Surgery Grand Rounds
|
|
- Antonia Joseph
- 5 years ago
- Views:
Transcription
1 Surgery Grand Rounds Coronary Artery Bypass Grafting versus Coronary Artery Stenting Charles Ted Lord, R1
2 Coronary Artery Disease Stenosis of epicardial vessels Metabolic & hematologic Statistics 500,000 CAD death annually in US (71% of all heart disease deaths) 7 million CAD deaths worldwide 16 million in US with CAD
3 Recent Historical Perspective of Invasive Management of CAD Bypass Grafting (430,000 in 2004) Percutaneous (1.3 million in 2004) Angioplasty Atherectomy Bare Metal Stents Drug-eluting Stents
4 CABG Indications 1. Left main stenosis / left main equivalent - prognostic benefit if LVEF <50% 2. No proven benefit in 1-2V disease without proximal LAD stenosis 3. NSTEMI if LM/LM equiv CAD 4. STEMI if failed PCI * Understanding of accepted clinical and anatomic indications key to interpretation of stent vs CABG data
5 Relevant Publications Bare Metal Stents 1. ARTS Stent or Surgery ERACI II Drug eluting Stents 1. Briguori Yang ARTS II
6 Arterial Revascularization Therapies Study (ARTS) Serruys JACC 2005; 46: Multicenter, randomized trial (600 BMS vs 605 CABG) multivessel disease First to compare BMS vs CABG outcomes (1, 3, 5 year follow-up)
7 ARTS Results Angina <0.05 Nitrates-SA Nitrates-LA
8 ARTS Results - Diabetics Within stenting arm Diabetic mortality 13.4% DM vs 6.8% (p 0.03, RR 1.98) Revascularization : 42% DM vs 27% (p= 0.002) Within CABG arm: no difference in any MACCE if DM
9 ARTS Conclusions 1. No difference MI / CVA / death but this study was underpowered to detect a difference in this endpoint. 2. Increased revascularization for BMS 3.5x (10% stent CABG) 3. Increased mortality & revascularization in stenting of diabetics, not CABG 4. Significantly improved symptoms in CABG vs stent
10 Stent or Surgery Trial Lancet 2002; 360: patients (500 CABG, 488 BMS), RC design for multivessel disease Randomized 5% of those requiring revascularization
11 SoS Results Stent 5% mortality Significantly less freedom from angina, more antianginal medications 21% revascularization 11% stent x1 2% stent x2 9% CABG CABG 2% mortality 6% revascularization 4% stent x1 1% stent x2 1% CABG
12 SoS Conclusions 1. 3 yr mortality with stenting 2. revascularization (3.8x); 10% CABG 3. More symptoms, more meds with BMS 4. Immodest Claims: Majority of patients randomized without LM or 3V CAD, all with normal LVEF yet primary purpose to examine development of PCI from single lesion procedures to complex multivessel revascularization
13 ERACI - II Rodriguez JACC 2001; 37:51-58 Randomized 225 BMS vs 225 CABG ( ) for multivessel disease, normal LVEF 16% of eligible enrolled 40% 2V, 55% 3V CAD Included unprotected LM disease (5%) for BMS if amenable according to interventionalist point of view (Class III according to AHA/ACC)
14 ERACI Results Complete revascularization: 85% CABG vs 50% BMS No revasc: 95% CABG vs 83% BMS (p<0.001) No angina: 92% CABG vs 84% BMS (p=0.001) In-hospital / 30 day Events
15 Observational Data Hannan NEJM 2005; 352: ,314 patients in NY registry of BMS vs CABG, Data risk-adjusted: CABG group with higher comorbidity, more extensive disease
16 Results Hannan NEJM 2005; 352: Group All (adjusted death HR) Diabetes (adjusted death HR) 2V (no LAD) 0.75 ( ) 0.69 ( ) 2V (nonprox LAD) 0.76 ( ) 0.59 ( ) 2V (prox LAD) 0.75 ( ) 0.71 ( ) 3V (nonprox LAD) 0.74 ( ) 0.65 ( ) 3V (prox LAD) 0.64 ( ) 0.69 ( ) Stent CABG Stent CABG
17 Drug-eluting Stents Briguori Am J Cardiol 2007; 99: DES (69) vs off-pump CABG (149): diabetics with multivessel CAD Prospective, nonrandomized, 12 mo follow-up No difference in MI, CVA (at 12 mo late thrombosis?) Increased revasc in DES (19% vs 4.7% at 12 mo)
18 Drug-eluting Stents Yang J Intervent Card 2007; 20:10-16 DES (235) vs CABG (231), prospective nonrandomized, 24 month follow-up Significant baseline disease differences, non-adjusted analysis No difference in MI, CVA, death. 4x increased revasc in DES 10.4 % 2.8% (p=0.001)
