Do it for the patients!

The mission of EuroPCR, the official annual meeting of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), a registered branch of the European Society of Cardiology (ESC), is to contribute to the advancement of professional education and information in the field of cardiovascular intervention. This endeavour is one of the essential means by which EAPCI and EuroPCR can contribute to reducing the burden of cardiovascular disease.
The key message of this 2009 EuroPCR edition is...

"Do it for the patients"

This message translates the ambition of EuroPCR - to be the leader in professional education and information in the field of cardiovascular interventions, by constantly focusing on patient-centred messages, strong work ethics and by collaborating with synergistic relationships.
EuroPCR promotes a strong relationship between the members of a Heart Team or a Vascular Team, all working together with one common objective, namely to identify "what is the best treatment option for each individual patient".
The close and growing collaboration between the European Association of Cardio-Thoracic Surgery (EACTS), the ESC Working Group on Cardiovascular Surgery, EAPCI and EuroPCR should serve as a role model. We wish to trigger similar synergies at all levels of our constituencies, first and foremost, at the patients′ bedside.
By sharing the best of our knowledge and experiences, by teaching and learning, back and forth, we will be able to demonstrate that current percutaneous cardiovascular interventions are safe and effective; that percutaneous cardiovascular interventions improve quality of life; that percutaneous cardiovascular interventions decrease mortality in appropriately selected patients.
Above all, the objective is to propose to each individual patient the best option and not to replace existing treatment modalities at any cost.

Today, as much as yesterday, it is not acceptable to automatically use percutaneous cardiovascular interventions as the default therapy, deferring the well validated surgical approach, that is certainly more invasive, but also more appropriate in given patients. This requires strong work ethics in delivering unbiased synthesis of scientific data derived from trials, studies or registries on epidemiology, diagnosis and treatment of cardiovascular disease. For this process to be successful, we need to critically assess, with a positive and open-minded spirit“what data matters”.

What data matters

Understanding "what data matters" is one essential asset of robust medical information, and the angular foundation of our daily practice. However, practitioners are aware of the difficulty in keeping up with constant changes in our specialities. We are faced with the continual challenge of obtaining quality clinical answers to questions concerning the best treatment option at the first stage of disease, or if the patient is unresponsive or has a recurrence. Nevertheless, our patients and our referents rely on us to propose the correct answers.
Finding those answers in scientific journals or congress reports may be difficult. The flow of data has become overwhelming and many practitioners have lost track monitoring the literature. The critical interpretation of limits and true implication of published data should not be an intellectual exercise in futility nor should it remain the prerogative of small groups of experts or elite members of scientific clubs. Understanding "what data matters&q allows us to remain impermeable to information that is biased by marketing objectives or tainted by other forms of conflict of interest.

A part of the mission of EuroPCR is to explain how this critical understanding of "what data matters" is important for each of us, in order to improve the quality of care, while taking into consideration the patient’s diversities, differences in culture, local constraints and regulations.
Evidence based medicine is considered as the gold standard of contemporary knowledge, empowering modern clinical practice.
However, the “evidence” as we refer to it, is an essential piece of the puzzle that is shaping our opinion and informing our practice.
Only when completed will this puzzle allow us to propose to each individual patient one or two treatment option(s) identified as the best in her (his) case from a set of possible options.
A search for excellence in healthcare requires that every physician engages in a thinking process that eventually integrates all shades of grey from the automatic application of evidence-based recommendations to purely intuitive reasoning, into a clearheaded judgementsupported by lots of good common sense. This form of judgement requires an organised approach to thinking about the puzzle of the clinical decision-making process, supported by appraisal of each individual patient data, a synthesis of evidence-based knowledge, as well as opinions (meaning experience). Once consolidated, the end result of this thinking process needs to be communicated to patients and relatives under the umbrella of proper ethics of information.
Controversial discussions on best revascularisation strategies for very elderly or diabetic patients can serve as an example of how to implement this process. We are and will be faced in the near future with an increasing number of patients and clinical scenarios to be treated, in the absence of strong evidence. Only judgement built through a team approach that integrates ethics of information will likely approach a recommendation closest to the best treatment for each individual patient.

