The COURAGE trial found that adding PCI to optimal medical therapy did not reduce the risk of death or heart attack compared to medical therapy alone in stable coronary artery disease patients over a median 4.6 years. PCI did provide better relief of angina. The MERLIN TIMI-36 trial found that adding ranolazine to standard therapy reduced recurrent ischemia in NSTE-ACS patients compared to placebo with no increase in safety issues. A Danish registry study reported higher rates of late stent thrombosis over 1 year with drug-eluting stents compared to bare-metal stents based on ARC definitions.
A great deal is happening in lupus-related research. This presentation will update participants on recent research developments and their impact on those affected by lupus. Dr. Petri will provide an overview of current lupus research and the prospects for the future of lupus treatments. Learn how to better manage your lupus and make knowledgeable decisions regarding your treatment plan.
A great deal is happening in lupus-related research. This presentation will update participants on recent research developments and their impact on those affected by lupus. Dr. Petri will provide an overview of current lupus research and the prospects for the future of lupus treatments. Learn how to better manage your lupus and make knowledgeable decisions regarding your treatment plan.
Was recently asked to discuss whether there is evidence to support the use of B vitamins in managing different aches and pains. Here's my talk delivered last 16 Sept 2016 at the 12th Post Graduate Course of the East Avenue Medical Center Department of Internal Medicine.
Reducing Perioperative Cardiac Risk: Do Beta blockers Help?Terry Shaneyfelt
Review of the effect of beta blockers on perioperative cardiac events including updated recommendations by the ACC/AHA (August 2014. Watch my YouTube video (http://youtu.be/WPLXDm9Nzoc) describing these slides.
Was recently asked to discuss whether there is evidence to support the use of B vitamins in managing different aches and pains. Here's my talk delivered last 16 Sept 2016 at the 12th Post Graduate Course of the East Avenue Medical Center Department of Internal Medicine.
Reducing Perioperative Cardiac Risk: Do Beta blockers Help?Terry Shaneyfelt
Review of the effect of beta blockers on perioperative cardiac events including updated recommendations by the ACC/AHA (August 2014. Watch my YouTube video (http://youtu.be/WPLXDm9Nzoc) describing these slides.
• Coeliac disease is a genetically-determined chronic inflammatory intestinal disease induced by an environmental precipitant, gluten.
• Patients with the disease might have mainly non-gastrointestinal symptoms, and as a result patients present to various medical practitioners.
• Epidemiological studies have shown that coeliac disease is very common and affects about one in 250 people.
• The disease is associated with an increased rate of osteoporosis, autoimmune diseases, and malignant disease, especially lymphomas.
• The mechanism of the intestinal immune-mediated response is not completely clear, but involves an HLA-DQ2 or HLA-DQ8 restricted T-cell immune reaction in the lamina propria as well as an immune reaction in the intestinal epithelium.
Ponencia realizada el 23 de noviembre de 2022 en CardioTV titulado 'Nuevas fronteras en la reducción del riesgo CV residual. Integrando icosapento de etilo en la práctica clínica' por el Dr. Subodh Verma
Presentations by Tawfiq Choudhury and Rocco Hadland from the second webinar of the Mastering Cholesterol webinar series on Thursday 11 May 2023, focusing on Statins.
XXVII Reunión anual de la sección de Hemodinámica y Cardiología Intervencionista
16 y 17 de junio de 2016 León
http://secardiologia.es/xxvii-reunion-anual-de-la-seccion-de-hemodinamica-y-cardiologia-intervencionista
Novedades en farmacología en intervencionismo
Antonio Fernández Ortiz (Hosp. Clínico San Carlos. Madrid)
Angina crónica estable: La punta del iceberg de la cardiopatía isquémica crónica
Congreso de las enfermedades cardiovasculares
Barcelona 22/10/2009
Sociedad Española de Cardiología
Weight diabetes and metabolic problems in patients taking atypical antipsycho...Alex J Mitchell
Free slide show on weight gain, diabetes and metabolic problems in those taking atypical antipsychotic medication in schizophrenia, bipolar disorder and related conditions. Image credits retained by original authors. Please give correct acknolwedgements if you present any material from here.
