CORDIS - Redefining PCI treatment after SELUTION DeNovo – David Hildick-Smith

Summary of the Trial and Case Presentation

Overview of the Trial

• The speaker reflects on their experience presenting in a lecture theater, likening it to PTSD from university days.

• They mention the concept of a flexible non-inferiority margin, noting its novelty and potential for adjustment during trials.

• The results show that two treatments (4.4 and 5.3) are statistically similar, indicating minimal difference between them.

Key Insights on Treatment Outcomes

• The speaker expresses disappointment at the lack of enthusiasm regarding the trial's bravery, highlighting that most participants were inexperienced with the technology used.

• Despite a high stent implantation rate (20%), the trial met its non-inferiority margin, which was unexpected but impressive.

• The speaker predicts that superiority will be established in five years based on current findings.

Significance of the Trial

• This trial is described as a "quantum shift" in interventional cardiology, emphasizing a change in approach towards stenting practices.

• Historically, stents were overused; now there's an emphasis on achieving better long-term outcomes even if initial results appear suboptimal.

Case Presentation: Clinical Example

Patient Background

• A case study is introduced involving a 55-year-old man with smoking history and hypercholesterolemia who presented with acute coronary syndrome (ACS).

Diagnostic Imaging

• Anterior ECG changes indicate significant issues; imaging shows disease along a calcified vessel but does not immediately suggest stenting.

Treatment Approach

• Initial treatment involved using progressively larger balloons to dilate narrowed vessels methodically.

• A cutting balloon technique was employed to enhance dilation effectiveness while minimizing pressure.

Outcome Assessment

• Post-treatment images reveal some residual disease but adequate blood flow (TIMI 3), indicating successful intervention despite imperfections.