19 Drug-eluting Stents Serruys ARTS II. Eurointervention 2005; 1: DES (607) vs historical comparison to ARTS I groups (BMS, CABG) Results: 1. Decreased vs BMS but increased revascularization rate vs CABG 2. Increased mortality and revascularization rates in presence of DM with DES
20 Future Directions FREEDOM Trial Multivessel CAD, diabetes: DES vs CABG Prospective randomization of 2,400 patients, opened 2004 Evaluate 5 year mortality, endpoint of all cause mortality/mi/cva CARDS (VA Coronary Artery Revascularization in Diabetes) Multivessel CAD, diabetes: DES vs CABG Randomized, multicenter, 790 enrollment open Outcome: time to death or MI
21 Future Directions CARDIA Coronary Artery Revascularization in Diabetes Multivessel or complex single vessel dz 600 patients, UK multicenter, prospective randomized SYNTAX Synergy Between PCI with Taxus & Cardiac Surgery Multivessel or LM CAD 1800 enrollment, Outcome: 12 month MACCE
22 In view of the survival benefit shown for coronary artery bypass grafting, the real controversy is why patients with symptoms and anatomy known to benefit from the procedure are still submitted to percutaneous coronary intervention. -Lancet 2006; 367: Because prior clinical trials comparing PCI techniques versus CABG showed that restenosis is the primary drawback, many interventionists consider it reasonable to assume that PCI with DES now ought to be considered equivalent, if not superior, to bypass surgery. -Klein, JACC 2006;47:22-6
23 Indication Creep for Stents 1 vessel 2 vessel 3 vessel CABG, LVEF Stent CABG Spectrum of CAD
24 Conclusions Study design Comparison in patients where CABG benefit is less Dilution of true differences by heterogeneity of multivessel disease Relevance? Small studies, none enrolling > 15% Equivalent revascularization at randomization Studies look only at initial treatment. No survival difference due to high re-pci/cabg crossover? Less symptomatic relief with stents Mortality increase in stenting diabetics No evidence that PCI safe or effective in LM CAD Future studies are similarly flawed to perpetuate BMS data errors into DES era Patients want less invasive treatment is a judgement
Controversies in Cardiac Surgery
Controversies in Cardiac Surgery 3 years after SYNTAX : Percutaneous Coronary Intervention for Multivessel / Left main stem Coronary artery disease Pro ESC Congress 2010, 28 August 1 September Stockholm
More informationUnprotected LM intervention
Unprotected LM intervention Guideline for COMBAT Seung-Jung Park, MD, PhD Professor of Internal Medicine, Seoul, Korea Current Recommendation for unprotected LMCA Stenosis Class IIb C in ESC guideline
More informationΔημήτριος Αγγοσράς, FETCS
ΣΕΜΙΝΑΡΙΟ ΟΜΑΔΩΝ ΕΡΓΑΣΙΑΣ Δημήτριος Αγγοσράς, FETCS Επίκοσρος Καθηγηηής Καρδιοτειροσργικής Ιαηρική Πανεπιζηημίοσ Αθηνών Πανεπιζηημιακό Γενικό Νοζοκομείο Αηηικόν Randomized Controlled Trials (RCTs) Why
More informationManagement of cardiovascular disease - coronary interventions -
Master Classes in Preventive Cardiology I Management of diabetes in patients with CVD European Heart House Management of cardiovascular disease - coronary interventions - Francesco Cosentino MD, PhD, FESC
More informationVCU Pauley Heart Center: A 2009 US News Top 50 Heart and Heart Surgery Hospital
VCU Pauley Heart Center: A 2009 US News Top 50 Heart and Heart Surgery Hospital Complex PCI: Multivessel Disease George W. Vetrovec, MD. Kimmerling Chair of Cardiology VCU Pauley Heart Center Virginia
More informationAdvances in Cardiovascular Diagnosis and Therapy. No disclosure or conflicts. Outline
Advances in Cardiovascular Diagnosis and Therapy Firas Zahr, MD Assistant Professor of Medicine Interventional Cardiology University Of Iowa No disclosure or conflicts Outline What is new with revascularization?