1. ACS Critical Pathways 2007 Teleconferences This activity is supported by an educational grant from the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. This activity is co-provided by the Network for Continuing Medical Education and EduPro Resources LLC. APRIL 11, 2007
2. Faculty Christopher P. Cannon, MD Associate Professor of Medicine Harvard Medical School Senior Investigator, TIMI Study Group Associate Physician, Cardiovascular Division Brigham and Women’s Hospital Boston, Massachusetts
3. The Network for Continuing Medical Education and EduPro Resources LLC require that CME/CNE faculty disclose, during the planning of an activity, the existence of any personal financial or other relationships they or their spouses/partners have with the commercial supporter of the activity or with the manufacturer of any commercial product or service discussed in the activity. Disclosure Statement
4. Christopher P. Cannon, MD , has served as a consultant to Abbott Laboratories, Alnylam Pharmaceuticals, Arena Pharmaceuticals, AstraZeneca Pharmaceuticals LP, Biosite, Bristol-Myers Squibb Company, Eisai Inc., GlaxoSmithKline, Johnson & Johnson, Merck & Co., Inc., Pfizer Inc, sanofi-aventis, Schering-Plough Corporation, Tethys Bioscience, and Vertex Pharmaceuticals. He has received honoraria from Accumetrics, AstraZeneca Pharmaceuticals LP, BGB New York, Bristol-Myers Squibb Company, DIME, Genentech, Inc., Merck & Co. Inc., Pfizer Inc, sanofi-aventis, and Schering-Plough Corporation, and has received research support from Accumetrics, AstraZeneca Pharmaceuticals LP, Merck & Co., Inc., and Schering-Plough Corporation. The team from Aurora St. Luke's Medical Center reports no such relationships. Faculty Disclosure Statement
5. Highlights From the American College of Cardiology 2007 Annual Scientific Session Christopher P. Cannon, MD
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7. COURAGE C linical O utcomes U tilizing R evascularization and A ggressive G uideline-Driven Drug E valuation
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12. COURAGE: Risk Factor Goals Boden WE, et al. N Engl J Med. 2007;356. Published online March 27, 2007. 30-45 min. moderate intensity 5x/week Physical Activity Initial BMI Weight Loss Goal 25-27.5 BMI <25 >27.5 10% relative weight loss Body Weight by BMI <130/85 mm Hg Blood Pressure HbA lc <7.0% Diabetes <200 mg/day Dietary Cholesterol 60-85 mg/dL LDL-C (primary goal) >40 mg/dL HDL-C (secondary goal) <150 mg/dL Triglyceride (secondary goal) <30% calories / <7% calories Total Dietary Fat / Saturated Fat Cessation Smoking Goal Variable
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15. COURAGE: Baseline Characteristics – Angina Boden WE, et al. N Engl J Med. 2007;356. Published online March 27, 2007. .24 .53 .83 148 (13) 341 (30) 425 (37) 221 (19) 2 (<1) 5 1-15 3 1-6 135 (12) 340 (30) 409 (36) 261 (23) 3 (<1) 5 1-15 3 1-6 Angina CCS class (no, %) 0 I II III Missing data Duration of angina (months) Median Interquartile range Episodes/week with exertion or at rest within last month Median Interquartile range P value OMT (N = 1138) PCI + OMT (N = 1149) Characteristic
16. COURAGE: Survival Free of Death From Any Cause and MI No. at Risk OMT 1138 1017 959 834 638 408 192 30 PCI+OMT 1149 1013 952 833 637 417 200 35 Years 0 1 2 3 4 5 6 0.0 0.5 0.6 0.7 0.8 0.9 1.0 PCI + OMT: 19%* OMT: 18.5%* Hazard ratio: 1.05 95% CI (0.87-1.27) P = .62 7 Boden WE, et al. N Engl J Med. 2007;356. Published online March 27, 2007. Survival Free of Death From Any Cause and MI *Cumulative event rates at a median of 4.6 years.
17. COURAGE: Cumulative Event Rates at a Median of 4.6 Years <.001 0.51–0.71 0.60 32.6 21.1 Revasc. (PCI or CABG) .56 0.84–1.37 1.07 11.8 12.4 Hospitalization for ACS .19 0.80–3.04 1.56 1.8 2.1 Stroke .33 0.89–1.43 1.13 12.3 13.2 Nonfatal MI .38 0.65–1.16 0.87 8.3 7.6 Death .62 0.87–1.27 1.05 19.5 20 Death, MI, stroke .62 0.87–1.27 1.05 18.5 19 Death, MI P value 95% CI Hazard ratio OMT (%) PCI + OMT (%) Outcome Boden WE, et al. N Engl J Med. 2007;356. Published online March 27, 2007.
