The Transcatheter Cardiovascular Therapeutics meeting (September 15–19, 2003) opened its week-long meeting this year in the new Washington, DC, Convention Center, a gleaming showcase for the latest developments in diagnosing and treating heart and vascular disease. While this meeting started small 11 years ago, it has always reflected an expansive view of interventional cardiology diagnosis and treatment. So the new venue is a fitting location as TCT’s 11th Annual Meeting continues the tradition of a comprehensive educational focus for this year’s 10,000+ attendees.

Several years ago, the meeting expanded beyond the treatment of coronary artery disease to embrace the rapidly developing field of interventional treatments of vascular disease. Utilizing similar diagnostic and treatment techniques, cardiologists broadened their horizons to a range of vascular sites, including renal, superficial femoral arteries, carotid, abdominal aorta, and iliacs. All of these sites have received attention and development efforts, and while none have undergone revolutionary change, the advances have been noteworthy.

This year’s meeting continues to broaden the focus for interventional cardiologists into structural heart disease topics, as treatment options for valve disorders, septal defects, and shunts continue to grow.

What’s New
The approval of a drug-eluting stent (Johnson & Johnson) earlier this year finally delivered a highly anticipated therapy to US–based patients and cardiologists. As every month goes by, and multiple thousands of these devices are implanted in patients worldwide, the information base swells with increasingly good news and reports. The bottom line is the application of a drug on a stent has become a potent weapon against restenosis. Boston Scientific is widely expected to gain FDA clearance and market share for its competing device soon, and then it may be another year or so before other options arrive in this field.

The TCT presentations on drug-eluting stents were exhaustive, including breakfast sessions, lunchtime sessions, and evening symposia sessions ad nauseam. For the past 2 years, drug-eluting stents have been the No 1 topic. You should expect to see this topic take top billing again as the results of even more clinical trials continue to arrive, ripe for debate and discussion. While early and midterm results from this combination device have been extremely positive, cardiologists have long ago learned the benefit of reading the rest of the story, which arrives in the form of long-term results. The range of drug coatings and stents has broadened considerably (though you might know this only if you live outside the United States), and smaller companies continue to arrive with products to challenge the traditional Goliaths in this industry. Of course, a few giants in the industry are sorely in need of an approved device for the US market as well.

VP = Vulnerable Plaque Patients
VP has garnered a fair amount of attention from the cardiology elites this past year. The prospect of diagnosing and treating a vulnerable plaque (ie, a low-grade stenosis likely to rupture if untreated) is a compelling vision. To date, its entry into the spotlight has been sobering, as this condition appears to be much more systemic and widespread than imagined.

In fact, it is leading researchers to comprehend just how early and wide-spread are the incidence of arterial plaque growth. From teenagers to soccer moms, to chiefs of state, cardiovascular disease is everywhere. We have been told it is an epidemic, but when one sees the latest statistics, it makes one look harder at the salad options on the fast-food menu.

While the prospect for discrete treatment of vulnerable plaque lesions is still being researched today, the research has been expanded to encompass the entire disease state, of which these lesions are now considered an intermediate expression of the disease. So treating the disease systemically has gained much more importance and funding in the past year, and we should be looking for results from this effort over the coming year. This should go well beyond the current recommendations to watch your diet, exercise, and keep your cholesterol levels under control. The forces of molecular biology will be unleashed into this field to discover its structure and the opportunities for novel pharmaceutical treatments.

Last year, molecular cardiology and genetics were a topic for the dreamers in the crowd—this year the topic will be of mainstream research interest, as biologists, geneticists, and cardiologists begin collaborations to attack this area with systematic and penetrating research.

Imaging Still Alive
The “cath lab” world also is benefiting from the work of well-known imaging equipment manufacturers, as cardiac CT and MRI systems enter the mainstream of this cardiovascular meeting. The former cath lab will likely be expanded to incorporate a substantial addition of new diagnostic imaging machines that improve their total diagnostic and treatment capabilities. Cardiac MRI has rapidly emerged as the preferred tool for pediatric cardiology diagnosis of congenital heart defects, and more cardiac MRI systems are entering the market due to the need to perform imaging studies on an emergency basis.

Information Drives Value
It is part of the rigorous approach of this group of data-driven cardiologists to continually collect and examine information to develop optimal treatment strategies for individual patient groups. The one-size-fits-all approach to diagnosing and treating cardiovascular disease does not sit well with this group, so the volume of clinical trials continues to expand at an ever-increasing rate. While the pace of technical innovation continues in the cardiovascular field, the data analysis of these innovations continues to grow at an even faster rate.

Doug Orr, president of J&M Group (Ridgefield Conn, consults with medical device
companies in strategy and business development for emerging growth markets, notably radiology and cardiology. Comments and suggestions can be sent to dforr@aol.com.