Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Size: px
Start display at page:

Download "Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation"

Transcription

1 Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation Recommendations of the European Society of Cardiology Updated version December 2002

2 Task Force on management of ACS without persistent ST-segment elevation Developed by the ESC Committee for Practice Guidelines (CPG) Approved by the Board of the ESC This Task Force was entirely supported financially by the European Society of Cardiology and was developed without any involvement of pharmaceutical companies

3 Task Force Members M.E. Bertrand (FR), Chair M.L. Simoons (NL) L.C. Wallentin (SE) K.A.A. Fox (GB) C.W. Hamm (DE) E.P. McFadden (FR) W. Ruzyllo (PL) P.J. De Feyter (NL) G.Specchia (IT)

4

5 ACUTE CORONARY SYNDROMES Different clinical expressions Resulting from a common underlying pathophysiological mechanism: Atherosclerotic plaque rupture (or erosion) Different degrees of superimposed thrombosis Distal embolization

6 ACS with persistent ST-segment elevation ACS without persistent ST-segment elevation Troponin or CK-MB Troponin elevated or not Myocardial infarction Unstable angina

7 Epidemiology N Countries Timing STE-ACS Non STE-ACS EuroHeart Survey 10, Sep % 51.2% Europe May 01 GRACE 11, Apr 99 30% 63% World Dec 00 Mortality and non-fatal MI at 6-month FU: 13%

8 Mechanisms Targeted approaches Inflammation Plaque rupture or erosion Stent β-blockers Myocardial Oxygen Supply Myoc demand PCI Luminal narrowing Platelet aggregation Adapted from M.J M Davies Aspirin GpIIb/IIIa receptor inhib Clopidogrel Thrombosis Nitrates Ca antagonists Vasospasm UH Heparin LMWH

9 ACS without persistent ST-segment elevation Treatment options Five categories of treatment: Anti-ischaemic agents Anti-thrombin agents Anti-platelet agents (Fibrinolytics) Coronary revascularization

10 Levels of evidence Level of evidence A Level of evidence B Level of evidence C Data derived from multiple randomized clinical trials or meta-analyses analyses Data derived from a single randomized trial or non- randomized studies Consensus opinion of the experts Early benefit ischaemia Early benefit Prevention of Death / MI Sustained Effect of Early benefit Additional Long-term Death / MI

11 Beta-blockers: Anti-ischaemic agents Three DB randomized trials comparing BB to placebo 13 % RR reduction in progression to Acute MI A B B A Nitrates No RDZ placebo-controlled trials Calcium channel blockers C (-) (-) (-) Small RDZ trials Meta-analysis on death and MI suggests that there is no prevention of death and MI B B (-) (-)

12 Heparin (UFH or LMWH) vs. Placebo 0.67 Control [95% CI] 7.9 % 10.4% UFH C B (-) (-) LMWH 0.34 Control [95% CI] 1.6 % 5.2% A A A A Heparin better Placebo better

13 Randomized trials comparing LMWH vs. UFH Randomized trials comparing LMWH vs. UFH Death and non-fatal MI

14 Death or MI (%) ASA vs. N Placebo Theroux Antiplatelets : Trials ASA vs. Placebo 479 ASA 2.46% Placebo 6.35% Lewis % 10.1% Cairns % 12.9% RISC % 17.1% Total % 11.8% 0.41 (-) A A A ASA better Pl. better

15 ADP receptor antagonists: Clopidogrel (CURE trial: 12,562 pts ) End-point CV death/mi/stroke Clopidogrel 9.3% Placebo 11.4% 0.80 P <0.001 CV death MI 5.1% 5.2% 5.2% 6.7% Death/MI 30-day 3.9% 4.8% Death/MI 9-mth 8.6% 10.5% Refractory isch. Major bleeding Minor bleeding 8.7% 3.7% 5.1% 9.3% 2.9% 2.4% <0.001 NEJM 2001;345: B B B B Clopidogrel better Placebo better

16 Gp IIb/IIIa receptor inhibitors. Death and MI at 30-day FU Seven Trials comparing GPIIb/IIIa vs Placebo in ACS: Both groups received Heparin +ASA A A A A

17 GpIIb/IIIa inhibitors and PCI: CAPTURE, PRISM-PLUS, PURSUIT combined 10% N=12,296 p=0.001 N=2,754 p=0.001 N=2,736 p= % 6% 4% 2% 0% 4.3% 2.9% Placebo 4.9% days PCI 8.0% IIb/IIIa blocker P IIb/IIIa 1.6% 1.3%

18 GpIIb/IIIa vs. Placebo : Death and non fatal MI at 30 days N patients GpIIb/IIIa Plac. Troponin (+) 4, % 12% Troponin (-) 6, % 6.2% PCI/CABG 11, % 17.3% No PCI/CABG 19, % 10.5% Diabetes 6, % 22% Diabetes (death) 6, % 6.2% GpIIb/IIIa better Placebo better

19 ACS without persistent ST-segment elevation Coronary revascularization Indications and approach depend on the extent and angiographic characteristics of the lesions Wide variation among countries In the use of coronary angiography: 52% in EuroHeartSurvey In subsequent revascularization(euroheartsurvey) : 25.4% of PCI (73.5% with stent implantation) 5.4% of CABG

20 70 Revascularization in contemporary trials % of revascularization 30.8% 28% 61% 37% 58% 37% PCI CABG Percentage Eur. H. Surv Invasive Conservative Invasive Conservative CURE TACTICS FRISC-II

21 ACS without persistent ST-segment elevation Respective Indications and Strategy! Single VD (30-38%) Usually PCI! LM (4-8%) or MVD (44-59%) Usually CABG! 2VD/3VD Evaluation on an individual basis! Invasive vs. Conservative strategy FRISC II: Revascularization at 4 days for PCI and 8 days for CABG TACTICS: Upstream Treatment with Tirofiban- Cor angio 4-48hrs RITA-3 : upstream enoxaparin At FU significant reduction of Death,or MI or Death/MI/Rec. Isch in favour of the invasive strategy

22 TACTICS, FRISC-II (6-mths), RITA-3 (1 yr) Invasive vs. Conservative strategy: Death and MI 16 22% p< Conservative Invasive % p< TACTICS FRISC-II UK MI definitions ACC/ESC MI definitions A A A A RITA-3 Percentage