18. COURAGE: Overall Survival No. at Risk OMT 1138 1073 1029 917 717 468 302 38 PCI+OMT 1149 1094 1051 929 733 488 312 44 Years 0 1 2 3 4 5 6 0.0 0.5 0.6 0.7 0.8 0.9 1.0 PCI + OMT: 7.6%* OMT: 8.3%* 7 Hazard ratio: 0.87 95% CI (0.65-1.16) P = .38 Boden WE, et al. N Engl J Med. 2007;356. Published online March 27, 2007. Overall Survival *Cumulative event rates at a median of 4.6 years.
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21. MERLIN TIMI-36 M etabolic E fficiency with R anolazine for L ess I schemia in N on-ST Elevation Acute Coronary Syndromes
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23. MERLIN TIMI-36: Study Design Follow-up visits: Day 14, Month 4, Q4 Months Placebo (n = 3,281) Matched IV/PO Ranolazine (n = 3,279) IV -> PO Standard Therapy for ACS Morrow DA, et al. Am Heart J. 2006;151:1186. UA/NSTEMI (N = 6560) 1) Rest symptoms within 48 h 2) High-risk features Holter monitoring at enrollment x 7d Final Visit Additional end points : Exercise performance, new/worsening heart failure, quality of life, extent of myocardial injury, clinically significant arrhythmia . Duration Event-driven Mean Follow-up: Median, 348 Days Primary end point: Composite of CV death, MI, or recurrent ischemia Secondary end point: Composites of CV death, MI, severe recurrent ischemia; and positive Holter at 30 days
24. MERLIN: Efficacy Results Morrow D, et al. Presented at: American College of Cardiology 2007 Scientific Sessions; March 27, 2007; New Orleans, Louisiana. .030 0.87 13.9 16.1 Recurrent ischemia .87 0.99 10.4 10.5 CV death/MI .11 0.92 21.8 23.5 CV death/recurrent ischemia (primary end point) P value Hazard Ratio Ranolazine (n = 3279) Placebo (n = 3281) End point
25. MERLIN: Safety Results Morrow D, et al. Presented at: American College of Cardiology 2007 Scientific Sessions; March 27, 2007; New Orleans, Louisiana. <.001 0.89 73.1% 83.1% Clinically significant arrhythmia on Holter (% of patients) .84 0.97 99 102 Symptomatic documented arrhythmia (number of patients) .43 0.87 56 65 Sudden cardiac death (number of patients) .91 0.99 172 175 Death, any cause (number of patients) P value Hazard ratio Ranolazine (n = 3268) Placebo (n = 3273) End point
32. Danish Registry: Results Maeng M, et al. Presented at: American College of Cardiology 2007 Scientific Sessions; March 24, 2007; New Orleans, Louisiana. <.0001 4.0 Data not Presented Data not Presented MI, 12-15 months .31 1.14 3.2 3.0 Overall MI .29 0.90 4.4 6.2 Overall death .029 10.9 0.09 0.009 Definite stent thrombosis, 12-15 months NS 0.92 1.8 2.15 Overall probable, possible, or definite stent thrombosis (ARC definition) <.0001 0.57 4.6 7.1 Target lesion revascularization P value Adj. RR DES (%) (n = 3268) BMS (%) (n = 8847) End point
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34. REACH Update: An International Risk Prediction Model for Recurrent CV Events Re duction of A therothrombosis for C ontinued H ealth (International Risk Reduction Model for Recurrent CV Events)
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37. REACH: Multivariable-adjusted HR and P Value for Variables Considered Morrow D, et al. Presented at: American College of Cardiology 2007 Scientific Sessions; March 27, 2007; New Orleans, Louisiana. Number at risk: 27,632; Number of events: 1,126. .2187 1.18 Hypertension therapy (yes/no) .0352 .87 Acetyl salicylic acid (yes/no) <.0001 .72 Statins (yes/no) <.0001 1.78 Cardiac failure (yes/no) <.0001 1.47 CV event in past year (yes/no) .0013 1.00, 1.20, 1.44 1, 2 or 3 vasc. beds (CAD, CVD, PAD) <.0001 1.60 Diabetes (yes/no) <.0001 1.42 Smoking (current vs other) <.0001 1.03 Age (year) .7087 1.02 Gender (male) P value HR per unit Variable (unit)
