Mee$ng!Highlights!and!Summary...CV death •! non-fatal MI •! non-fatal stroke •!...
Transcript of Mee$ng!Highlights!and!Summary...CV death •! non-fatal MI •! non-fatal stroke •!...
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Mee$ng Highlights and Summary
Robert C. Welsh, MD, FRCPC Professor of Medicine
Director, Adult Cardiac Catheteriza$on and Interven$onal Cardiology
Co-‐Chair, Vital Heart Response Co-‐director, U of A Chest Pain Program
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Chest Pain and Minimal CAD – T. AndersonResults – Survivor analysis for Women
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Prac%cal Recommenda%ons Atrial Fibrilla$on
Plus ACS or Coronary Artery Stent
High Risk of Stroke? (CHADS2> 1)
High Risk of Bleeding?
Triple Therapy
Warfarin and Clopidogrel
ADAPTED from : Circula$on 2010; 121: 2067-‐2070
Yes
No
Yes
No Dual An$platelet Therapy
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GEMINI ACS 1 Randomized, Double-‐blind, Double-‐dummy, Ac%ve-‐controlled, Parallel-‐group, Mul%center Study to Compare the Safety of Rivaroxaban versus Acetylsalicylic Acid in Addi%on to Either Clopidogrel or Ticagrelor Therapy in Subjects with Acute
Coronary Syndrome Biomarker posi%ve ACS Managed with DAPT
ASA + Clopidogrel ASA + Ticagrelor
ASA 100mg
Rivaroxaban 2.5 mg bid
ASA 100 mg
Rivaroxaban 2.5 mg bid
Primary safety endpoint: Combined TIMI bleeding Exploratory efficacy endpoint: composite of CV death, MI, ischemic stroke, and stent
thrombosis.
N=3000
R 1:1
R 1:1
TicagrelorClopidogrel
Post Angiography and PCI
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30 Days or 30 Months – What is the Optimal
Duration of Dual Antiplatelet Therapy
(DAPT)?
Shaun Goodman
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Improving Care Through Systems Re-engineering
Christopher Granger, MD
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ESCAPE Outcomes
2015-‐02-‐11 www.escapetrial.org 7
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COAPT Trial Clinical Outcomes Assessment of the MitraClip Percutaneous Therapy for High Surgical Risk Pa$ents
• High surgical risk pa$ent with Mod-‐Sev / Severe Func$onal MR
• Randomized to OMT vs MitraClip + OMT • Primary Endpoint: 12 month composite:
– death (all-‐cause), stroke (major and minor), new onset or worsening of kidney dysfunc$on, le_ ventricular assist device (LVAD) implant, and heart transplant
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Transcatheter Aortic Replacement: Advances in Technology,
Procedure and Patient Selection
Alexander (Sandy) Dick, MD ACC Rockies, 2015
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4187 4212
4056 4051
3891 3860
3282 3231
2478 2410
1716 1726
1005 994
280 279
LCZ696 Enalapril
Enalapril (n=4212)
LCZ696 (n=4187)
HR = 0.84 (0.76-0.93) P<0.0001
Kap
lan-
Mei
er E
stim
ate
of
Cum
ulat
ive
Rat
es (%
)
Days After Randomization Patients at Risk
360 720 1080 0 180 540 900 1260 0
16
32
24
8
835
711
PARADIGM-‐HF: All cause mortality
McMurray NEJM 2014
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All-Cause Mortality
Hemorrhagic Stroke
0.90 (0.85 - 0.95)
0.49 (0.38 - 0.64)
Risk Ratio (95% CI)
p=0.0003
p<0.0001
Favors NOAC Favors Warfarin
0.2 0.5 1 2
Overview of 4 Trials of Novel Agents vs Warfarin in 72,000 Patients (Lancet December 2013)
Heterogeneity p=NS for all outcomes Ruff CT, et al. Lancet 2013 [in-press]
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AVERROES Study: Bleeding Analysis Bleeding events
ICH: 11 apix, 13 ASA
Flaker G. Stroke. 2012;43:3291-7
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IMPROVE-IT vs. CTT: Ezetimibe vs. Statin Benefit
CTT Collaboration. Lancet 2005; 366:1267-78; Lancet 2010;376:1670-81.
IMPROVE-IT
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PCSK9 Outcome Trials Alirocumab Evolocumab Bococizumab
Trial ODYSSEY Outcomes (secondary prevention)
FOURIER (secondary prevention)
SPIRE1 (secondary prevention)
SPIRE2 (primary prevention)
No of patients 18000 22500 12000 6300 Dosage s/c, Q2W s/c, Q2W or Q4W s/c, Q2W s/c, Q2W
Start date Oct 2012 Jan 2013 Oct 2013 Oct 2013
Expected End date Mar 2018 Feb 2018 Aug 2017 Aug 2017 Primary endpoint
• CHD death • non-fatal MI • fatal and non-fatal ischemic stroke • high risk UA
requiring hospitalization
• CV death • MI • Stroke • hospitalization for
UA • coronary
revascularization
• CV death • non-fatal MI • non-fatal stroke • hospitalization for
UA needing urgent revascularization
• CV death • non-fatal MI • non fatal stroke • hospitalization for
UA needing urgent revascularization
Duration Up to Month 64 Up to 5 years Up to Month 60 Up to Month 60
Population Patients 4 to 52 wks post ACS • LDL-C ≥70 (1.8)
History of clinically evident CVD: MI, stroke or symptomatic PAD and ≥1 major RF or ≥ 2 minor RFs • LDL-C ≥70 (1.8) or
High risk patients • LDL-C ≥70 (1.8) and
<100 (2.6) or
High risk subjects • LDL-C ≥100 (2.6) or
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Heart Failure Anthracyclines
Trastuzumab Suni%nib
High dose cyclophosphamide
Thrombosis
Tamoxifen
Cispla$n
Hypertension
Bevaci-‐ zumab
Ischemia
5-‐FU/Capecitabine
Sorafenib
Taxanes Anastrazole
Bortezomib
Cardiovascular Effects of Common Cancer Treatments
Chest Irradia%on
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Mee$ng Highlights and Summary
CCS Stable Ischemic Heart Disease Workshop CCS Atrial Fibrilla$on Workshop
CVC Research Symposium Diabetes Workshop
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Evalua%ons
• Please complete your evalua$ons! • CCS workshops • Cer$ficates of par$cipa$on can be picked up from Hospitality Desk upon submission of completed evalua$on form
25 credits
Section 1 - Accredited group learning activity Maintenance of Certification Royal College of Physicians and Surgeons of Canada
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Acknowledgments ACC Rockies CommiRees
• Scien%fic CommiRee – Drs. T. Anderson, J. Genest, B. Gersh, J. Kornder, & R. Welsh
• Organizing CommiRee – Drs. J. Genest & R. Welsh, Evidence Based Marke$ng (Karen and Clay Earl)
• Rimrock Resort Hotel
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