FFR CT : Clinical studies
|
|
|
- Sydney O’Brien’
- 8 years ago
- Views:
Transcription
1 FFR CT : Clinical studies Bjarne Nørgaard Department Cardiology B Aarhus University Hospital Skejby, Denmark Disclosures: Research grants: Edwards and Siemens
2 Coronary CTA: High diagnostic sensitivity for detecting CAD, and the best non-invasive test for ruling-out CAD BUT!! Cheng V et al, JACC Imag Meijboom W et al, JACC 2008 Schuijj JD et al JACC 2006
3 Coronary CTA: High diagnostic sensitivity for detecting CAD, and the best noninvasive test for ruling-out CAD BUT!! Poor correlation to stenosis severity as assessed with ICA Cheng V et al, JACC Imag Meijboom W et al, JACC 2008 Schuijj JD et al JACC 2006
4 Coronary CTA: High diagnostic sensitivity for detecting CAD, and the best noninvasive test for ruling-out CAD BUT!! Poor correlation to stenosis severity as assessed with ICA The hemodynamic significance of a stenosis cannot be assessed Cheng V et al, JACC Imag Meijboom W et al, JACC 2008 Schuijj JD et al JACC 2006
5
6 FFR CT : Clinical studies PET-CT eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeeeeeeeeeeeee FFR CT eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeemmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmeeeeeee eeeeeeeeeeeeeeee Image source Gaemperli O, EHJ 2011
7 FFR CT : Clinical studies PET-CT CT-perfusion eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeeeeeeeeeeeee FFR CT eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeemmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmeeeeeee eeeeeeeeeeeeeeee Image source Gaemperli O, EHJ 2011
8 FFR CT : Clinical studies PET-CT CT-perfusion eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeeeeeeeeeeeee FFR eeeeeeeeeeeeeeeeeeeeeee CT FFR CT eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeeeeeeeeeeeee eeeeeeeeeeeemmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmmmmm mmmmmmmmmmeeeeeee eeeeeeeeeeeeeeee Image source Gaemperli O, EHJ 2011
9 FFR CT : Clinical studies DISCOVER-FLOW Completed 2011 N=104 patients DeFACTO Completed 2012 N=252 patients NXT Completed 2013 N~254 patients
10 FFR CT : Clinical studies, DISCOVER-FLOW trial 4 centers Patients with suspected or known CAD who underwent ccta, ICA and FFR Koo B-K, JACC 2011
11 FFR CT : Clinical studies, DISCOVER-FLOW trial 4 centers Patients with suspected or known CAD who underwent ccta, ICA and FFR Significant CAD by ccta: stenosis >50% (>2 mm vessel) Ischemia def: FFR CT / FFR 0.80 FFR CT and ccta core lab reads, FFR local reads Koo B-K, JACC 2011
12 FFR CT : Clinical studies, DISCOVER-FLOW trial 4 centers Patients with suspected or known CAD who underwent ccta, ICA and FFR Significant CAD by ccta: stenosis >50% (>2 mm vessel) Ischemia def: FFR CT / FFR 0.80 FFR CT and ccta core lab reads, FFR local reads 104 patients, 159 vessels Mean age, 63 y, 20% with known disease (AMI / PCI), 56% with FFR 0.80 Koo B-K, JACC 2011
13 FFR CT : Clinical studies, DISCOVER-FLOW trial Koo B-K, JACC 2011
14 FFR CT : Clinical studies, DISCOVER-FLOW trial P=0.001 P= Koo B-K, JACC 2011
15 FFR CT : Clinical studies, DeFACTO trial 17 centers Clinically non-emergent indicated ICA after ccta <60 days ICA stenosis 30%-90% (>2 mm vessel) % Min J et al, JAMA 2012
16 FFR CT : Clinical studies, DeFACTO trial 17 centers Clinically non-emergent indicated ICA after ccta <60 days ICA stenosis 30%-90% (>2 mm vessel) Significant CAD by ccta: stenosis >50% (>2 mm vessel) Ischemia def: FFR CT / FFR 0.80 % Min J et al, JAMA 2012
17 FFR CT : Clinical studies, DeFACTO trial 17 centers Clinically non-emergent indicated ICA after ccta <60 days ICA stenosis 30%-90% (>2 mm vessel) Significant CAD by ccta: stenosis >50% (>2 mm vessel) Ischemia def: FFR CT / FFR 0.80 % FFR CT and ccta core lab reads, FFR local reads Min J et al, JAMA 2012
18 FFR CT : Clinical studies, DeFACTO trial 17 centers Clinically non-emergent indicated ICA after ccta <60 days ICA stenosis 30%-90% (>2 mm vessel) Significant CAD by ccta: stenosis >50% (>2 mm vessel) Ischemia def: ccta stenosis >50%, FFR CT / FFR 0.80 % FFR CT and ccta core lab reads, FFR local reads Primary study end-point: Per-patient diagnostic accuracy of FFR CT for the diagnosis of ischemia with a lower limit of 95% CI >70% Min J et al, JAMA 2012
19 FFR CT : Clinical studies, DeFACTO trial Min J et al, JAMA patients, 406 vessels Patient Characteristics Age (years) [mean + SD] 63 ± 9 Male gender 71% Prior MI 6% Prior PCI 6% Hypertension 71% Diabetes mellitus 22% Agatston score [mean + SD] 382 ± 401 FFR %
![SD] 63 ± 9 Male gender 71% Prior MI 6% Prior PCI 6% Hypertension 71%](/docs-images/42/14912343/images/page_19.jpg "Diabetes mellitus 22% Agatston score [mean + SD] 382 ± 401 FFR 0.")