23 Levels of evidence of the different therapeutic options Early benefit Reduction ischaemia Early benefit Prevention Death/MI Sustained Effect of Early benefit Additional Long-term Death/MI Beta-blockers A B B A Nitrates C (-) (-) (-) Ca Antagonists B B (-) (-) Aspirin (-) A A A Thienopyridines B B B B IIb/IIIa receptor blockers A A A A Unfractionated heparin C B (-) (-) LWMH A A A C Direct antithrombins (-) A A (-) Revascularization C B B B

24 ACS Without Persistent ST-segment Elevation Risk stratification: Two types of risk Acute risk i.e. Thrombotic risk Long-term risk Underlying CAD and LV function Inflammation

25 ACS without persistent ST-segment elevation Risk assessment Thrombotic risk Recurrent ischaemia ST-segment depression Dynamic ST-segment changes Elevated troponins Thrombus on angiography Acute risk Underlying coronary artery disease Clinical markers Age History of prior MI, CABG Diabetes, HF Biological markers CRP, Fibrinogen, IL-6, BNP Renal dysfunction Angiographical markers EF Extension of vessel disease Long-term risk

26 Death/MI, Ref Ang at 30days ST-depression Inverted T- waves ECG: Risk predictor Normal 7 Transient STelevation Death/MI at 30 day s Death & MI No ST ST 1 mm ST > 2mm Death/MI at 30 day s Death & MI episodes /d 2-5 episodes /d >5 epidodes /d

27 Comparison Troponin (+ ) vs. Troponin (- ) T+ T- Death Death/MI short-term short-term 5.7% 13.4% 0.9% 3.0% N=3091 Death Death/MI long-term long-term 7% 20.2% 3.5% 9% N= Ottani et al Am Heart J 2000; 140:917 x (risk if TnT +)

28 Admission Working diagnosis Chest pain Suspicion of Acute Coronary Syndrome ECG Biochemistry Risk stratification Persistent ST elevation CK-MB Troponin No persistent ST elevation Troponin High Risk Low Risk Normal or atypical ECG changes Troponin Twice negative Probably not ACS Treatment Secondary prevention

29 Patients judged to be at high risk for progression to MI or death Heparin (LMWH or UFH), ASA, Clopidogrel, Betablockers, Nitrates h Patients with recurrent ischaemia Recurrent chest pain Dynamic ST-segment changes (ST-segment depression or transient ST segment elevation) Elevated troponin levels Diabetes Early post infarction unstable angina Haemodynamic instability Major arrhythmias (VF, VT) GpIIb/IIIa blocker & Coronary angiography In Emergency

30 Patients judged to be at low risk for progression to death or MI Heparin (LMWH or UFH), ASA, Clopidogrel, Beta-blockers, Nitrates No recurrence of chest pain within observational period No elevation of troponin or other biochemical markers of thrombosis No ST-segment depression (Negative or flat T-waves, normal ECG Repeat troponin measurements between 6 and 12 hours No ECG changes and second troponin measurement: negative Heparin discontinued Oral treatment with ASA, Clopidogrel, Beta-blockers, Nitrates) Stress test to to confirm or or to to establish a diagnosis of of CAD To assess the risk of of future events

31 Clinical suspicion of ACS Physical examination, ECG monitoring, Blood samples Persistent ST-Segment elevation Thrombolysis PCI No persistent ST-Segment elevation Heparin (LMWH or UFH), ASA, Clopidogrel*, Betablockers, Nitrates Undetermined diagnosis ASA High risk Low risk GPIIb/IIIa Cor. Angiography PCI, CABG or medical management Second troponin measurement Positive Depending upon clinical and angiographic features * omit clopidogel if the patient is likely to go to CABG within 5 days Twice negative Stress test Cor. angiography

32 ACS without persistent ST-segment elevation Long-term management Aggressive and extensive risk factor modification Patients should quit smoking ASA ( mg for life), Clopidogrel (9 months, possibly 12 months) Betablockers Lipid lowering drugs: HMG-CoA reductase inhibitors HPS, 4S, CARE, LIPID, (A to Z ongoing) ACE inhibitors (HOPE), (EUROPA, PEACE ongoing)

33 Guidelines: ACS without persistent ST-segment elevation Caveats Guidelines are based upon evidence resulting from many clinical trials: These trials were restricted to selected populations Guidelines describe the current knowledge but They do not give the solution for an individual patient Clinical science is different from Practice

34 Conclusion (1) Importance of risk-stratification To perform the triage To choose the best strategy To predict the prognosis

35 Conclusion (2) High-risk patients require: Aggressive anti-thrombotic treatment Antithrombin agents Aggressive antiplatelet treatment: blockade of the three principal pathways ASA Clopidogrel GpIIb/IIIa Invasive strategy PCI prepared by upstream treatment Rapidly evolving field: frequent update Needs for implementation programme across Europe

36 The End

Dual Antiplatelet Therapy. Stephen Monroe, MD FACC Chattanooga Heart Institute

Dual Antiplatelet Therapy. Stephen Monroe, MD FACC Chattanooga Heart Institute Dual Antiplatelet Therapy Stephen Monroe, MD FACC Chattanooga Heart Institute Scope of Talk Identify the antiplatelet drugs and their mechanisms of action Review dual antiplatelet therapy in: The medical

More information

RISK STRATIFICATION for Acute Coronary Syndrome in the Emergency Department

RISK STRATIFICATION for Acute Coronary Syndrome in the Emergency Department RISK STRATIFICATION for Acute Coronary Syndrome in the Emergency Department Sohil Pothiawala FAMS (EM), MRCSEd (A&E), M.Med (EM), MBBS Consultant Dept. of Emergency Medicine Singapore General Hospital

More information

DUAL ANTIPLATELET THERAPY. Dr Robert S Mvungi, MD(Dar), Mmed (Wits) FCP(SA), Cert.Cardio(SA) Phy Tanzania Cardiac Society Dar es Salaam Tanzania

DUAL ANTIPLATELET THERAPY. Dr Robert S Mvungi, MD(Dar), Mmed (Wits) FCP(SA), Cert.Cardio(SA) Phy Tanzania Cardiac Society Dar es Salaam Tanzania DUAL ANTIPLATELET THERAPY Dr Robert S Mvungi, MD(Dar), Mmed (Wits) FCP(SA), Cert.Cardio(SA) Phy Tanzania Cardiac Society Dar es Salaam Tanzania DUAL ANTIPLATELET THERAPY (DAPT) Dual antiplatelet regimen