More informationMedical Rx vs PCI vs CABG
Medical Rx vs PCI vs CABG S. Hinan Ahmed, MD Associate Professor: Cardiology and Cardiothoracic Surgery Program Director: Interventional Fellowship Program Assoc Editor: Cath and Cardiovasc Intervention
More informationThe SYNTAX-LE MANS Study
The SYNTAX-LE MANS Study Synergy Between PCI with TAXUS Express and Cardiac Surgery: Late (15-month) Left Main Angiographic Substudy A. Pieter Kappetein, MD, PhD Erasmus MC, Rotterdam, NL SYNTAX-LE MANS
More informationDiabetic Patients: Current Evidence of Revascularization
Diabetic Patients: Current Evidence of Revascularization Alexandra J. Lansky, MD Yale University School of Medicine University College of London The Problem with Diabetic Patients Endothelial dysfunction
More informationEXCEL vs. NOBLE: How to Treat Left Main Disease in 2017 AATS International Cardiovascular Symposium December 8-9, 2017
EXCEL vs. NOBLE: How to Treat Left Main Disease in 2017 AATS International Cardiovascular Symposium December 8-9, 2017 Igor F. Palacios, MD Director of Interventional Cardiology Professor of Medicine Massachusetts
More informationTreatment Options for Angina
Treatment Options for Angina Interventional Cardiology Perspective Michael A. Robertson, M.D. 10/30/10 Prevalence of CAD in USA 15 million Americans with CAD 2 million diagnostic catheterizations 1 million
More informationUnprotected Left Main Stenting: Patient Selection and Recent Experience. Alaide Chieffo. S. Raffaele Hospital, Milan, Italy
Unprotected Left Main Stenting: Patient Selection and Recent Experience Alaide Chieffo S. Raffaele Hospital, Milan, Italy Class IIa (Level B) AHA/ACC 2005 Guidelines Left Main CAD The use of PCI for pts
More informationWhen should we indisputably perform CABG? Quand faut-il indiscutablement opérer? Dr Hakim BENAMER
When should we indisputably perform CABG? Quand faut-il indiscutablement opérer? Dr Hakim BENAMER ICPS, Massy ICV-GVM La Roseraie, Aubervilliers Hôpital FOCH, Suresnes Disclosure Statement of Financial
More informationCOMMENT DEFINIR UN PLURITRONCULAIRE. Didier Carrié CHU Toulouse Rangueil
COMMENT DEFINIR UN PLURITRONCULAIRE VISION ANGIOGRAHIQUE DU PLURITRONCULAIRE Didier Carrié CHU Toulouse Rangueil Congrès GRCI 03 Décembre 2010 Pôle Cardiovasculaire et Métabolique Avec quel œil je regarde
More informationLessons learned From The National PCI Registry
Lessons learned From The National PCI Registry w a v e On Behalf of The Publication Committee of the National PCI Registry Objectives & Anticipated Achievements To determine the epidemiology of patients
More informationSurgical vs. Percutaneous Revascularization in Patients with Diabetes and Acute Coronary Syndrome
Surgical vs. Percutaneous Revascularization in Patients with Diabetes and Acute Coronary Syndrome Chris C. Cook, MD Associate Professor of Surgery Director, CT Residency Program, WVU ACOI 10/17/18 No Disclosures
More informationCan Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO!