Innovation and new technology

Implementation of innovation and new technologies is essential in reducing the burden of cardiovascular disease. Thanks to innovation in the field of percutaneous cardiovascular interventions, we now have the ability to approach patients with very complex anatomies who would otherwise be candidates for conventional or new surgical techniques. However, just because percutaneous cardiovascular intervention is feasible does not mean that it should be proposed as the sole option, let alone performed. At each stage of innovation new dramatic claims are made that are often prone to exaggeration. All too often we have witnessed that after longer follow-up periods or further larger trials, only a modest benefit of the promising new revolutionary approach remains, ‘regression’ to the truth occurs and initial claims are revised.
We have learnt in the recent past how the fast, widespread use of drug-eluting stents by extension of indications in patients with very complex coronary anatomies has led to more than controversial or disappointing results, with an undervaluation of their performance and a negative perception of percutaneous coronary interventional procedures in general as a consequence.

While promoting the need and the strength of innovation, with a positive and constructive spirit during EuroPCR 2009, we should explain that an overly rapid widespread application of the latest technologies does not always serve excellence in health care, even if this seems attractive to doctors and patients.
We will promote the beneficial aspects of a scientific and ethical appraisal of innovative data, leaving time for discussion of the different treatment options in a Heart or Vascular Team environment, while sharing different viewpoints in a climate of mutual confidence.

Putting these principles into practice is a difficult challenge that implies we agree to share the concept of ethics and resist any form of conflict of interest in the hope of constructively discussing divergence in opinion.

European Clinical Research Renaissance – together we achieve more

Clinical evaluation and implementation of innovation entails a strong, well-structured and costly collaborative journey between all stakeholders involved with clinical research. Both industry-driven and investigator-driven research have strengths and weaknesses. In addition, trials are all too often of limited clinical relevance and generalisation of the results is questionable.

A worrisome trend is that the cardiovascular community is becoming sceptical regarding the true clinical value of "evidence" derived from current research strategies.

Could an independent, federating body not provide the community with a solution by uniting the best European intellectual forces and developing an innovative concept of European clinical trials?

In stimulating individual creativity to move forward to a common concept on research processes, we will be able to anticipate the possible evolutions of our specialities and to craft a clear vision for the future.

As it stands, individual initiatives are often chaotic, redundant or dispersed, and will never provide the productive strength of a coordinated European research plan. We have the intellectual capacity and the required infrastructure to reach this innovative objective of a European Research Federation.

To move forward in this direction, we must rally together, joining both the individual and collective creativity of all ESC affiliated National Working Groups and EACTS around a project that is innovative, resulting in both intellectual and promotional satisfaction. By doing so, we would in fact mobilise the energy and intelligentsia and create a project of which we could all be proud.

The concept of a "European Clinical Research Renaissance", based on essential clinical patient-centred questions, as expressed by physicians who are sensitive to unmet needs may be federated around European-driven projects that could be called the "EuroTrials" project.

This "EuroTrials" project would, in the interest of the community, use the existing structures that in recent years have proven to be Europe’s leaders in several interventional cardiology domains. We must consider this as part of our European patrimony, to be preserved and nurtured, so as to become a permanent figure on the scientific landscape. EuroPCR 2009 provides us with the opportunity to share and discuss this prophetic vision of a "European Clinical Research Renaissance" project, as well as the other points raised in this editorial.

We sincerely hope to meet the expectations of all of those who choose to spend their valuable time taking part in EuroPCR 2009.

Jean Marco, Chairman of EuroPCR
William Wijns, President of EAPCI Patrick W. Serruys, Editor in Chief, EuroIntervention