidemia and hypertension to guideline targets dramatically reduces risk and COURAGE and BARI trials confirm that medical therapy is a very reasonable choice for the initial therapy of coronary artery disease with or without diabetes. However， patients with more extensive disease concomitant with diabetes， may be better off with initial revascularization. In this group (those with multi-vessel disease)， CABG was shown to have a significant survival advantage over PTCA (5 year survival 81%， compared to 65%). The SYNTAX five year follow-up results are eagerly awaited and the FREEDOM trial just completed will give a lot more information on the subject. But current data indicates the preference of CABG over PCI for patients with diabetes and multi-vessel CAD.

    The inadequacies of PCI were outlined by Professor David Holmes Jr. from the Mayo Clinic， Rochester， USA by looking closely at the relevant parts of the SYNTAX trial. He pointed out there are always “two sides of the coin” with respect to randomized and registry data， and consequently in the demographics of registry data - those patients who are CABG ineligible， and the CABG registry who are PCI ineligible. PCI falls short， he says， mainly because we need to treat complex anatomy and because of untreatable CTO. It is a question of degrees of complexity and the higher the SYNTAX score， MACCE rates increase. Chronic total occlusion is identified in 15% of patients referred for coronary angiography and remains the strongest independent predictor of surgical referral. Success rates are low， but where successful is associated with enhanced survival， improved LV function and symptomatic relief. However， Professor Holmes emphasized that if you are going to do it， you need to go all out and not just “give it a try”.