More information

Antiplatelet and Antithrombotics From clinical trials to guidelines

Antiplatelet and Antithrombotics From clinical trials to guidelines Antiplatelet and Antithrombotics From clinical trials to guidelines Ashraf Reda, MD, FESC Prof and head of Cardiology Dep. Menofiya University Preisedent of EGYBAC Chairman of WGLVR One of the big stories

More information

Rivaroxaban for acute coronary syndromes

Rivaroxaban for acute coronary syndromes Northern Treatment Advisory Group Rivaroxaban for acute coronary syndromes Lead author: Nancy Kane Regional Drug & Therapeutics Centre (Newcastle) May 2014 2014 Summary Current long-term management following

More information

Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation European Heart Journal (2002) 23, 1809 1840 doi:10.1053/euhj.2002.3385, available online at http://www.idealibrary.com on Task Force Report Management of acute coronary syndromes in patients presenting

More information

Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease

Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Home SVCC Area: English - Español - Português Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Martial G. Bourassa, MD Research Center, Montreal Heart Institute, Montreal, Quebec,

More information

Duration of Dual Antiplatelet Therapy After Coronary Stenting

Duration of Dual Antiplatelet Therapy After Coronary Stenting Duration of Dual Antiplatelet Therapy After Coronary Stenting C. DEAN KATSAMAKIS, DO, FACC, FSCAI INTERVENTIONAL CARDIOLOGIST ADVOCATE LUTHERAN GENERAL HOSPITAL INTRODUCTION Coronary artery stents are

More information

Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial

Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Apixaban Plus Mono vs. Dual Antiplatelet Therapy in Acute Coronary Syndromes: Insights from the APPRAISE-2 Trial Connie N. Hess, MD, MHS, Stefan James, MD, PhD, Renato D. Lopes, MD, PhD, Daniel M. Wojdyla,

More information

Antiaggreganti. STEMI : cosa c è di nuovo? Heartline 2015. Genova 13 14 Novembre 2015

Antiaggreganti. STEMI : cosa c è di nuovo? Heartline 2015. Genova 13 14 Novembre 2015 Heartline 2015 Genova 13 14 Novembre 2015 STEMI : cosa c è di nuovo? Antiaggreganti Luigi Oltrona Visconti Divisione di Cardiologia IRCCS Fondazione Policlinico S. Matteo Pavia STEMI : cosa c è di nuovo?

More information

Perspectives on the Selection and Duration of Dual Antiplatelet Therapy

Perspectives on the Selection and Duration of Dual Antiplatelet Therapy Perspectives on the Selection and Duration of Dual Antiplatelet Therapy Dominick J. Angiolillo, MD, PhD, FACC, FESC, FSCAI Director of Cardiovascular Research Associate Professor of Medicine University

More information

Getting smart about dyspnea and life saving drug therapy in ACS patients. Kobi George Kaplan Medical Center Rehovot

Getting smart about dyspnea and life saving drug therapy in ACS patients. Kobi George Kaplan Medical Center Rehovot Getting smart about dyspnea and life saving drug therapy in ACS patients Kobi George Kaplan Medical Center Rehovot 78 year old female Case description Presented with resting chest pain and dyspnea Co morbidities:

More information

National Medicines Information Centre

National Medicines Information Centre National Medicines Information Centre VOLUME 11 NUMBER 4 2005 ST. JAMES S HOSPITAL DUBLIN 8 TEL 01-4730589 or 1850-727-727 FAX 01-4730596 www.nmic.ie For personal use only. Not to be reproduced without

More information

Il punto sulla terapia antitrombotica nelle sindromi coronariche acute

Il punto sulla terapia antitrombotica nelle sindromi coronariche acute Santa Margherita Ligure TIGULLIO CARDIOLOGIA 2012 16-17 Febbrajo 2012 Il trattamento dell infarto miocardico acuto ad ST spraslivellato: dal territorio al laboratorio di emodinamica Il punto sulla terapia

More information

Management of Acute Coronary Syndrome / NSTEMI

Management of Acute Coronary Syndrome / NSTEMI CLINICAL GUIDELINE Management of Acute Coronary Syndrome / NSTEMI For use in (clinical areas): For use by (staff groups): For use for (patients): Document owner: Status: All clinical areas Medical and

More information

Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations.

Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations. INTRODUCTION Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations. Although decrease in cardiovascular mortality still major cause of morbidity & burden of disease.

More information

6/5/2014. Objectives. Acute Coronary Syndromes. Epidemiology. Epidemiology. Epidemiology and Health Care Impact Pathophysiology

6/5/2014. Objectives. Acute Coronary Syndromes. Epidemiology. Epidemiology. Epidemiology and Health Care Impact Pathophysiology Objectives Acute Coronary Syndromes Epidemiology and Health Care Impact Pathophysiology Unstable Angina NSTEMI STEMI Clinical Clues Pre-hospital Spokane County EMS Epidemiology About 600,000 people die

More information

Addendum to Clinical Review for NDA 22-512

Addendum to Clinical Review for NDA 22-512 Addendum to Clinical Review for DA 22-512 Drug: Sponsor: Indication: Division: Reviewers: dabigatran (Pradaxa) Boehringer Ingelheim Prevention of stroke and systemic embolism in atrial fibrillation Division

More information

Cilostazol versus Clopidogrel after Coronary Stenting

Cilostazol versus Clopidogrel after Coronary Stenting Cilostazol versus Clopidogrel after Coronary Stenting Seong-Wook Park, MD, PhD, FACC Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul, Korea AMC, 2004 Background

More information

Scelte Antitrombotiche nelle SCA delle UTIC Italiane: Nuovi Dati dal Registro EYESHOT

Scelte Antitrombotiche nelle SCA delle UTIC Italiane: Nuovi Dati dal Registro EYESHOT CARDIOLUCCA 2014 HEART CELEBRATION Lucca, palazzo Ducale Sala Ademollo 27-29 Novembre 2014 Scelte Antitrombotiche nelle SCA delle UTIC Italiane: Nuovi Dati dal Registro EYESHOT Leonardo De Luca, MD, PhD,