Can Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO! Young-Hak Kim, MD, PhD Heart Institute, University of Ulsan College of Medicine Asan Medical Center,
More informationWhat do the guidelines say?
Percutaneous coronary intervention in 3-vessel disease and main stem What do the guidelines say? Nothing to disclose Dariusz Dudek Institute of Cardiology, Jagiellonian University Krakow, Poland The European
More informationLeft Main Intervention: Where are we in 2015?
Left Main Intervention: Where are we in 2015? David A. Cox, MD FSCAI Director, Cardiology Research Associate Director, Cardiac Cath Lab Lehigh Valley Health Network Allentown, PA Fall Fellows Course Laa
More informationAsian AMI Registry Session The 17 th Joint Meeting of Coronary Revascularization (JCR 2017) Busan, Korea Dec 8 th 2017
Asian AMI Registry Session The 17 th Joint Meeting of Coronary Revascularization (JCR 2017) Busan, Korea Dec 8 th 2017 Trends of acute myocardial infarction in Korea from the experience of Korea Acute
More informationFAME STUDY: 2-year Follow-Up & CLINICAL SUBGROUP ANALYSIS
Coronary Physiology In The Cathlab FAME STUDY: 2-year Follow-Up & CLINICAL SUBGROUP ANALYSIS Educational Training Program ESC European Heart House april 7th 9th 2011 Nico H.J.Pijls, MD, PhD Catharina Hospital,
More informationPCI vs. CABG From BARI to Syntax, Is The Game Over?
PCI vs. CABG From BARI to Syntax, Is The Game Over? Seung-Jung Park, MD, PhD Professor of Medicine, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea PCI vs CABG Multi-Vessel Disease
More informationSouthern Thoracic Surgical Association CABG in 2012: Implications of the New ESC/EACTS Guidelines
Southern Thoracic Surgical Association 2011 CABG in 2012: Implications of the New ESC/EACTS Guidelines David P Taggart MD PhD FRCS Professor of Cardiovascular Surgery, University of Oxford Conflicts of
More informationChronic Total Occlusion: a case for coronary artery bypass grafting
Chronic Total Occlusion: a case for coronary artery bypass grafting Rune Haaverstad Professor & Chief Dept. of Cardiothoracic Surgery Haukeland University Hospital Bergen, Norway Disclosure Research cooperation
More informationCite this article as:
doi: 10.21037/acs.2018. 05.12 Cite this article as: Ngu JM, Sun LY, Ruel M. Pivotal contemporary trials of percutaneous coronary intervention vs. coronary artery bypass grafting: a surgical perspective..
More informationDESs in Multivessel Disease
DESs in Multivessel Disease Lessons learned from large registry experience. BY DANIEL W. CARLSON, MD, AND MARK A. TURCO, MD, FACC, FSCAI For patients with limitation of ordinary physical activity secondary
More informationLeft Main Intervention: Will it become standard of care?
