4th Annual International Course «Modern Trends in the Treatment of STEMI – from Guidelines to Daily Practice» (MOSCOW-STEMI)
The 4th Annual International Course «Modern Trends in the Treatment of STEMI – from Guidelines to Daily Practice» was held in Moscow World Trade Center on October 5-7, 2016. The Course was dedicated to the 20th anniversary of Moscow City Center of interventional Cardioangiology. The program included six sessions with lectures, presentations and live case demonstration of endovascular procedures in patients with acute coronary syndrome, as well as one satellite symposium. The leading international manufacturers exhibited the samples of medical equipment and expandable materials.
Russian manufacturer of the products for interventional procedures – Angioline Ltd – held its satellite symposium «Use of Calypso Stent in Real Clinical Practice (long-term follow-up, evaluation of the effectiveness and the safety» on October 5th. The symposium was entirely dedicated to the results of the use of drug-eluting stent Calypso in everyday clinical practice. The symposium was chaired by Professor Avtandil Babunashvili. Many well-known experts from various regions of Russia took part in its work. They discussed the problems of the effectiveness of Calypso, the short- and long-term clinical follow-up of patients with various forms of coronary heart disease, presented interesting clinical cases. Active discussions concerned different aspects of the use of drug-eluting stents in the management of patients with coronary heart disease. The specialists confirmed their interest in the Russia-made products.
In accordance with the tradition, the leading Russian and foreign cardiologists took part in the work of the Course. The opening remarks were made by the Chairman of the Organizing Committee, the Director of Moscow City Center of Interventional Cardioangiology, Corresponding member of Russian Academy of Sciences, Professor David Iosseliani. The president of Russian Society of Interventional Cardioangiology Professor Alexander Osiev greeted the audience. The attendees received welcoming addresses from the Chairman of the Government of the Russian Federation Dmitry Medvedev, the Minister of Healthcare of the RF Veronica Skvortsova, the Chairman of the Executive Committee – the Executive Secretary of CIS Serguey Lebedev, the assistant of the President of the RF Academician Serguey Glaziev and other eminent persons. World-wide known experts – Cindy Grines (USA), Anthony DeMaria (USA), Andrejs Erglis (Latvia), Christoph Naber (Germany), Richard Conti (USA), Flavio Ribicini (Italy), Marie-Claude Morice (France), Florim Cuculi (Switzerland), as well as many reputed Russian specialists participated in the work of the Course. In total, 475 attendants were registered, who came from different regions – Moscow and the Moscow region, St, Petersburg, Oriol, Vladimir, Krasnodar, Ulianovsk, Grozny, Pern, Riazan, Magnitogorsk, Kaluga, Kazan, Penza, Yekaterinburg, etc.
During the first day of the Course a great interest was provoked by the lecture of Dr. C. Grines (Detroit, USA) covering the problem of the state of stents in the infarct-related artery (IRA) in the long-term follow-up. Dr. Grimes presented the results of major randomized trials concerning the various generations of the coronary stents. It is important to note the lecture of Dr. F. Ribicini (Verona, Italy), who spoke of intravascular imaging in patients with acute coronary syndrome. The lecturer presented all the routine methods of intravascular imaging used in the practice of a modern cath. lab, described in details the advantages and the drawbacks of each technique, particularly, in the context of acute myocardial infarction. Dr. Ribicini provided several interesting clinical examples illustrating the capabilities of the methods of intravascular imaging for the optimization of the tactics of interventions in patients with myocardial infarction. Between the lectures the audience watched a live case of endovascular procedure performed in Moscow City Center of Interventional Cardioangiology in a 79-years-old male with AMI. The operating team was headed by Drs. Ilya Kovalchuk and Dmitry Kurtasov. The Chairpersons and the attendees had the opportunity for remote discussion of the case, to ask questions, to share their experience, to give their recommendations. The patient underwent coronary angiography revealing the left-type coronary circulation, a critical extended stenosis of the circumflex branch of the left coronary artery (CxB LCA), as well as a chronic occlusion of the LAD. After panel discussion with the audience and the Chairpersons it was decided to perform the stenting of the affected segment of the CxB LCA supplemented by IVUS. The attempt of recanalization of the chronically occluded LAD failed. The live case provoked an active interest of the audience towards this format of conference.