More information

Endoscopy & ACS. 8/1/2014 Dr. Whang

Endoscopy & ACS. 8/1/2014 Dr. Whang Endoscopy & ACS 8/1/2014 Dr. Whang Outline I. Antiplatelets II. Coronary Artery Disease in U.S. III. GI Bleeding in ACS IV. ACC/AHA guidelines: Dual Antiplatelet Therapy in CAD V. PPI and Plavix Controversy

More information

Redefining the NSTEACS pathway in London

Redefining the NSTEACS pathway in London Redefining the NSTEACS pathway in London Sotiris Antoniou Consultant Pharmacist, Cardiovascular Medicine, Barts and The London NHS Trust and Project Lead, North East London Cardiovascular and Stroke Network

More information

ESC PCI Guidelines: / Sigmund Silber et al. 1

ESC PCI Guidelines: / Sigmund Silber et al. 1 For the first time! ESC PCI Guidelines: / Sigmund Silber et al. 1 in 2002: 649.332 in 2002: 541.964 ESC PCI Guidelines: Introduction and Definitions / Sigmund Silber et al. 2 ESC PCI Guidelines: Introduction

More information

1 / 174. Xavier Bosch. Authors. Contact person. Dates. Review No. What's new

1 / 174. Xavier Bosch. Authors. Contact person. Dates. Review No. What's new Platelet glycoprotein IIb/IIIa blockers during percutaneous coronary intervention and as the initial medical treatment of non-st segment elevation acute coronary syndromes (9819) Review information Authors

More information

ACC/AHA 2009 STEMI Guideline Focused Update and What s New in 2012 Guideline

ACC/AHA 2009 STEMI Guideline Focused Update and What s New in 2012 Guideline ACC/AHA 2009 STEMI Guideline Focused Update and What s New in 2012 Guideline David Zhao, MD, FACC, FSCAI Professor of Medicine and Cardiac Surgery Harry and Shelley Page Professor in Interventional Cardiology

More information

The largest clinical study of Bayer's Xarelto (rivaroxaban) Wednesday, 14 November 2012 07:38

The largest clinical study of Bayer's Xarelto (rivaroxaban) Wednesday, 14 November 2012 07:38 Bayer HealthCare has announced the initiation of the COMPASS study, the largest clinical study of its oral anticoagulant Xarelto (rivaroxaban) to date, investigating the prevention of major adverse cardiac

More information

A PATIENT S GUIDE TO SECONDARY PREVENTION IN ACUTE CORONARY SYNDROME (ACS)

A PATIENT S GUIDE TO SECONDARY PREVENTION IN ACUTE CORONARY SYNDROME (ACS) A PATIENT S GUIDE TO SECONDARY PREVENTION IN ACUTE CORONARY SYNDROME (ACS) This medicine is subject to additional monitoring. This will allow quick identification of new safety information. If you get

More information

έΰζβν αππ έκυ,νσϊίία κν1γν πλδζέκυνβί1γ π ηία δεόμνκαλ δκζόΰκμ, θν δ υγυθ άμνγνκαλ /εάμ ΚζδθδεάμΝ υλωεζδθδεάμν

έΰζβν αππ έκυ,νσϊίία κν1γν πλδζέκυνβί1γ π ηία δεόμνκαλ δκζόΰκμ, θν δ υγυθ άμνγνκαλ /εάμ ΚζδθδεάμΝ υλωεζδθδεάμν ΝΠθ ζζάθδκνσθϋ λδκν έΰκ μνεδν ιωθκ κεκη δεάμνι λδεάμ έΰζβν έκ,νσϊίί κν1γν λδζέκνβί1γ Α Α φ ; έζ δκμννένσθόμ ηί δεόμνκλ δκζόΰκμ, θν δ γθ άμνγνκλ /εάμ ΚζδθδεάμΝ λωεζδθδεάμν ένivus Scientific Director, Mediolanum

More information

NAME OF THE HOSPITAL: 1. Coronary Balloon Angioplasty: M7F1.1/ Angioplasty with Stent(PTCA with Stent): M7F1.3

NAME OF THE HOSPITAL: 1. Coronary Balloon Angioplasty: M7F1.1/ Angioplasty with Stent(PTCA with Stent): M7F1.3 1. Coronary Balloon Angioplasty: M7F1.1/ Angioplasty with Stent(PTCA with Stent): M7F1.3 1. Name of the Procedure: Coronary Balloon Angioplasty 2. Select the Indication from the drop down of various indications

More information

URN: Family name: Given name(s): Address:

URN: Family name: Given name(s): Address: State of Queensland (Queensland Health) 2015 Licensed under: http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Contact: Clinical_Pathways_Program@health.qld.gov.au Facility:... Clinical pathways

More information

ANESTHESIA FOR PATIENTS WITH CORONARY STENTS FOR NON CARDIAC SURGERY. Dr. Mahesh Vakamudi. Professor and Head

ANESTHESIA FOR PATIENTS WITH CORONARY STENTS FOR NON CARDIAC SURGERY. Dr. Mahesh Vakamudi. Professor and Head ANESTHESIA FOR PATIENTS WITH CORONARY STENTS FOR NON CARDIAC SURGERY Dr. Mahesh Vakamudi Professor and Head Department of Anesthesiology, Critical Care and Pain Medicine Sri Ramachandra University INTRODUCTION

More information

Elderly Patients with renal insufficiency: Which anti-platelet/ Anti thrombin/minimizing Major bleeds

Elderly Patients with renal insufficiency: Which anti-platelet/ Anti thrombin/minimizing Major bleeds Elderly Patients with renal insufficiency: Which anti-platelet/ Anti thrombin/minimizing Major bleeds Blair J O Neill MD FRCPC FACC Text Professor of Medicine, University of Alberta Clinical Co-Director

More information

New Approaches to, and Indications for, Antiplatelet Therapy

New Approaches to, and Indications for, Antiplatelet Therapy New Approaches to, and Indications for, Antiplatelet Therapy Kenneth A. Bauer, MD Professor of Medicine, Harvard Medical School Chief, Hematology Section, VA Boston Healthcare System Director, Thrombosis

More information

Ischemic Heart Disease: Angina Pectoris

Ischemic Heart Disease: Angina Pectoris Ischemic Heart Disease: Angina Pectoris Robert J. Straka, Pharm.D. FCCP Associate Professor University of Minnesota College of Pharmacy Minneapolis, Minnesota, USA strak001@umn.edu Learning Objectives

