EVAOLD
Firstly, Professor Gilles Barone-Rochette (University Hospital of Grenoble - La Tronche, France) presented results from the EVAOLD trial comparing stress imaging-guided selective invasive management with routine invasive management for patients aged 80 years or older with NSTEMI. The trial was stopped for futility at the first prespecified interim analysis because the conditional power to demonstrate noninferiority was low for the primary endpoint of all-cause death, nonfatal MI and nonfatal stroke at 1 year. “The trial also showed that implementing the stress imaging-guided strategy was challenging in this population, which is an important finding in itself,” concluded Prof. Barone-Rochette.
ISOLEDS
Next, Professor Yong Zeng (Beijing AnZhen Hospital, Capital Medical University - Beijing, China) presented ISOLEDS, a trial dedicated to comparing OCT vs. IVUS for PCI guidance in patients with true distal left main bifurcation lesions. At a median follow-up of 362 days, target lesion failure with OCT-guided PCI was noninferior to IVUS-guided PCI (12-month Kaplan–Meier estimates: 14.4% vs. 19.6%; adjusted hazard ratio 0.90; 95% CI 0.59 to 1.36; p for noninferiority=0.0003). Prof. Zeng noted: “These findings do not establish equivalence or superiority. In practice, selection of the imaging modality should account for coronary anatomy, image-acquisition feasibility and local expertise."
CorCal Outcomes
The CorCal Outcomes study, presented by Professor Joseph B Muhlestein (Intermountain Medical Center - Murray, USA), investigated two methods for selecting patients to receive statins for primary prevention: traditional risk factor-based assessment using the pooled cohort equations (PCE) and coronary artery calcium (CAC) measurement. After 4.2 years of follow-up, there was no difference in major CV events between the groups, with lower-than-expected event rates. The researchers found that patients randomised to the PCE group received a recommendation to initiate statins more than three times as frequently as those in the CAC group. However, patients recommended a statin based on their CAC score were much more adherent with their medication than in the PCE group.
CoCAP
Associate Professor Jonas Holm (Linkoping University Hospital - Linkoping, Sweden) ended the session by presenting results from the CoCAP trial, a substudy of the TACSI trial. He described how ticagrelor plus aspirin did not improve graft patency compared with aspirin alone, when graft patency was assessed using CCTA a mean of 20 months after CABG.