20 FFR CT : Clinical studies, DeFACTO trial Min J et al, JAMA 2012 Primary end point FFR CT <0.80 ccta >50% % CI FFR CT ccta Accuracy Sensitivity Specificity PPV NPV
21 FFR CT : Clinical studies, DeFACTO trial Min J et al, JAMA 2012 % AUC, 0.68 ( ) vs 0.81 ( ) p<0.0001
22
23 FFR CT : Clinical studies, DeFACTO vs NXT trial design Gaur S et al, JCCT 2013
24 FFR CT : Clinical studies, DeFACTO vs NXT trial design Gaur S et al, JCCT 2013
25 FFR CT : Clinical studies, DeFACTO vs NXT trial design Gaur S et al, JCCT 2013
26 FFR CT : Clinical studies, DeFACTO vs NXT trial design Gaur S et al, JCCT 2013
27 Abbara S et al. JCCT 2009 FFR CT : Clinical studies, NXT trial, Study objectives To determine the diagnostic performance of non-invasive FFR CT using FFR as the reference standard To compare the diagnostic performance of FFR CT vs. anatomic testing (coronary CTA or invasive coronary angiography)
28 FFR CT : Clinical studies, NXT trial, Patient recruitment Inclusion Criteria: Underwent >64-row CT and ICA scheduled < 60 days between CT and ICA Exclusion Criteria: Prior CABG or PCI Suspected ACS Recent MI within 30 days of CT Contraindication to nitrates, beta blockade or adenosine ICA = Invasive coronary angiography; CABG = coronary artery bypass surgery; ACS = acute coronary syndrome; MI = myocardial infarction; PCI = percutaneous coronary intervention
29 FFR CT : Clinical studies, NXT trial, Endpoints Primary Endpoint: Per-patient diagnostic performance as assessed by the area under the receiver operating characteristic curve (AUC) of FFR CT vs. coronary CTA for the diagnosis of ischemia in patients with stenosis severity 30%-90% (vessel diameter >2 mm) Secondary Endpoint: Diagnostic performance (accuracy, sensitivity, specificity, PPV and NPV) of FFR CT, coronary CTA, and invasive coronary angiography
30 FFR CT : Clinical studies, NXT trial, Study procedures Blinded core laboratories for FFR, FFR CT, and ICA CT: -Acquisition protocols according to societal guidelines 1 -Image quality independently evaluated using a predefined scoring system 2 -Site-read stenosis severity >50% 3 ICA: -Core-lab read stenosis severity >50% FFR: At maximum hyperemia during ICA Adenosine micg/kg/min IV Positive: Abbara S et al. JCCT Nørgaard B et al. JCCT Raff GL et al. JCCT Tonino PA et al. NEJM 2009
31 FFR CT : Clinical studies, NXT trial, Patient enrollment Screened Cohort (n=357) Study enrollment 9/2012 8/ sites in Europe, Asia, and Australia Image artifacts (n=44, 13%) Failed inclusion criteria (n=27) Excluded FFR quality (n=22): Invalid FFR (n=8), FFR in vessel <2 mm (n=11), missing measure location (n=3) Other (n=10) Secondary endpoints Patients n=254 Vessels n=484 Excluded from Primary Endpoint No ccta stenosis 30%-90% (n=3) Primary Endpoint Patients n=251
32 FFR CT : Clinical studies, NXT trial, Patients and CT characteristics CT Characteristics Nitrates 99.6% Patient Characteristics Age (years) [mean + SD] 64 ± 10 Male gender 64% Prior MI 2% Diabetes mellitus 23% Hypertension 69% Pre-test Likelihood of CAD 58% FFR % FFR assigned a value of 0.50 in 16 occluded vessels 3% Beta Blockers 78% Heart Rate (bpm) 63 Range Prospective 54% mean dose (msv) 3 Retrospective 46% mean dose (msv) 14 Calcium score* Mean 302 Range >300 33% *Available for 214 patients
33 FFR CT : Clinical studies, NXT trial, Per-vessel FFR - FFR CT correlation Pearson s CC = 0.82, P<0.0001
34 Sensitivity FFR CT : Clinical studies, NXT trial, Discrimination of ischemia Per-patient Per-Vessel (n=484) Per-Patient Per-vessel (n=251) 1 - Specificity N=252 *Area under the receiver operating characteristics curve
35 FFR CT : Clinical studies, NXT trial, Per-patient diagnostic performance % % N=254 CI Accuracy Specificity PPV Sensitivity NPV FFR CT < 0.80
36 FFR CT : Clinical studies, NXT trial, Per-patient diagnostic performance % % N=254 CI * * Accuracy Specificity PPV Sensitivity NPV * CT > 50% ICA > 50% FFR CT < 0.80 * p<0.0001