More information

Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics. Yen Tibayan, M.D. Division of Cardiovascular Medicine

Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics. Yen Tibayan, M.D. Division of Cardiovascular Medicine Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics Yen Tibayan, M.D. Division of Cardiovascular Medicine Case Presentation 69 y.o. woman calls 911 with the complaint of

More information

For more information www.escardio.org/guidelines

For more information www.escardio.org/guidelines For more information www.escardio.org/guidelines Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation* The Task Force for the management

More information

Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty

Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty Round Table: Antithrombotic therapy beyond ACS Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty M. Matsagkas, MD, PhD, EBSQ-Vasc Associate Professor

More information

Marco Ferlini Struttura Semplice di Emodinamica, UO Cardiologia Dipartimento Cardiotoracovascolare Fondazione IRCCS, Policlinico San Matteo

Marco Ferlini Struttura Semplice di Emodinamica, UO Cardiologia Dipartimento Cardiotoracovascolare Fondazione IRCCS, Policlinico San Matteo Marco Ferlini Struttura Semplice di Emodinamica, UO Cardiologia Dipartimento Cardiotoracovascolare Fondazione IRCCS, Policlinico San Matteo Acute Coronary Syndromes: oral antithrombotic therapy Focus on

More information

EMR Tutorial Acute Coronary Syndrome

EMR Tutorial Acute Coronary Syndrome EMR Tutorial Acute Coronary Syndrome How to find the Acute Coronary Syndrome AAA Home Page 1 of 26 Master Tool Bar Icon When the Template button is clicked you will be presented with the preference list.

More information

SIGN 93 Acute coronary syndromes. A national clinical guideline Updated February 2013

SIGN 93 Acute coronary syndromes. A national clinical guideline Updated February 2013 Help us to improve SIGN guidelines - click here to complete our survey SIGN 93 Acute coronary syndromes A national clinical guideline Updated February 2013 Evidence KEY TO EVIDENCE STATEMENTS AND GRADES

More information

Networking for optimal treatment of STEMI and NSTEMI. European Stent for life Project

Networking for optimal treatment of STEMI and NSTEMI. European Stent for life Project Networking for optimal treatment of STEMI and NSTEMI European Stent for life Project Dariusz Dudek on behalf of Department of Interventional Cardiology, Institute of Cardiology, Krakow, Poland The European

More information

Update in Acute Coronary Syndromes Hani Jneid, MD, FACC, FAHA Baylor College of Medicine Michael E. DeBakey VAMC

Update in Acute Coronary Syndromes Hani Jneid, MD, FACC, FAHA Baylor College of Medicine Michael E. DeBakey VAMC Update in Acute Coronary Syndromes Hani Jneid, MD, FACC, FAHA Baylor College of Medicine Michael E. DeBakey VAMC NAAMA 37 th National Medical Convention September 5 th, 2015 Atherosclerosis Coronary Heart

More information

Unstable Angina/ Non ST-Elevation Myocardial Infarction. Management of Patients With. Learn and Live SM. ACC/AHA Pocket Guideline

Unstable Angina/ Non ST-Elevation Myocardial Infarction. Management of Patients With. Learn and Live SM. ACC/AHA Pocket Guideline Learn and Live SM ACC/AHA Pocket Guideline Based on the ACC/AHA 2007 Guideline Revision Management of Patients With Unstable Angina/ Non ST-Elevation Myocardial Infarction October 2007 Special thanks to

More information

Preoperative Cardiac Stents Perioperative Management. Mark A. Taylor, MD Department of Anesthesia

Preoperative Cardiac Stents Perioperative Management. Mark A. Taylor, MD Department of Anesthesia Preoperative Cardiac Stents Perioperative Management Mark A. Taylor, MD Department of Anesthesia Revasc prior to NCS If it offered long term benefit-- --made sense to do it 1-22 vessel CAD by angiogram,

More information

Objectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History

Objectives. Preoperative Cardiac Risk Stratification for Noncardiac Surgery. History Preoperative Cardiac Risk Stratification for Noncardiac Surgery Kimberly Boddicker, MD FACC Essentia Health Heart and Vascular Center 27 th Heart and Vascular Conference May 13, 2011 Objectives Summarize

More information

Acute Coronary Syndromes Education for Healthcare Providers. Hani Kozman, MD Cardiology Division SUNY Upstate Medical University

Acute Coronary Syndromes Education for Healthcare Providers. Hani Kozman, MD Cardiology Division SUNY Upstate Medical University Acute Coronary Syndromes Education for Healthcare Providers Hani Kozman, MD Cardiology Division SUNY Upstate Medical University NSTEMI 2 Types ACS: Chest pain related to a progressively enlarging intracoronary

More information

HOW TO CITE THIS ARTICLE:

HOW TO CITE THIS ARTICLE: CORRELATION OF TIMI RISK SCORE WITH ANGIOGRAPHIC SEVERITY IN PREDICING THE EXTENT OF CORONARY ARTERY DISEASE IN PATIENTS WITH NON ST ELEVATION ACUTE CORONARY SYNDROME N. Senthil 1, S. R. Ramakrishnan 2,

More information

rivaroxaban 2.5mg film-coated tablets (Xarelto ) SMC No. (1062/15) Bayer plc.

rivaroxaban 2.5mg film-coated tablets (Xarelto ) SMC No. (1062/15) Bayer plc. rivaroxaban 2.5mg film-coated tablets (Xarelto ) SMC No. (1062/15) Bayer plc. 05 June 2015 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards

More information

Clinical Study Synopsis

Clinical Study Synopsis Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace

More information

Copenhagen University Hospital Rigshospitalet Aarhus University Hospital Skejby Denmark

Copenhagen University Hospital Rigshospitalet Aarhus University Hospital Skejby Denmark Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-elevation myocardial infarction 3 year follow-up of the randomised trial Peter Clemmensen, Henning Kelbæk,

More information

Pretrattamento con Antiaggreganti Piastrinici nelle SCA. No, Sempre Necessario

Pretrattamento con Antiaggreganti Piastrinici nelle SCA. No, Sempre Necessario 9 MEETING CARDIOLUCCA CONTROVERSIA D AUTORE: PRETRATTAMENTO CON ANTIAGGREGANTI PIASTRINICI NELLE SCA Lucca, Auditorium S. Francesco 28-30 Novembre 2013 Pretrattamento con Antiaggreganti Piastrinici nelle

