Consensus Update

conservative approach in patients with stable coronary artery disease. However, STS claims that the majority of patients in the ISCHEMIA trial were not representative of US patients undergoing CABG, and therefore the study did not fully represent the comparative benefits for patients who had multiple blockages in their coronary arteries.

The latest analysis, which was performed by a team of

Of the major cardiovascular society meetings coming up in 2023, the American College of Cardiology (ACC) annual meeting (4–6 March, New Orleans, USA) is the first out of the gate, with a programme that features several latebreaking trials namechecked by both Mehran and Alasnag.

Mehran highlights the release of results from the TRILUMINATE pivotal trial, the first major randomised trial evaluating the safety and efficacy of transcatheter tricuspid valve edgeto-edge repair (TEER) for severe tricuspid regurgitation (TR) as one to watch at the meeting. Trials in tricuspid interventions are of “pivotal” importance, Mehran comments, after significant previous focus has been placed on the aortic and mitral valves in the past. “New technologies are emerging that could take care of tricuspid valve regurgitation”, Mehran observed of the field in general.

TRILUMINATE is exploring the use of the Triclip (Abbott) system in patients in North America and Canada, and Mehran commented

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Continued from page 1 cardiac surgeons, cardiologists, and researchers at West Virginia University, included outcomes over a threeyear period, from 2018‒2020, capturing data from the US Centers for Medicare and Medicaid Services database for patients undergoing isolated CABG or multivessel PCI for acute coronary syndrome.

“We used one of the largest and most inclusive databases of patients hospitalised in the USA, including all patients over the age of 65 on Medicare,” said Mehaffey. “We performed a very robust statistical analysis including propensity score balancing to help ensure that the groups of patients who underwent stenting versus those who underwent bypass surgery were well matched and well balanced in order to compare their outcomes.”

The population included 104,127 patients with multivessel coronary disease, with more than 51,000 patients undergoing CABG and 52,000 undergoing PCI following the application of exclusion criteria.

According to Mehaffey, the analysis demonstrated a significantly lower hospital mortality for the patients who underwent CABG compared to those who underwent PCI. “CABG was associated with significantly improved longitudinal survival, with a nearly 60% reduction in all-cause mortality at only three years,” Mehaffey told delegates at the STS meeting, a finding that was met with a smattering of applause from members of the audience.

Additionally, the researchers found a marked reduction in both 30-day and three-year readmissions for myocardial infarction (MI). CABG patients were also significantly less likely to need any additional stenting or intervention on their coronary arteries during those three years, Mehaffey reported.

In discussion that followed the presentation at STS, speakers agreed upon the need to reappraise the recommendations within the ACC, AHA and SCAI guidelines based upon the analysis. Mehaffey commented that the findings underscore the importance of physicians “reading the fine print” when it comes to interpreting guidelines into their own practice. However, speaking to

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