37 FFR CT : Clinical studies, NXT trial, Per-patient diagnostic performance % % N=254 CI * * Accuracy Specificity PPV Sensitivity NPV * CT > 50% ICA > 50% FFR CT < 0.80 * p<0.0001
38 FFR CT : Clinical studies, NXT trial, Per-patient diagnostic performance % % N=254 CI * * * FFR CT correctly reclassified 68% of 34 CT false positive to true negatives 30 Accuracy Specificity PPV Sensitivity NPV CT > 50% ICA > 50% FFR CT < 0.80 * p<0.0001
39 FFR CT : Clinical studies, NXT trial, Per-patient diagnostic performance LAD stenosis 70-90% FFR CT 0.93 FFR 0.94 FFR CT Model
40 FFR CT : Clinical studies, NXT trial, Per-vessel diagnostic performance % N=484 95% C * * * Accuracy Specificity PPV Sensitivity NPV 95 CT > 50% ICA > 50% FFR CT < 0.80 * p<0.0001
41 FFR CT : Clinical studies, NXT trial, Intermediate lesions (30%-70%) % 51 * * * ccta >50% FFR CT <0.80 *p< Acc Spec PPV Sens NPV n= 235 (93%)
42
43 FFR CT : Clinical studies, NXT trial, Coronary calcification Acc Sens Spec Acc Sens Spec Acc Sens Spec FFR CT <0.80 Agatston score: mean, 302 range, Ag: >300 N (214):
44 FFR CT : Clinical studies, NXT trial, Coronary calcification * * * * * * FFR CT <0.80 ccta >50% *p< Agatston score: mean, 302 range, Acc Sens Spec Acc Sens Spec Acc Sens Spec Ag: >300 N (214):
45 FFR CT : Clinical studies, DISCOVER-FLOW, DeFACTO, and NXT trials FFR CT has high diagnostic accuracy and discrimination for the diagnosis of ischemia
46 FFR CT : Clinical studies, DISCOVER-FLOW, DeFACTO, and NXT trials FFR CT has high diagnostic accuracy and discrimination for the diagnosis of ischemia When compared to anatomic interpretation by coronary CTA or invasive angiography, FFR CT leads to a marked increase in diagnostic accuracy, specificity, and PPV
47 FFR CT : Clinical studies, DISCOVER-FLOW, DeFACTO, and NXT trials FFR CT has high diagnostic accuracy and discrimination for the diagnosis of ischemia When compared to anatomic interpretation by coronary CTA or invasive angiography, FFR CT leads to a marked increase in diagnostic accuracy, specificity, and PPV FFR CT is performed from standard acquired CT datasets without the need for additional imaging, radiation or medication
48 FFR CT : Clinical studies, FFRct vs other non-invasive testing modalities Desai RR, AJR 2013
49 FFR CT : Clinical studies, FFRct vs other non-invasive testing modalities Per patient pooled sens / spec: 89% (95% CI, 84-93) / 85% (77-91) Per-territory pooled sens / spec: 88% (84-91) / 89% (87-90) Desai RR, AJR 2013
50 FFR CT : Clinical studies, FFRct vs other non-invasive testing modalities Single-center studies Desai RR, AJR 2013
51 FFR CT : Clinical studies, FFRct vs other non-invasive testing modalities Single-center studies # patients: Desai RR, AJR 2013
52 FFR CT : Clinical studies, FFRct vs other non-invasive testing modalities Single-center studies # patients: Local FFR reads Desai RR, AJR 2013
53 FFR CT : Clinical studies, FFRct vs other non-invasive testing modalities Single-center studies # patients: Local FFR reads The rate of actual FFR measurements was <70% in 10 of 12 studies (ICA stenosis >90% => FFR, 0.50, and in normal vessels => FFR, 0.95) Desai RR, AJR 2013
54 FFR CT : Clinical studies, FFRct vs other non-invasive testing modalities Single-center studies # patients: Local FFR reads The rate of actual FFR measurements was <70% in 10 of 12 studies (ICA stenosis >90% => FFR, 0.50, and in normal vessels => FFR, 0.95) Desai RR, AJR 2013
55 FFR CT : Clinical studies, FFRct vs other non-invasive testing modalities 22%-69% of FFR values were directly measured Desai RR, AJR 2013
56 FFR CT : Clinical studies, FFRct vs other non-invasive testing modalities 22%-69% of FFR values were directly measured All FFR values were directly measured Desai RR, AJR 2013
57 Diagnostic performance of Coronary diagnostic tests for Functional (FFR 0.80) disease
58 Diagnostic performance of Coronary diagnostic tests for Functional (FFR 0.80) disease