More information

Investor News. Not intended for U.S. and UK media

Investor News. Not intended for U.S. and UK media Investor News Not intended for U.S. and UK media Bayer AG Investor Relations 51368 Leverkusen Germany www.investor.bayer.com Bayer s Xarelto (Rivaroxaban) Approved for the Treatment of Pulmonary Embolism

More information

Description of problem Description of proposed amendment Justification for amendment ERG response

Description of problem Description of proposed amendment Justification for amendment ERG response KEY INACCURACIES Issue 1 Distinguishing between groups of STEMI patients Key issue throughout the report The ERG distinguishes between groups of STEMI patients defining four patient groups: STEMI without

More information

L'aspirina è diventata obsoleta nell'era dei nuovi inbitori P2Y12? Leonardo Bolognese MD, FESC, FACC Cardiovascular Department, Arezzo, Italy ISO 9001

L'aspirina è diventata obsoleta nell'era dei nuovi inbitori P2Y12? Leonardo Bolognese MD, FESC, FACC Cardiovascular Department, Arezzo, Italy ISO 9001 L'aspirina è diventata obsoleta nell'era dei nuovi inbitori P2Y12? Leonardo Bolognese MD, FESC, FACC Cardiovascular Department, Arezzo, Italy Scientific Advances and Cardiovascular Mortality Nabel and

More information

GENERAL HEART DISEASE KNOW THE FACTS

GENERAL HEART DISEASE KNOW THE FACTS GENERAL HEART DISEASE KNOW THE FACTS WHAT IS Heart disease is a broad term meaning any disease affecting the heart. It is commonly used to refer to coronary heart disease (CHD), a more specific term to

More information

None. Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management. 76 year old male LINGO 1/5/2015

None. Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management. 76 year old male LINGO 1/5/2015 Financial Disclosure Information Dual Antiplatelet Therapy Plus Systemic Anticoagulation: Bleeding Risk and Management Robert D. McBane, M.D. Division of Cardiology Mayo Clinic Rochester Dual Antiplatelet

More information

Cardiac Risk Assessment: Matching Intensity of Therapy to Risk

Cardiac Risk Assessment: Matching Intensity of Therapy to Risk Cardiol Clin 24 (2006) 67 78 Cardiac Risk Assessment: Matching Intensity of Therapy to Risk Mark R. Vesely, MD, Mark D. Kelemen, MD, MSc, FACC* Division of Cardiology, University of Maryland School of

More information

EXAMINATION trial. Manel Sabaté Hospital Clínic, Barcelona (On behalf of the Examination Investigators)

EXAMINATION trial. Manel Sabaté Hospital Clínic, Barcelona (On behalf of the Examination Investigators) EXAMINATION trial Manel Sabaté Hospital Clínic, Barcelona (On behalf of the Examination Investigators) EXAMINATION trial Background and Rationale (I) Acute coronary syndromes repeatedly appear as independent

More information

Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg

Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg 2 nd Annual Duke Renal Transplant Symposium March 1, 2014 Durham, NC Joseph G. Rogers, M.D. Associate

More information

LEADERS: 5-Year Follow-up

LEADERS: 5-Year Follow-up LEADERS: -Year Follow-up from a Prospective, Randomized Trial of Biolimus A9-eluting Stents with a Biodegradable Polymer vs. Sirolimus-eluting Stents with a Durable Polymer : Final Report of the LEADERS

More information

Therapeutic Class Overview Oral Anticoagulants

Therapeutic Class Overview Oral Anticoagulants Therapeutic Class Overview Oral Anticoagulants Therapeutic Class Overview/Summary: The oral anticoagulants, dabigatran etexilate mesylate (Pradaxa ), rivaroxaban (Xarelto ), and warfarin (Coumadin, Jantoven

More information

A Patient s Guide to Primary and Secondary Prevention of Cardiovascular Disease Using Blood-Thinning (Anticoagulant) Drugs

A Patient s Guide to Primary and Secondary Prevention of Cardiovascular Disease Using Blood-Thinning (Anticoagulant) Drugs A Patient s Guide to Primary and Secondary Prevention of PATIENT EDUCATION GUIDE What Is Cardiovascular Disease? Cardiovascular disease (CVD) is a broad term that covers any disease of the heart and circulatory

More information

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South

Medical management of CHF: A New Class of Medication. Al Timothy, M.D. Cardiovascular Institute of the South Medical management of CHF: A New Class of Medication Al Timothy, M.D. Cardiovascular Institute of the South Disclosures Speakers Bureau for Amgen Background Chronic systolic congestive heart failure remains

More information

Issues and Challenges in ACS Management. Dr.Nakul Sinha MD.DM, FACC. Sahara Hospital, LUCKNOW

Issues and Challenges in ACS Management. Dr.Nakul Sinha MD.DM, FACC. Sahara Hospital, LUCKNOW 1 Issues and Challenges in ACS Management Dr.Nakul Sinha MD.DM, FACC. Sahara Hospital, LUCKNOW 2 Disclaimer Presentation are intended for educational purposes only and do not replace independent professional

More information

WOEST TRIAL- NO ASPIRIN IN STENTED PATIENTS REQUIRING ANTICOAGULATION. Van Crisco, MD, FACC, FSCAI First Coast

WOEST TRIAL- NO ASPIRIN IN STENTED PATIENTS REQUIRING ANTICOAGULATION. Van Crisco, MD, FACC, FSCAI First Coast WOEST TRIAL- NO ASPIRIN IN STENTED PATIENTS REQUIRING ANTICOAGULATION Van Crisco, MD, FACC, FSCAI First Coast Conflicts of Interest I have been a paid consultant and speaker for AstraZeneca, makers of

More information

STROKE PREVENTION IN ATRIAL FIBRILLATION. TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: ABBREVIATIONS: BACKGROUND:

STROKE PREVENTION IN ATRIAL FIBRILLATION. TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: ABBREVIATIONS: BACKGROUND: STROKE PREVENTION IN ATRIAL FIBRILLATION TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention

More information

Bayer Extends Clinical Investigation of Rivaroxaban into Important Areas of Unmet Medical Need in Arterial Thromboembolism