Left Main Intervention: Will it become standard of care? David Cox, MD FSCAI, FACC Director, Interventional Cardiology Research Associate Director, Cardiac Cath Lab Lehigh Valley Health Network Allentown,
More informationThe Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery: The SYNTAX Study
The Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery: The SYNTAX Study Five-Year Results in the French Subset René Koning, MD On behalf of the SYNTAX investigators Three-year
More informationhigh SYNTAX Score? I Sheiban Division of Cardiology Interventional Card. University of Turin Turin / Italy
What to do with patients with high SYNTAX Score? I Sheiban Division of Cardiology Interventional Card. University of Turin San Giovanni Battista Hospital Turin / Italy Who are the patients with high SYNTAX
More informationMichael Mack, M.D. Baylor Healthcare System Heart Hospital Baylor Plano Dallas, TX
Michael Mack, M.D. Baylor Healthcare System Heart Hospital Baylor Plano Dallas, TX Boston Scientific, Inc.- Syntax Trial Steering Committee Member- travel expenses paid by trial sponsor Maquet, Inc.- unpaid
More informationRevascularization In HFrEF: Are We Close To The Truth. Ali Almasood
Revascularization In HFrEF: Are We Close To The Truth Ali Almasood HF epidemic 1-2% of the population have HF At least one-half have heart failure with reduced ejection fraction (HF- REF) The most common
More informationThe Case for PCI as the Preferred Therapy in Most Patients with Chronic Stable Angina
The Case for PCI as the Preferred Therapy in Most Patients with Chronic Stable Angina Ajay J. Kirtane,, MD Columbia University Medical Center The Cardiovascular Research Foundation Conflict of Interest
More informationRevascularization after Drug-Eluting Stent Implantation or Coronary Artery Bypass Surgery for Multivessel Coronary Disease
Impact of Angiographic Complete Revascularization after Drug-Eluting Stent Implantation or Coronary Artery Bypass Surgery for Multivessel Coronary Disease Young-Hak Kim, Duk-Woo Park, Jong-Young Lee, Won-Jang
More informationRationale for Percutaneous Revascularization ESC 2011
Rationale for Percutaneous Revascularization Marie Claude Morice, Massy FR MD, FESC, FACC ESC 2011 Paris Villepinte - 27-31 August, 2011 Massy, France Potential conflicts of interest I have the following
More informationMaster Class in Preventive Cardiology Focus on Diabetes and Cardiovascular Disease Geneva April
Master Class in Preventive Cardiology Focus on Diabetes and Cardiovascular Disease Geneva April 14 2011 Coronary interventions in patients with diabetes Lars Rydén Karolinska Institutet Stockholm, Sweden
More informationImplications of the New ESC/EACTS Guidelines for Myocardial Revascularization in 2011
Implications of the New ESC/EACTS Guidelines for Myocardial Revascularization in 2011 Prof. Dr. Volkmar Falk Klinik für Herz- und Gefäßchirurgie, Universitätsspital Zürich, Schweiz In 2004 headlines were
More informationClinical Seminar. Which Diabetic Patient is a Candidate for Percutaneous Coronary Intervention - European Perspective
Clinical Seminar Which Diabetic Patient is a Candidate for Percutaneous Coronary Intervention - European Perspective Stephan Windecker Department of Cardiology Swiss Cardiovascular Center and Clinical
More informationMise à Jour sur le traitement du Pluritronculaire Philippe Généreux, MD
Mise à Jour sur le traitement du Pluritronculaire Philippe Généreux, MD Columbia University Medical Center and The Cardiovascular Research Foundation, New York, USA Hôpital du Sacré-Coeur de Montréal,
More informationMichael Mack, M.D. Baylor Healthcare System Heart Hospital Baylor Plano Dallas, TX
Michael Mack, M.D. Baylor Healthcare System Heart Hospital Baylor Plano Dallas, TX Maquet, Inc.,- unpaid consultant Cordis, Inc.,- unpaid consultant Boston Scientific, Inc.,- travel expenses paid for Syntax
More informationNew Generation Drug- Eluting Stent in Korea
New Generation Drug- Eluting Stent in Korea Young-Hak Kim, MD, PhD Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Purpose To briefly introduce the
More informationImportant LM bifurcation studies update