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39. ACUITY: One Year Results A cute C atheterization and U rgent I ntervention T riage Strateg Y
40. ACUITY: Patient Follow-up at 1 Year* All patients N = 13,819 25 Withdrawn 62 Lost to Follow-up Heparin + IIb/IIIa 4,516 (98.1%) 1-year FU Bivalirudin + IIb/IIIa 4,502 (97.8%) 1-year FU Bivalirudin alone 4,521 (98.0%) 1-year FU 33 Withdrawn 69 Lost to Follow-up 25 Withdrawn 66 Lost to Follow-up *End points adjudicated: Composite ischemia (death, MI, unplanned revasc) and stent thrombosis Stone GW. Presented at: American College of Cardiology 2007 Scientific Sessions; March 26, 2007; New Orleans, Louisiana. Heparin + GP IIb/IIIa 4,603 Bivalirudin + GP IIb/IIIa 4,604 Bivalirudin alone 4,612 R
41. ACUITY: Ischemic Composite End Point (Death, MI, unplanned revascularization for ischemia) 0 30 60 90 120 150 180 210 240 270 300 330 360 390 0 5 15 25 Ischemic Composite (%) Days From Randomization 10 20 UFH/Enoxaparin + IIb/IIIa Bivalirudin + IIb/IIIa Bivalirudin alone Bivalirudin alone vs Hep + GPI HR [95% CI] = 1.05 (0.95-1.17) Bivalirudin + GPI vs Hep + GPI HR [95% CI] = 1.05 (0.94-1.16) UFH/Enoxaparin + GPI vs Bivalirudin + GPI vs Bivalirudin Alone Stone GW. Presented at: American College of Cardiology 2007 Scientific Sessions; March 26, 2007; New Orleans, Louisiana. Estimate P (log rank) 30-day 7.4% .36 7.8% .34 7.9% — Estimate P (log rank) 16.3% .38 16.5% .31 16.4% 1-year — P = .55
42. ACUITY: Stent Thrombosis (Protocol Defn.) 0 30 60 90 120 150 180 210 240 270 300 330 360 390 0 3 4 5 Stent Thrombosis (%) Days From Randomization 2 1 Drug-eluting Stents (DES) vs Bare-Metal Stents (BMS) Estimate P (log rank) ≥ 1 DES (N = 4630) .38 2.2% 1-year Stone GW. Presented at: American College of Cardiology 2007 Scientific Sessions; March 26, 2007; New Orleans, Louisiana. All BMS (N = 2528) 2.3% All (N = 7158) 2.2%
43. Mortality (%) Days From Randomization 0 30 60 90 120 150 180 210 240 270 300 330 360 390 0 5 15 30 10 25 20 1-year Estimate ACUITY: Impact of MI and Major Bleeding (non-CABG) in the First 30 Days on Risk of Death Over 1 Year 28.9% 12.5% 8.6% 3.4% Stone GW. Presented at: American College of Cardiology 2007 Scientific Sessions; March 26, 2007; New Orleans, Louisiana. Major Bleed only (without MI) (N = 551) 12.5% 28.9% Both MI and Major Bleed (N = 94) 3.4% No MI or Major Bleed (N = 2,557) MI only (without Major Bleed) (N = 611) 8.6%
47. Progress Checklist: Immediate Goals Circulate discharge plan and other tools to all cardiology, ED, and CV nursing staff for comments Circulate pathways to all cardiology, ED, and CV nursing staff for comments Develop draft pathways Assemble team and set up meeting of working group
48. Progress Checklist: Short-term Goals/Activities Grand rounds/conference: Cardiology/IM Grand rounds/conference: Emergency Dept. Grand rounds/conference: Nursing Circulate memo Launch critical pathways Finalize critical pathways
49. Progress Checklist: Long-term Goals/Activities NRMI AHA Get With The Guidelines ACC National Cardiovascular Data Registry CRUSADE GRACE REACH Other Monitor data: which registry?
51. Concluding Remarks Christopher P. Cannon, MD Next Program Christopher P. Cannon, MD Wednesday, May 16, 2007 12:00 Noon Eastern Time (9:00 AM Pacific Time) The AHA/ACC/SCAI/ACS/ADA Science Advisory on Prevention of Premature Discontinuation of Dual Antiplatelet Therapy in Patients With Coronary Artery Stents