Bayer Extends Clinical Investigation of Rivaroxaban into Important Areas of Unmet Medical Need in Arterial Thromboembolism Investor News Not intended for U.S. and UK Media Bayer AG Investor Relations 51368 Leverkusen Germany www.investor.bayer.com Bayer Extends Clinical Investigation of Rivaroxaban into Important Areas of

More information

NOAC s post Myocardial Infarction Peter Clemmensen MD, PhD, FESC, FSCAI Chief of Cardiology

NOAC s post Myocardial Infarction Peter Clemmensen MD, PhD, FESC, FSCAI Chief of Cardiology NOAC s post Myocardial Infarction Peter Clemmensen MD, PhD, FESC, FSCAI Chief of Cardiology Department of Medicine Division of Cardiology Nykøbing F Hospital Denmark Disclosure of Conflict of Interest

More information

How can registries contribute to guidelines? Nicolas DANCHIN, HEGP, Paris

How can registries contribute to guidelines? Nicolas DANCHIN, HEGP, Paris How can registries contribute to guidelines? Nicolas DANCHIN, HEGP, Paris Pros and cons of registers Prospective randomised trials constitute the cornerstone of "evidence-based" medicine, and they therefore

More information

Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM

Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism ERRATUM This report was commissioned by the NIHR HTA Programme as project number 12/78

More information

Appropriate Use: Big Brother is Watching. Jason H. Rogers, MD Director, Interventional Cardiology UC Davis Medical Center

Appropriate Use: Big Brother is Watching. Jason H. Rogers, MD Director, Interventional Cardiology UC Davis Medical Center Appropriate Use: Big Brother is Watching Jason H. Rogers, MD Director, Interventional Cardiology UC Davis Medical Center Disclosures Consultant Boston Scientific, Medtronic, Middle Peak Medical, Millipede,

More information

6.3. Management 6.3.1. Routine Measures

6.3. Management 6.3.1. Routine Measures ACC/AHA 2004 Practice Guidelines for STEMI 6.3. Management 6.3.1. Routine Measures 6.3.1.1. Oxygen Supplemental oxygen should be administered to patients with arterial oxygen desaturation (SaO2 less than

More information

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction Executive Summary

ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction Executive Summary Journal of the American College of Cardiology Vol. 50, No. 7, 2007 2007 by the American College of Cardiology Foundation and the American Heart Association, Inc. ISSN 0735-1097/07/$32.00 Published by Elsevier

More information

MANAGEMENT AKUTES KORONARSYNDROM: RISIKOSTRATIFIZIERUNG UND THERAPIE. Peter Wenaweser Universitätsklinik für Kardiologie

MANAGEMENT AKUTES KORONARSYNDROM: RISIKOSTRATIFIZIERUNG UND THERAPIE. Peter Wenaweser Universitätsklinik für Kardiologie MANAGEMENT AKUTES KORONARSYNDROM: RISIKOSTRATIFIZIERUNG UND THERAPIE Peter Wenaweser Universitätsklinik für Kardiologie Scientific Advances & Cardiovascular Mortality 1950 to 2010 Nabel EM and Braunwald

More information

Long term anticoagulant therapy in patients with atrial fibrillation at high risk of stroke: a new scenario after RE-LY trial

Long term anticoagulant therapy in patients with atrial fibrillation at high risk of stroke: a new scenario after RE-LY trial Long term anticoagulant therapy in patients with atrial fibrillation at high risk of stroke: a new scenario after RE-LY trial Camillo Autore Università di Roma Sapienza II Facoltà di Medicina e Chirurgia

More information

Antonio Colombo MD on behalf of the SECURITY Investigators

Antonio Colombo MD on behalf of the SECURITY Investigators Second Generation Drug-Eluting Stents Implantation Followed by Six Versus Twelve-Month - Dual Antiplatelet Therapy - The SECURITY Randomized Clinical Trial Antonio Colombo MD on behalf of the SECURITY

More information

DATE: 29 August 2012 CONTEXT AND POLICY ISSUES

DATE: 29 August 2012 CONTEXT AND POLICY ISSUES TITLE: Dual Antiplatelet Therapy and Enoxaparin or Unfractionated Heparin for patients with ST-elevation Myocardial Infarction: A Review of the Clinical Evidence DATE: 29 August 2012 CONTEXT AND POLICY

More information

prodigy study: duration of dual antiplatelet therapy under review In BrIef In Brief NPS RADAR AuguSt 2012

prodigy study: duration of dual antiplatelet therapy under review In BrIef In Brief NPS RADAR AuguSt 2012 3 In BrIef A digest of news items about NPS RADAR, new drugs and changes to PBS listings prodigy study: duration of dual antiplatelet therapy under review Dual antiplatelet therapy with aspirin and clopidogrel

More information

Bayer Initiates Rivaroxaban Phase III Study to Support Dose Selection According to Individual Benefit-Risk Profile in Long- Term VTE Prevention

Bayer Initiates Rivaroxaban Phase III Study to Support Dose Selection According to Individual Benefit-Risk Profile in Long- Term VTE Prevention Investor News Not intended for U.S. and UK Media Bayer AG Investor Relations 51368 Leverkusen Germany www.investor.bayer.com Long-term prevention of venous blood clots (VTE): Bayer Initiates Rivaroxaban

More information

06 Validation of risk prediction model

06 Validation of risk prediction model HA Territory-wide PCI Audit 2003-06 06 Validation of risk prediction model PCI Audit Working Group Central Committee (Cardiac Services) HA Convention 2007 Background Participants: All HA hospitals via

More information

Guidelines for Use of Clopidogrel (Plavix )

Guidelines for Use of Clopidogrel (Plavix ) East Lancashire Medicines Management Board representing East Lancashire Hospitals NHS Trust, Lancashire Care Trust, Blackburn with Darwen PCT, East Lancs PCT Licensed Indications Guidelines for Use of

More information

Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations

Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations Dardo E. Ferrara MD Cardiac Electrophysiology North Cascade Cardiology PeaceHealth Medical Group Which anticoagulant

More information

Unstable Angina/ Non ST-Elevation Myocardial Infarction. Management of Patients With. ACCF/AHA Pocket Guideline

Unstable Angina/ Non ST-Elevation Myocardial Infarction. Management of Patients With. ACCF/AHA Pocket Guideline ACCF/AHA Pocket Guideline Management of Patients With Unstable Angina/ Non ST-Elevation Myocardial Infarction (Adapted from the 2007 ACCF/AHA Guideline and the 2011 ACCF/AHA Focused Update) 2011 American