8 th European Bifurcation Club 12-13 October 2012 - Barcelona Important LM bifurcation studies update I Sheiban E-mail: isheiban@yahoo.com Unprotected LM Percutaneous Revascularization What is important
More informationKomplexe Koronarintervention heute: Von Syntax zu bioresorbierbaren Stents
Komplexe Koronarintervention heute: Von Syntax zu bioresorbierbaren Stents Prof. Dr. med. Julinda Mehilli Medizinische Klinik und Poliklinik I Klinikum der Universität München Campus Großhadern Key Factors
More informationPerspective of LM stenting with Current registry and Randomized Clinical Data
Asian Pacific TCT Perspective of LM stenting with Current registry and Randomized Clinical Data Patrick W. Serruys MD PhD Yoshinobu Onuma MD Seung-Jung Park MD, PhD 14:48-15:00, 2009 Symposium Arena, Level
More informationAdults With Diagnosed Diabetes
Adults With Diagnosed Diabetes 1990 No data available Less than 4% 4%-6% Above 6% Mokdad AH, et al. Diabetes Care. 2000;23(9):1278-1283. Adults With Diagnosed Diabetes 2000 4%-6% Above 6% Mokdad AH, et
More informationSAHA PCI or CABG for Left Main and Multi-Vessel Disease: when I would definitely/ maybe/never refer my patient for PCI or CABG
SAHA 2017 PCI or CABG for Left Main and Multi-Vessel Disease: when I would definitely/ maybe/never refer my patient for PCI or CABG David P Taggart MD PhD FRCS FESC Professor of Cardiovascular Surgery,
More informationLeft Main Disease: what is left to surgery? Prof. Jacques Monségu CardioVascular Institute Grenoble, France
Left Main Disease: what is left to surgery? Prof. Jacques Monségu CardioVascular Institute Grenoble, France Background on LM stenosis 5% of patients undergoing angiography Of the myocardium 80% Bifurcation
More informationFractional Flow Reserve: Review of the latest data
Fractional Flow Reserve: Review of the latest data Michalis Hamilos, MD, PhD, FESC University Hospital of Heraklion Fractional Flow Reserve (FFR) Coronary angiography does not always tell the truth Most
More informationDESCRIPTION: Percentage of patients aged 18 years and older undergoing isolated CABG surgery who received an IMA graft
Measure #43 (NQF 0134): Coronary Artery Bypass Graft (CABG): Use of Internal Mammary Artery (IMA) in Patients with Isolated CABG Surgery National Quality Strategy Domain: Effective Clinical Care 2017 OPTIONS
More informationLésions du tronc commun: Reste t il une place pour la chirugie? Pierre Deharo, CHU TIMONE, Marseille
Lésions du tronc commun: Reste t il une place pour la chirugie? Pierre Deharo, CHU TIMONE, Marseille Disclosure Statement of Financial Interest I currently have, or have had over the last two years, an
More informationCoronary Artery Disease: Revascularization (Teacher s Guide)
Stephanie Chan, M.D. Updated 3/15/13 2008-2013, SCVMC (40 minutes) I. Objectives Coronary Artery Disease: Revascularization (Teacher s Guide) To review the evidence on whether percutaneous coronary intervention
More informationAssessing Myocardium at Risk: Applying SYNTAX
Assessing Myocardium at Risk: Applying SYNTAX Farouc Jaffer MD PhD FSCAI FACC FAHA Associate Professor of Medicine, Harvard Medical School Director, CAD Program and Chronic Total Occlusion PCI Program
More informationLM stenting - Cypher
LM stenting - Cypher Left main stenting with BMS Since 1995 Issues in BMS era AMC Restenosis and TLR (%) 3 27 TLR P=.282 Restenosis P=.71 28 2 1 15 12 Ostium 5 4 Shaft Bifurcation Left main stenting with
More informationManagement of Multivessel CAD: Stenting or CABG?
Management of Multivessel CAD: Stenting or CABG? Filippos Triposkiadis, MD, FESC, FACC Department of Cardiology, University of Thessaly Long-term Outcome of Patients With 3VD Undergoing CABG A Report from
More informationLeft Main and Bifurcation Summit I. Lessons from European LM Studies
Left Main and Bifurcation Summit I Apr 29 8.56-9.09 Lessons from European LM Studies Alaide Chieffo, MD S. Raffaele Hospital, Milan, Italy Nothing to disclose regarding this presentation Lesion Location
More informationFFR in Multivessel Disease
FFR in Multivessel Disease April, 26 2013 Coronary Physiology in the Catheterization Laboratory Location: European Heart House, Nice, France Pim A.L. Tonino, MD, PhD Hartcentrum, Eindhoven, the Netherlands
More informationCase Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)?