An original and mostly correct position relating to the management of patients with non-STEMI was offered by the eminent American cardiologist Richard Conti (Gainesville, USA). He emphasized the necessity and the importance of a common approach to the tactics of treatment of AMI regardless of the presence or the absence of ECG changes indicating the STEMI or non-STEMI. This lecture was followed by an active and interesting discussion. Dr. F. Cuculi (Luzern, Switzerland) who has a large experience with the clinical use of bioresorbable scaffolds, reported the results of these scaffolds use in patients with AMI. Cited clinical cases illustrated the advantages and the drawbacks of bioresorbable scaffolds, that still are not fully studied in all the aspects and raise a lot of questions. In particular, it concerns the use of bioresorbable scaffolds in patients with acute coronary syndrome. The second live case from the cath.lab – a successful stenting performed in a patient with acute coronary syndrome and multivessel coronary disease – afforded ground for a vivid interesting discussion. The team headed by D.Kurtsaov and I. Kovalchuk used optical coherence tomography (OCT) and fractional flow reserve (FFR) for the diagnosis and during the intervention. OCT was used for the evaluation of eventual stent apposition in the infarct-related artery, while the degree of stenosis in other coronary arteries was assessed with FFR. The attendees could evaluate the diagnostic and the therapeutic techniques, share their own experience as well as discuss the particularities of various manipulations.
The PCR-branded session «STEMI in multivessel disease» was chaired by A. Erglis (Riga, Latvia) and C. Naber (Essen, Germany). Russian doctors Oleg Sukhorukov and Evgueny Merkulov acted as moderators. This was an interactive session: the attendees discussed a pre-recorded case with a detailed presentation of all stages of management of AMI in an elderly female in a London hospital. Successive stages and tactics of decision making and treatment of this pathology were shown from the ambulance up to the intensive care unit. During the interactive session, at the wish of the attendees, the film could be stopped, the episodes could be replayed, and everyone could make remarks, give recommendations and express wishes, share one’s opinion or tell examples from the practice. The session turned out to be fruitful and educative, the young specialists had the opportunity to contact with experienced colleagues and received their recommendations and instructions.
On the second day, the first session started with a live case from the cath. Lab of Moscow City Center of Interventional Cardioamgiology. The team of interventionists headed by Djamil Asadov and Dmitry Kurtasov performed a procedure in a 84-years-old female with complex and rare form of multivessel coronary disease with multiple aneurismal dilatations of the vessels. This ambiguous and rare case provoked a vivid discussion concerning the etiology of such changes of the coronary arteries and the pathogenesis and the causes of acute ischemia, as well as the tactics of treatment. Some experts suggested to abstain from any endovascular or surgical interventions. Taking into account the stable patient’s condition and rather severe changes, it was decided to perform coronary stenting. As a result, multiple stenting was carried out under the guidance of OCT, with good immediate results. During the same session, the well-known French cardiologist M.-C. Morice presented a lecture on the tactics of reperfusion in patients with non Q-wave MI. The eminent American Professor A. DeMaria shared his experience with the management of myocardial infarction and also presented a lecture on the follow-up of STEMI patients after endovascular reperfusion of IRA. An interesting and rather poorly studied subject of combined lesion of the treatment of patients with acute coronary syndrome and pre- existing severe aortic valve disease was highlighted in the lecture of professor A. Erglis (Riga, Latvia). It is known that aortic stenosis is a severe structural heart pathology often concomitant with acute myocardial infarction and negatively influencing the long-term prognosis. To date, there is no commonly adopted tactics of the treatment of these two associated pathologies. Just the first steps are being undertaken in this direction. While discussing the lecture, some attendees suggested the necessity of simultaneous procedures of stenting of the IRA and balloon angioplasty of the aortic valve in such patients. However, it is necessary to continue the search of the most optimal tactics for the treatment of severe concomitant pathology.
In accordance with the tradition, Dr. Tamara Djordjikia presented the long-term clinical and angiographic follow-up of patients who had been treated during the 3rd Course, and this lecture was met enthusiastically. The patients were present in the audience, and the opportunity to ask them various questions added a special originality to the session.
The seminar “Thrilling problems of out-patient cardiology - prospects of examination and rehabilitation of a coronary patient” was held within the frames of the Course by two Pirogov University clinics – the clinic of conservative endovascular and surgical cardioangiology and the clinic of general medical practice.
The formal meeting dedicated to the 20th anniversary of the foundation of Moscow City Center of Interventional Cardioangiology was held after the end of the Course. The Center’s Director, Corresponding member of the Russian Academy of Sciences, Professor David Iosseliani gave an account of the Center, described in details the history of its foundation and development, told about people who stood at the origins of the Center. The attendees commemorated the employees of the Center who had died before their time. A special place in the talk of David Iosseliani was assigned to the achievements of the Center in the development and practical introduction of new techniques of diagnosis and treatment of cardiovascular diseases. The attendees congratulated the staff of the center, presented their wishes of further fruitful work in the most important field – the preservation of people’s health.