10th INDIA LIVE 2019 - An Era of Emerging Technology

The 10th India Live Conference is turning out to be a gold mine of information with attendance from some of the best professionals in the field of cardiology, both from India and abroad.

Cardiovascular Diseases (CVDs) are witnessing a rise across the globe. If studies are to go by, it would be the single largest cause of death in the world accounting for more than a third of all deaths in years to come. With the disease taking an alarming shape, efforts are on to come up with better and innovative methods of treatment to curtail its spread. 

With an exhaustive scientific programme and distinguished global experts under one roof, the conference is a step forward in providing world-class, cutting-edge technologies and line of treatment based on clinical evidence for our fellow Indians.
--Dr. Ashwin B Mehta, Chief of Cardiology, Jaslok Hospitasl, Mumbai

The 10th National Conference of India Live is organised on the same lines - to exchange ideas on the latest innovations in interventional cardiology. Organised under the able leadership of Dr. Ashwin B. Mehta, Chief of Cardiology, Jaslok Hospital, Mumbai, the four-day event aims to find some simple answers to complex cardiology. More than 2,500 physicians, both from India and overseas came together to engage and share knowledge on the progress in coronary intervention.

For a better understanding, a state-of-the-art scientific programme has also been organised with complete emphasis on academics and education. The primary idea is to discuss processes that simplifies complex cardiology interventions in complex subsets like left main diseases, bifurcation lesions, CTOs, calcified lesions, graft interventions and focus on the structural interventions like TAVR, Mitral valve interventions, LAA Closures amongst others. Dr. Ajit Desai, Additional Director, Jaslok Hospital, Mumbai and the Organising Secretary of India Live, who has been instrumental in conducting this conference welcomed the cardiologists on behalf of the organising team. "Our aim is to share the best practices and that's what we intend to achieve in this conclave," he said.


India is witnessing a rise in multivessel coronary artery disease (MVD); two-thirds of the patients are receiving multivessel stenting. But with rising complexities, the choice of stent should be based on clinical evidence with proven safety and efficacy.
-- Dr. Mathew Samuel, Lilavati hospital, Mumbai

One of key speakers at the conference was Dr. Mathew Samuel - also known as the father of angioplasty in India - and credited to have introduced advanced techniques like Rotablation, Atherectomy, etc. Calling India the diabetes capital of the world, he said that in diabetics, the occurrence of coronary arteries gets smaller and progression of the disease is faster making the treatment very challenging. In such cases with Multi Vessel Disease (MVD) with DM, it is recommended to use evidence-based stents backed by robust clinical data. Giving more details about the best stent options, he said, "Among the DES types, Everolimus Eluting Stent (Xience) was found most efficacious and safe compared to other stents." He also highlighted some of the other clinical trials on diabetes like TWENTE and TUXEDO (Indian Diabetic PatientStudy), where the EES showed good clinical outcome.


Bypass surgery is the gold standard treatment for the Left main disease, but the latest clinical data in Excel study will give the confidence to physicians to treat this complex subset with evidence-based stents.
-- Dr. Samin Sharma, Mount Sinai Hospital New York, USA. 

Talking about the innovations in the field, Dr. Samin Sharma from Mount Sinai Hospital New York, USA - a pioneer in the field credited to have performed the highest number of complex coronary interventions annually with the highest success rate in angioplasty - said that newer trials in DES are enhancing the treatment options for managing complex coronary lesions like Left Main Coronary Artery Disease (LMCA). "The gold standard treatment for LMCA from decades was Coronary Artery Bypass Grafting (CABG) and it was traditionally the exclusive realm of cardiac surgeons. But the latest trials such as Excel has proved that in patients with LMCA disease who prefer a minimally invasive approach can now rest assured that a stent is as effective as a bypass surgery and is safer with fewer complications," he said.


Precision in cardiac intervention can be achieved by using FFR and OCT, which help optimize treatment procedures and present long-term solutions to reduce revision surgeries and patient re-procedure rate
-- Dr. Ajit Mullasari, Director of Cardiology, Madras Medical Mission

Getting back to interventional cardiology, Dr. Ajit Mullasari of Madras Medical Mission, Chennai, spoke about how it is getting more advanced and precise and is culminating towards precision PCI. His centre caters to complex patients and uses Optical Coherence Tomography (OCT) and Fractional Flow Reserve (FFR) technologies for precision and good clinical outcomes. "OCT helps in choosing the right stent and how it should be placed. It also helps in validating if the stent is well expanded and properly placed, thereby helping to avoid any post-treatment complications."

Experts also discussed how in 2016, for the first time in a late breaking trial, EXCEL was presented, which highlighted that PCI with an Everolimus eluting DES (Xience) is achieving the same clinical results in treating LMCA disease as compared to CABG. The trial showed equivalent result in the end results between PCI with DES and CABG with very low complications in patients treated with DES in LMCA disease.


Selection of the drug eluting stent should always be guided by clinical evidence supporting the device. It is in everyone's interest, to achieve superior outcomes by using the best quality evidence-based stents.
-- Dr. Mitchell Krucoff, Duke Clinical Research Institute, USA

Bringing a global perspective to the table was Dr. Krucoff of Duke Clinical Research Institute, USA. "Providing the best treatment based on clinical evidence is the need of the hour," he said. "In India, there are more than 50 DES brands available, but the quality of outcome and evidence varies significantly." He explained that DES is a permanent implant, because of which, it takes larger study cohorts, longer follow-up and global publications of research findings to really understand the behaviour of a particular DES platform.

To combat CVDs effectively, stakeholders from the entire healthcare value chain need to collaborate and identify innovations that would help in arresting the disease and the deaths leading from it. And the India Live Conference is a step towards that. 

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