More information

Time of Offset of Action The Trial

Time of Offset of Action The Trial New Antithrombotic Agents DISCLOSURE Relevant Financial Relationship(s) Speaker Bureau - None Consultant Amgen Tom DeLoughery, MD FACP FAWM Oregon Health and Sciences University What I am Talking About

More information

Guidelines for Percutaneous Coronary Interventions

Guidelines for Percutaneous Coronary Interventions Publish-Ahead-of-Print published March 29, 2005 European Heart Journal doi:10.1093/eurheartj/ehi138 ESC Guidelines Guidelines for Percutaneous Coronary Interventions The Task Force for Percutaneous Coronary

More information

University of Ulsan College of Medicine, Asan Medical Center on behalf of the REAL-LATE and the ZEST-LATE trial

University of Ulsan College of Medicine, Asan Medical Center on behalf of the REAL-LATE and the ZEST-LATE trial Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation A Pooled Analysis of the REAL-LATE and the ZEST-LATE Trial Seung-Jung Park MD PhD Seung-Jung Park, MD, PhD, University of Ulsan

More information

Cardiovascular Disease and Diabetes Management of Chronic Coronary Disease

Cardiovascular Disease and Diabetes Management of Chronic Coronary Disease Cardiovascular Disease and Diabetes Management of Chronic Coronary Disease Donald E. Cutlip, MD Beth Israel Deaconess Medical Center Harvard Clinical Research Institute Harvard Medical School Diabetes

More information

New Oral Anticoagulants

New Oral Anticoagulants New Oral Anticoagulants Tracy Minichiello, MD Associate Professor of Medicine Chief, San FranciscoVA Anticoagulation and Thrombosis Service Ansell, J. Hematology Copyright 2010 American Society of Hematology.

More information

Update on Antiplatelets and anticoagulants. Outlines. Antiplatelets and Anticoagulants 1/23/2013. Timir Paul, MD, PhD

Update on Antiplatelets and anticoagulants. Outlines. Antiplatelets and Anticoagulants 1/23/2013. Timir Paul, MD, PhD Update on Antiplatelets and anticoagulants Timir Paul, MD, PhD Antiplatelets Indications Doses Long term use (beyond 12 months) ASA and combination use of NSAIDS ASA resistance Plavix resistance Plavix

More information

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC

Treating AF: The Newest Recommendations. CardioCase presentation. Ethel s Case. Wayne Warnica, MD, FACC, FACP, FRCPC Treating AF: The Newest Recommendations Wayne Warnica, MD, FACC, FACP, FRCPC CardioCase presentation Ethel s Case Ethel, 73, presents with rapid heart beating and mild chest discomfort. In the ED, ECG

More information

Stent for Life Initiative How can we improve system delay and patients delay in STEMI

Stent for Life Initiative How can we improve system delay and patients delay in STEMI Stent for Life Initiative How can we improve system delay and patients delay in STEMI Z. Kaifoszova SFL Initiative Europe 2011 Stent for Life Initiative 10 countries participate in the program Declaration

More information

Como mejorar el manejo médico de los diabéticos con SCA

Como mejorar el manejo médico de los diabéticos con SCA DIABETES Y ENFERMEDAD CORONARIA EN 2011 Como mejorar el manejo médico de los diabéticos con SCA Antonio Fernández-Ortiz Jueves, 20 Octubre 2011 INSTITUTO CARDIOVASCULAR Conflicto de interés: Antonio Fernández-Ortiz

More information

Optimal Duration of Dual Antiplatelet Therapy

Optimal Duration of Dual Antiplatelet Therapy Optimal Duration of Dual Antiplatelet Therapy Luis A Guzman, MD, FACC, FSCAI Associate Professor of Medicine Director, Cardiac and Vascular Cath Lab University of Florida College of Medicine - Jacksonville

More information

Antiplatelet therapy:

Antiplatelet therapy: Balanced information for better care Antiplatelet therapy: Aggregating the latest evidence Evaluating the choices for a preventive therapy with impressive benefits and important risks Antiplatelet agents

More information

CONFLICT OF INTEREST : ELI LILLY- DAICHII SANKYO, MERCK, MEDICINES COMPANY, ASTRA ZENECA: Advisory Board Meetings, Speaker s fees

CONFLICT OF INTEREST : ELI LILLY- DAICHII SANKYO, MERCK, MEDICINES COMPANY, ASTRA ZENECA: Advisory Board Meetings, Speaker s fees Stefano De Servi Dipartimento Cardiovascolare Azienda Ospedaliera Ospedale Civile di Legnano 1910 1960 CONFLICT OF INTEREST : ELI LILLY- DAICHII SANKYO, MERCK, MEDICINES COMPANY, ASTRA ZENECA: Advisory

More information

Risk stratification for patients who present to the

Risk stratification for patients who present to the CLINICAL INVESTIGATIONS Application of the TIMI Risk Score for Unstable Angina and Non-ST Elevation Acute Coronary Syndrome to an Unselected Emergency Department Chest Pain Population Charles V. Pollack

More information

After acute myocardial infarction, diabetes CARDIAC OUTCOMES AFTER MYOCARDIAL INFARCTION IN ELDERLY PATIENTS WITH DIABETES MELLITUS

After acute myocardial infarction, diabetes CARDIAC OUTCOMES AFTER MYOCARDIAL INFARCTION IN ELDERLY PATIENTS WITH DIABETES MELLITUS CARDIAC OUTCOMES AFTER MYOCARDIAL INFARCTION IN ELDERLY PATIENTS WITH DIABETES MELLITUS By Deborah Chyun, RN, PhD, Viola Vaccarino, MD, PhD, Jaime Murillo, MD, Lawrence H. Young, MD, and Harlan M. Krumholz,

More information

East Kent Prescribing Group

East Kent Prescribing Group East Kent Prescribing Group Rivaroxaban (Xarelto ) Safety Information Approved by the East Kent Prescribing Group. Approved by: East Kent Prescribing Group (Representing Ashford CCG, Canterbury and Coastal

More information

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION

COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION European Medicines Agency Pre-Authorisation Evaluation of Medicines for Human Use London, 25 September 2008 Doc. Ref. EMEA/CHMP/EWP/311890/2007 COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) GUIDELINE

More information