59 FFR CT : Clinical studies, Building the Body of Evidence 609 patients 1051 vessels, FFR directly measured in 1035 vessels (98%) DISCOVER-FLOW NXT DeFACTO Cath lab Population Dx Accuracy 30-90% Stenosis Dx Accuracy
60 Use of FFR CT to select patients for ICA and PCI may result in 30% lower costs and 12% fewer events at one year compared to the most common strategy of ICA 60
61 FFR CT : Clinical studies, Building the Body of Evidence 609 patients 1051 vessels, FFR directly measured in 1035 vessels (98%) DISCOVER-FLOW DeFACTO NXT PLATFORM Randomized Controlled Trials Analysis of existing databases Cath lab Population Dx Accuracy 30-90% Stenosis Dx Accuracy Stable Angina Outcomes and resources ACS (- enzyme) Outcomes and resources
62 Thank you for the attention
63 FFR CT false-negatives and FFR grey zone 24 vessels had false negative results of FFR CT when compared to FFR. FRR ( grey zone ), n=17
64 FFR CT false-negatives and FFR grey zone 24 vessels had false negative results of FFR CT when compared to FFR. FRR ( grey zone ), n=17 Assuming, patients with false-negative FFR CT values in the grey zone are in fact true negatives, the NPV for FFR CT increased to 98%. Thus, in vessels with FFR CT >0.80 the risk of having an FFR <0.75 is only 2%.
65 Limitations No control over CT image acquisition protocol at clinical sites Did not interrogate every vessel with invasive FFR Did not solely enroll patients with intermediate stenosis Did not test whether FFR CT -based revascularization reduces ischemia
66 Conclusions FFR CT demonstrated improved accuracy over CT for diagnosis of patients and vessels with ischemia FFR CT diagnostic accuracy 73% (95% CI 67-78%) Pre-specified primary endpoint >70% lower bound of 95% CI Increased discriminatory power FFR CT superior to CT for intermediate stenoses FFR CT computed without additional radiation or imaging First large-scale demonstration of patient-specific computational models to calculate physiologic pressure and velocity fields from CT images Proof of feasibility of FFR CT for diagnosis of lesion-specific ischemia
For the NXT Investigators
Diagnostic performance of non-invasive fractional flow reserve derived from coronary CT angiography in suspected coronary artery disease: The NXT trial Bjarne L. Nørgaard, Jonathon Leipsic, Sara Gaur,
Non-invasive FFR Using Coronary CT Angiography and Computational Fluid Dynamics Predicts the Hemodynamic Significance of Coronary Lesions
Non-invasive FFR Using Coronary CT Angiography and Computational Fluid Dynamics Predicts the Hemodynamic Significance of Coronary Lesions Andrejs Erglis, Sanda Jegere, Zanda Runkule, Ligita Zvaigzne, Dace
Non-invasive functional testing in 2014
Non-invasive functional testing in 2014 Bjarne Nørgaard Department Cardiology B Aarhus University Hospital Skejby, Disclosures: Research grants: Edwards and Siemens Non-invasive functional testing in 2014
MYOCARDIAL PERFUSION COMPUTED TOMOGRAPHY PhD course in Medical Imaging. Anne Günther Department of Radiology OUS Rikshospitalet
MYOCARDIAL PERFUSION COMPUTED TOMOGRAPHY PhD course in Medical Imaging Anne Günther Department of Radiology OUS Rikshospitalet CORONARY CT ANGIOGRAPHY (CTA) Accurate method in the assessment of possible
Main Effect of Screening for Coronary Artery Disease Using CT
Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,
PRECOMBAT Trial. Seung-Whan Lee, MD, PhD On behalf of the PRECOMBAT Investigators
Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease PRECOMBAT Trial Seung-Whan Lee, MD, PhD On behalf
Efficient Evaluation of Chest Pain
Efficient Evaluation of Chest Pain Vikranth Gongidi, DO FACC FACOI Indian River Medical Center Vero Beach, FL No Disclosures Outline Background Chest pain pathway Indications for stress test Stress test
Majestic Trial 12 Month Results
Majestic Trial 12 Month Results S.Müller-Hülsbeck, MD, EBIR, FCIRSE, FICA ACADEMIC HOSPITALS Flensburg of Kiel University Ev.-Luth. Diakonissenanstalt zu Flensburg Knuthstraße 1, 24939 FLENSBURG Dept.
