Jose Tafur, MD: Managing Patient Goals Through Stent Therapy

For care providers like Jose Tafur, MD, annual medical meetings are an opportunity to assess current tools and practices against the discussions driven by newly presented data. But, more importantly, they’re an opportunity to consider more practically whether patients are receiving the best care possible.

In an interview with MD Magazine® while at the American College of Cardiology (ACC) 2019 Annual Meeting in New Orleans, LA, Tafur, an interventional cardiologist for Ochsner Medical Center, gauged the current state of stents against new ACC data, and explained how the meeting can improve his care for at-risk patients.

MD Mag: How has stent therapy progressed, and where can it go now?

Tafur: We have generations of stents. The stents have gotten so advanced that it's very hard to make them better. The question that remains to ask is: how do we manage the medications on the patient that received stents—drug-eluting stents in particular, which are probably the mainstay of therapy for coronary disease.

And there's going to be several trials presented here trying to answer that question. there's a very important trial being presented at the meeting called the AUGUSTUS Trial, in which they're going to try to evaluate how we should be treating people who get stents and have atrial fibrillation at the same time. So, they need blood thinners, they have dual antiplatelet therapy for the stents, and they also need anticoagulation for their atrial fibrillation. So, what is the best way to manage those patients?

There's a study that's trying to answer that question. It's a factorial design, and basically they're comparing whether people should get novel oral anticoagulant (NOAC) versus warfarin, and 1 anti-platelet versus 2 anti-platelet medication. So, those things are going to be discussed here.

How do physicians gauge when to apply invasive care to a cardiovascular patient?

Everything in medicine that we do is trying to do either 1 of 2 things for a patient. We’re either trying to make them live longer, or trying to make them live better. And every time we do these studies, we try to answer that question of, ‘Is this therapy going to improve mortality, or is this therapy going to improve the symptoms of the patient?’

And that's how we compare everything that we do. Everything new that comes, we compare it to a standard-of-care and decide whether those things are necessary or not, and in terms of coronary disease—which is what I do every day—there is nowadays a lot of debate on when people have stable coronary disease, whether they should be just managed medically with medications or they should have an invasive strategy using stents.

Obviously, I'm an interventional cardiologist—I will tell you everybody needs a stent, which is not true. But, how do we use this data to put it into real practice, and try to do what's best for every single patient? Meetings like this is when you hear the insights from every single expert in the world, and you try to decide what's best for you, as a physician with your particular population of patients.