Professor Gilles Montalescot (Pitié-Salpêtrière Hospital - Paris, France) has been at the forefront of clinical trials developing many new therapies over the past three decades and his work has been instrumental in refining clinical practice guidelines.
“Twenty years ago, I created the ACTION Group at Pitié-Salpêtrière, a not-for-profit research organisation looking to perform cardiology trials that would go on to provide real answers to important clinical questions. Much of my work has focused on antithrombotics and an early trial, ADMIRAL, led to the first demonstration that more potent platelet inhibition, using a platelet GPIIb/IIIa receptor antagonist, with stenting in acute MI halved the rate of complications [1]. Interestingly, we recently published (25 years later!) confirmation of the benefit of a new-generation drug of the same class administered during transfer of acute STEMI patients to the cathlab [2]. In addition, work on new anticoagulants showed that the low-molecular-weight heparin, enoxaparin, had favourable safety and efficacy compared with unfractionated heparin in PCI, including in primary PCI for acute MI [3,4]. These findings led to enoxaparin’s inclusion in ESC Guidelines with a class IIa recommendation, a position it continues to hold over 10 years later.
To help inform understanding of the best use of these agents, we conducted a series of studies looking at the timing of administration with a view to determining if earlier use would further improve benefits, in particular in acute MI. The answer was more complicated than we had anticipated. The ATLANTIC study indicated that early administration of an oral P2Y12 antagonist, although not improving early reperfusion, did reduce the rate of stent thrombosis without safety issues [5]. However, in the case of NSTEMI, there was no such benefit and instead there was an excess of major bleeding complications [6]. These findings are reflected in ESC Guidelines, with a class III recommendation for routine pretreatment in NSTEMI. Efforts to refine individualisation of antithrombotic therapy, including leveraging platelet function monitoring and genotyping (as shown in ARCTIC, ARCTIC-GENE and ANTARCTIC [7–9]) have so far failed to show an advantage of these more complex approaches. We are continuing to collaborate with other investigators to optimise antiplatelet use, including in trials involving patients not undergoing PCI.
Outside the sphere of antithrombotics, we recently demonstrated that in patients receiving beta-blockers after an MI, interruption of treatment was not non-inferior to continuation and had no detectable benefit on quality of life [10]. We also have a series of studies ongoing looking at lipids, including the AMUNDSEN trial, which is investigating the early use of PCSK9 inhibition before PCI in high-risk patients with acute MI. The results from this trial will be presented at a Hot Line session at ESC Congress 2026!”
“For this profession, be prepared to listen and observe, to give and share, and to face setbacks and pressure.”