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,
Perioperative Cardiac Evaluation
Perioperative Cardiac Evaluation Caroline McKillop Advisor: Dr. Tam Psenka 10-3-2007 Importance of Cardiac Guidelines -Used multiple times every day -Patient Safety -Part of Surgical Care Improvement Project
The Bioresorbable Vascular Stent Dr Albert Ko
The Bioresorbable Vascular Stent Dr Albert Ko Dr Albert Ko MB BS, FRACP, FCSANZ Interventional/General Cardiologist Ascot Cardiology Symposium 2013 Treatment Goals for Coronary Artery Disease Relieve of
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
Prognostic impact of uric acid in patients with stable coronary artery disease
Prognostic impact of uric acid in patients with stable coronary artery disease Gjin Ndrepepa, Siegmund Braun, Martin Hadamitzky, Massimiliano Fusaro, Hans-Ullrich Haase, Kathrin A. Birkmeier, Albert Schomig,
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
Renovascular Hypertension
Renovascular Hypertension Philip Stockwell, MD Assistant Professor of Medicine (Clinical) Warren Alpert School of Medicine Cardiology for the Primary Care Provider September 28, 201 Renovascular Hypertension
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
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
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,
2/20/2015. Cardiac Evaluation of Potential Solid Organ Transplant Recipients. Issues Specific to Transplantation. Kidney Transplantation.
DISCLOSURES I have no relevant financial relationships to disclose. Cardiac Evaluation of Potential Solid Organ Transplant Recipients Michele Hamilton, MD Director, Heart Failure Program Cedars Sinai Heart
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
on behalf of the AUGMENT-HF Investigators
One Year Follow-Up Results from AUGMENT-HF: A Multicenter Randomized Controlled Clinical Trial of the Efficacy of Left Ventricular Augmentation with Algisyl-LVR in the Treatment of Heart Failure* Douglas
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
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
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.
Sponsor. Novartis Generic Drug Name. Vildagliptin. Therapeutic Area of Trial. Type 2 diabetes. Approved Indication. Investigational.
Clinical Trial Results Database Page 1 Sponsor Novartis Generic Drug Name Vildagliptin Therapeutic Area of Trial Type 2 diabetes Approved Indication Investigational Study Number CLAF237A2386 Title A single-center,
Specific Basic Standards for Osteopathic Fellowship Training in Cardiology
Specific Basic Standards for Osteopathic Fellowship Training in Cardiology American Osteopathic Association and American College of Osteopathic Internists BOT 07/2006 Rev. BOT 03/2009 Rev. BOT 07/2011
Listen to your heart: Good Cardiovascular Health for Life
Listen to your heart: Good Cardiovascular Health for Life Luis R. Castellanos MD, MPH Assistant Clinical Professor of Medicine University of California San Diego School of Medicine Sulpizio Family Cardiovascular
CORONARY ARTERY BYPASS GRAFTS, STENTS, AND EXTRACORONARY CARDIAC DZ. Charles White MD
CORONARY ARTERY BYPASS GRAFTS, STENTS, AND EXTRACORONARY CARDIAC DZ Charles White MD Director of Thoracic Imaging Department of Radiology University of Maryland CORONARY ARTERY BYPASS GRAFTS First performed
Vascular Quality Initiative - Carotid Artery Stent. Last Name First Name Middle Initial
Vascular Quality Initiative - Carotid Artery Stent Last Name First Name Middle Initial Date of Birth Medical Record Social Security General Information Patient Data Zip/Postal Code Gender Male Female Ethnicity
Steven J. Yakubov, MD FACC For the CoreValve US Clinical Investigators
Long-Term Outcomes Using a Self- Expanding Bioprosthesis in Patients With Severe Aortic Stenosis Deemed Extreme Risk for Surgery: Two-Year Results From the CoreValve US Pivotal Trial Steven J. Yakubov,
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
Mattias Törnerud, Capio St Görans sjukhus AB, Stockholm. Invasiv tryckmätning FFR
Namn: Titel: Mattias Törnerud, Capio St Görans sjukhus AB, Stockholm Invasiv tryckmätning FFR Har mo/agit förläsararvoden från St Jude Medical. Intrakoronar tryckmätning, FFR i daglig praxis 1000 angio
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
PCI vs. CABG for Left Main Disease
The EXCEL Ti Trial Design, Status, t and Timelines Gregg W. Stone, MD Columbia University Medical Center NewYork-Presbyterian Hospital Cardiovascular Research Foundation PCI vs. CABG for Left Main Disease
Pooled RESOLUTE Clinical Program
The Relationship Between Short and Long-term Antiplatelet Therapy Use and Stent Thrombosis Following Percutaneous Coronary Intervention With the Resolute Zotarolimus-eluting Stent Pooled RESOLUTE Clinical
FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION IMPACT ON RACIAL AND ETHNIC DISPARITIES
FULL COVERAGE FOR PREVENTIVE MEDICATIONS AFTER MYOCARDIAL INFARCTION IMPACT ON RACIAL AND ETHNIC DISPARITIES Niteesh K. Choudhry, MD, PhD Harvard Medical School Division of Pharmacoepidemiology and Pharmacoeconomics
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
Will The Coronary Calcium Score Affect the Decision To Treat With Statins?
