Three late-breaking clinical trials – SCAAR, TACTICS and SUGAR – presented Sept. 19 during TCT 2022 offer important insights into strategies and treatment for key patient populations with coronary artery disease.

In the observational SCAAR study, researchers used data from the Swedish Coronary Angiography and Angioplasty Registry to compare survival in patients with left main coronary disease undergoing revascularization with percutaneous PCI or CABG. In presenting the findings, Elmir Omerovic, MD, PhD, said CABG "was associated with lower mortality risk" compared with PCI in this patient population. He added that "the benefit of CABG was highest in younger patients with longer life expectancy."

The multicenter, observational TACTICS study out of Japan, aimed to identify the prevalence of underlying causes of acute coronary syndrome (ACS) using optical coherence tomography (OCT)-defined morphological assessment of the culprit lesion and its impact on clinical outcomes. In presenting the results, Toshiro Shinke, MD, PhD, FACC, said OCT-guided primary PCI was applied in 40.7% of patients and changed the PCI strategy in 58.1% of the cases. According to Toshiro: "Underlying causes of ACS defined by OCT enable us to stratify the future risk of [major adverse cardiovascular events] in ACS patients indicated for primary PCI. Further study is warranted to reveal whether OCT can optimize primary PCI in each underlying cause of ACS."

In the SUGAR trial, researchers attempted to compare the second generation Amphilimus-eluting stents (Cre8 EVO) with Zotarolimus-eluting stents (Resolute Onyx) in patients with diabetes who are at increased risk of adverse events from PCI. Patients were randomized (1:1) to receive either the Cre8 EVO or the Resolute Onyx. The primary endpoint was target lesion failure at two years. In presenting the findings, Pablo Salinas, MD, and Rafael Romaguera, MD, said the trial "did not meet the primary outcome, so there is no evidence to support choosing one stent over the other, and both showed good performance." However, they noted that extended follow-up until five years is warranted.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Transcatheter Cardiovascular Therapeutics, TCT22, Percutaneous Coronary Intervention, Coronary Artery Disease, Coronary Angiography, Coronary Artery Bypass, Angioplasty, Acute Coronary Syndrome, Tomography, Optical Coherence, Drug-Eluting Stents, Diabetes Mellitus, Sirolimus

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