Will The Coronary Calcium Score Affect the Decision To Treat With Statins? Amresh Raina M.D. Division of Cardiology University of Pennsylvania Disclosures No financial relationships relevant to this presentation
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
Cardiac Rehabilitation The Best Medicine for Your CAD Patients. James A. Stone
James A. Stone BPHE, BA, MSc, MD, PhD, FRCPC, FAACVPR, FACC Clinical Professor of Medicine, University of Calgary Total Cardiology, Calgary Acknowledgements and Disclosures Acknowledgements Jacques Genest
Intracoronary Stenting and. Robert A. Byrne, Julinda Mehilli, Salvatore Cassese, Franz-Josef Neumann, Susanne Pinieck, Tomohisa Tada,
Prospective, Randomized Trial of Paclitaxel-Eluting Balloon versus Paclitaxel-Eluting Stent versus Balloon Angioplasty for Treatment of Coronary Restenosis in Limus- Eluting Stents Intracoronary Stenting
Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators
Journal Club: Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy by the AIM-HIGH Investigators Shaikha Al Naimi Doctor of Pharmacy Student College of Pharmacy Qatar University
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
Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient?
Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient? --- NIRS-IVUS TVC Imaging Adds Additional Information for the Heart Team Dr. Luis Tami Memorial Regional Hospital
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
Section 8: Clinical Exercise Testing. a maximal GXT?
Section 8: Clinical Exercise Testing Maximal GXT ACSM Guidelines: Chapter 5 ACSM Manual: Chapter 8 HPHE 4450 Dr. Cheatham Outline What is the purpose of a maximal GXT? Who should have a maximal GXT (and
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
HA Territory-wide PCI Audit 2003-05
HA Territory-wide PCI Audit 23-5 5 PCI Audit Working Group Central Committee (Cardiac Services) HA Convention 26 Percutaneous Coronary Intervention Background HA AP target 2/3, coordinated by PCI Working
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
Predictive Implications of Stress Testing (Chapt. 14) 1979, Weiner and coworkers. Factors to improve the accuracy of stress testing
Predictive Implications of Stress Testing (Chapt. 14) Sensitivity Specificity Predictive Value Patient Risk 1979, Weiner and coworkers Stress testing has very little diagnostic value. A positive stress
Effect of Spinal Cord Stimulation on Myocardial Flow Reserve in Patients with Refractory Angina Pectoris
Effect of Spinal Cord Stimulation on Myocardial Flow Reserve in Patients with Refractory Angina Pectoris Antti Varis, Heikki Ukkonen, Antti Saraste, Tuija Vasankari, Satu Tunturi, Markku Taittonen, Pirkka
Q1: Global risk assessment using PROCAM, SCORE, FRAMINGHAM or REYNOLDS ecc is sufficient YES NO NEED MORE DATA DISCUSS within Taskforce Your Comments
Site ID: Q1: Global risk assessment using PROCAM, SCORE, FRAMINGHAM or REYLDS ecc is sufficient Q2: The value of an emerging test is best assessed using C - statistics Q3: Atherosclerosis imaging may be
4/7/2015. Cardiac Rehabilitation: From the other side of the glass door. Chicago, circa 1999. Objectives. No disclosures, no conflicts
Cardiac Rehabilitation: From the other side of the glass door No disclosures, no conflicts Charles X. Kim, MD, FACC, ABVM Objectives 1. Illustrate common CV benefits of CV rehab in real world practice.
DISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD
STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with
Evaluation of Predictive Models
Evaluation of Predictive Models Assessing calibration and discrimination Examples Decision Systems Group, Brigham and Women s Hospital Harvard Medical School Harvard-MIT Division of Health Sciences and
All patients presenting to the Emergency Department with symptoms suggestive of
APPENDIX: Online Data Supplements Clinical Trial Inclusion and Exclusion Criteria All patients presenting to the Emergency Department with symptoms suggestive of acute coronary syndrome (ACS) were screened
Low-dose CT for Pulmonary Embolism
Low-dose CT for Pulmonary Embolism Gautham Gautham P. P. Reddy, Reddy, MD, MD, MPH MPH University University of of Washington Washington Introduction Introduction CT CT accounts accounts for for > 50%
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
PIHRATE Trial. Polish-Italian-Hungarian Randomized ThrombEctomy Trial. Dariusz Dudek MD, PhD. On behalf PIHRATE investigators
Polish-Italian-Hungarian Randomized ThrombEctomy Trial PIHRATE Trial On behalf PIHRATE investigators Dariusz Dudek MD, PhD Institute of Cardiology, Krakow, Poland Impact of distal embolization Distal embolization
Utilizing the Cath Lab for Cardiac Arrest
Utilizing the Cath Lab for Cardiac Arrest Khaled M. Ziada, MD Director, Cardiovascular Catheterization Laboratories Gill Heart Institute, University of Kentucky UK/AHA Strive to Revive Symposium May 2013
Remote Delivery of Cardiac Rehabilitation
Remote Delivery of Cardiac Rehabilitation Bonnie Wakefield, RN, PhD Kariann Drwal, MS Melody Scherubel, RN Thomas Klobucar, PhD Skyler Johnson, MS Peter Kaboli, MD, MS VA Rural Health Resource Center Central
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
Intravascular Diagnostic Procedures and Imaging Techniques Versus Angiography Alone in Coronary Stenting: Future Research Needs
Future Research Needs Paper Number 25 Intravascular Diagnostic Procedures and Imaging Techniques Versus Angiography Alone in Coronary Stenting: Future Research Needs Future Research Needs Paper Number
Evaluation of Diagnostic and Screening Tests: Validity and Reliability. Sukon Kanchanaraksa, PhD Johns Hopkins University
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this
R.P. Zecchin*, J. Baihn, Y.Y. Chai, J. Hungerford, G. Lindsay, M. Owen, J. Thelander, D.L. Ross, C. Chow, A.R. Denniss. Westmead Hospital, Sydney,
R.P. Zecchin*, J. Baihn, Y.Y. Chai, J. Hungerford, G. Lindsay, M. Owen, J. Thelander, D.L. Ross, C. Chow, A.R. Denniss. Westmead Hospital, Sydney, Australia Cardiac rehabilitation is an effective and safe
California Health and Safety Code, Section 1256.01
California Health and Safety Code, Section 1256.01 1256.01. (a) The Elective Percutaneous Coronary Intervention (PCI) Pilot Program is hereby established in the department. The purpose of the pilot program
This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.
abcd Clinical Study for Public Disclosure This clinical study synopsis is provided in line with s Policy on Transparency and Publication of Clinical Study Data. The synopsis which is part of the clinical
Adult Cardiology. Diagnosis of Arterial Disease of the Lower Extremities With Duplex Scanning: A Validation Study
Adult Cardiology Diagnosis of Arterial Disease of the Lower Extremities With Duplex Scanning: A Validation Study Rosella S. Arellano, MD; Ma. Teresa B. Abola, MD. Background --- While standard x-ray arteriography
Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care
Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY
Clinical Research Intracoronary Stenting with Crushing in Coronary Artery Bifurcation Lesions: Initial Results and Medium-Term Follow Up
Hellenic J Cardiol 45: 379-383, 2004 Clinical Research Intracoronary Stenting with Crushing in Coronary Artery Bifurcation Lesions: Initial Results and Medium-Term Follow Up PETROS S. DARDAS, DIMITRIS
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,
MEDICAL POLICY No. 91580-R1 DRUG-ELUTING STENTS FOR ISCHEMIC HEART DISEASE
DRUG-ELUTING STENTS FOR ISCHEMIC HEART DISEASE Effective Date: October 1, 2015 Review Dates: 10/11, 10/12, 10/13, 8/14, 8/15 Date Of Origin: October 12, 2011 Status: Current Summary of Changes Clarifications:
Cardiac Rehabilitation An Underutilized Class I Treatment for Cardiovascular Disease
Cardiac Rehabilitation An Underutilized Class I Treatment for Cardiovascular Disease What is Cardiac Rehabilitation? Cardiac rehabilitation is a comprehensive exercise, education, and behavior modification
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 Recommendations of the European Society of Cardiology Updated version December 2002 Task Force on management
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
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
scan: : a new tool to analyse
Gated CT-scan scan: : a new tool to analyse the shape of the aortic annulus. SEROUSSI SAFAR K, JONDEAU G, LANSAC E., SERFATY JM Bichat Hospital, U698, Paris, France Anatomy: 3D + spatial resolution Retrospective
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,
Platelet Function Testing vs Genotyping : Focus on Pharmacogenomics of Clopidogrel. Kiyuk Chang, M.D., Ph.D.
Platelet Function Testing vs Genotyping : Focus on Pharmacogenomics of Clopidogrel Kiyuk Chang, M.D., Ph.D. Cardiovascular Center & Cardiology Division Seoul St. Mary s Hospital The Catholic University
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
Atherosclerosis of the aorta. Artur Evangelista
Atherosclerosis of the aorta Artur Evangelista Atherosclerosis of the aorta Diagnosis Classification Prevalence Risk factors Marker of generalized atherosclerosis Risk of embolism Therapy Diagnosis Atherosclerosis
Research Skills for Non-Researchers: Using Electronic Health Data and Other Existing Data Resources
Research Skills for Non-Researchers: Using Electronic Health Data and Other Existing Data Resources James Floyd, MD, MS Sep 17, 2015 UW Hospital Medicine Faculty Development Program Objectives Become more
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
Diagnostic and Therapeutic Procedures
Diagnostic and Therapeutic Procedures Diagnostic and therapeutic cardiovascular s are central to the evaluation and management of patients with cardiovascular disease. Consistent with the other sections,
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
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
Acute Coronary Syndrome. What Every Healthcare Professional Needs To Know
Acute Coronary Syndrome What Every Healthcare Professional Needs To Know Background of ACS Acute Coronary Syndrome (ACS) is an umbrella term used to cover a spectrum of clinical conditions that are caused
Press. Siemens solutions support diagnosis and treatment of cardiovascular diseases
Press Healthcare Erlangen, August 29, 2015 ESC 2015: ExCel London Exhibition and Convention Center, Booth #G700 Siemens solutions support diagnosis and treatment of cardiovascular diseases New cardiovascular
Atrial Fibrillation, Chronic - Antithrombotic Treatment - OBSOLETE
Atrial Fibrillation, Chronic - Antithrombotic Treatment - OBSOLETE Clinical practice guidelines serve as an educational reference, and do not supersede the clinical judgment of the treating physician with
Corporate Medical Policy
Corporate Medical Policy Computed Tomography to Detect Coronary Artery Calcification File Name: computed_tomography_to_detect_coronary_artery_calcification Origination: 3/1994 Last CAP Review 11/2014 Next
Priority setting for research in healthcare: an application of value of. information analysis to glycoprotein IIb/IIIa antagonists in non-st elevation
Priority setting for research in healthcare: an application of value of information analysis to glycoprotein IIb/IIIa antagonists in non-st elevation acute coronary syndrome. Further information 1. The
Elevated heart rate at twelve months after heart transplantation is an independent predictor of long term mortality
Elevated heart rate at twelve months after heart transplantation is an independent predictor of long term mortality C. Tomas, MA Castel, E Roig, I. Vallejos, C. Plata, F. Pérez-Villa Cardiology Department,
The Minvasys Amazonia Pax & Nile Pax Polymer Free Paclitaxel Eluting Stent Program
The Minvasys Amazonia Pax & Nile Pax Polymer Free Paclitaxel Eluting Stent Program Jean Fajadet, MD, FESC Clinique Pasteur - Toulouse - France Disclosure statement Nothing to disclose Dedicated Delivery
COMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR DISEASE PREVENTION
European Medicines Agency London, 19 July 2007 Doc. Ref. EMEA/CHMP/EWP/311890/2007 COMMITTEE FOR HUMAN MEDICINAL PRODUCTS (CHMP) DRAFT GUIDELINE ON THE EVALUATION OF MEDICINAL PRODUCTS FOR CARDIOVASCULAR
Repeat Coronary Revascularization Procedures after Successful Bare-Metal or Drug-Eluting Stent Implantation
Original Contribution Repeat Coronary Revascularization Procedures after Successful Bare-Metal or Drug-Eluting Stent Implantation Cynthia A. Yock, MS, J. Michael Isbill, MS, Spencer B. King III, MD, Mark
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.
ADenosine Vasodilator Independent Stenosis Evaluation II
ADenosine Vasodilator Independent Stenosis Evaluation II A prospective, observational, non-randomized, double blind, global, multi-center registry with an adaptive design, investigating the diagnostic
38 year old female with mild obesity. She is planning an exercise program to loose weight. She has no other known risk factors for CAD.
Stress Testing: Wael A. Jaber, MD,FACC 38 year old female with mild obesity She is planning an exercise program to loose weight. She has no other known risk factors for CAD. You recommend: A. Exercise
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,
Chest Pain. Acute Myocardial Infarction: Differential Diagnosis and Patient Management. Common complaint in ED. Wide range of etiologies
Acute Myocardial Infarction: Differential Diagnosis and Patient Management Presented By: Barbara Furry, RN-BC, MS, CCRN, FAHA Director The Center of Excellence in Education Director of HERO Chest Pain