Cronicon OPEN ACCESS CARDIOLOGY Case Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)? Valentin Hristov* Department of Cardiology, Specialized
More informationAbbott Vascular. PROTOCOL EXCEL Clinical Trial
Abbott Vascular PROTOCOL Clinical Trial Evaluation of XIENCE PRIME or XIENCE V versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization PCI (1 st gen DES) vs. CABG for Left
More informationControversies in Coronary Revascularization. Atlanta CCU April 15, 2016
Controversies in Coronary Revascularization Atlanta CCU April 15, 2016 Habib Samady MD FACC FSCAI Professor of Medicine Director, Interventional Cardiology, Emory University Director, Cardiac Catheterization
More informationReconciling the Results of the Randomized Trials
Management of Stable Angina in Multivessel Disease: Reconciling the Results of the Randomized Trials Eric A. Cohen MD, FRCPC Schulich Heart Centre Sunnybrook Health Sciences Centre Toronto ON ACC Rockies
More informationCoronary Heart Disease in Patients With Diabetes
Journal of the American College of Cardiology Vol. 49, No. 6, 2007 2007 by the American College of Cardiology Foundation ISSN 0735-1097/07/$32.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2006.09.045
More informationThe synergy between percutaneous coronary intervention with TAXUS and cardiac surgery study: A surgical perspective
SYNTAX STUDY The synergy between percutaneous coronary intervention with TAXUS and cardiac surgery study: A surgical perspective Jacques van Wyk ABSTRACT Panorama Medi-Clinic and Department of Cardiothoracic
More informationAdecade ago, many cardiac surgeons believed
CABG for Multivessel CAD Recent studies show that CABG is still preferred over PCI for most patients. BY SUBHASIS CHATTERJEE, MD; JOHN C. ALEXANDER, MD; AND PAUL J. PEARSON, MD, PHD Adecade ago, many cardiac
More informationManagement of Stable Ischemic Heart Disease. Vinay Madan MD February 10, 2018
Management of Stable Ischemic Heart Disease Vinay Madan MD February 10, 2018 1 Disclosure No financial disclosure. 2 Overview of SIHD Diagnosis Outline of talk Functional vs. Anatomic assessment Management
More informationCount Down to COMBAT
Count Down to COMBAT Randomized COMparison of Bypass Surgery versus AngioplasTy using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease Roxana Mehran, MD Associate Professor of
More informationManagement of High-Risk Coronary Artery Disease
Management of High-Risk Coronary Artery Disease Jeffrey J. Popma, MD Director, Interventional Cardiology Clinical Services Beth Israel Deaconess Medical Center Associate Professor of Medicine Harvard Medical
More informationCPORT E Trial. Atlantic C PORT
CPORT E Trial Randomized trial comparing medical, economic and quality of life outcomes of non primary PCI at hospitals with and without on site cardiac surgery Mo#va#on for Trial Sustain primary PCI program
More informationPCI in Left Main Disease: Are We There Yet?
PCI in Left Main Disease: Are We There Yet? Moderator Mark A. Turco, MD Director Center for Cardiac & Vascular Research Washington Adventist Hospital Takoma Park, Maryland Panelists David E. Kandzari,
More informationDrug Eluting Stents: Bifurcation and Left Main Approach
TCT Asia 2006 Drug Eluting Stents: Bifurcation and Left Main Approach Eberhard Grube MD FACC, FSCAI Heart Center,, Germany Stanford University, School of Medicine, CA, USA DES in High Risk Lesions TAXUS
More informationSupplementary Material to Mayer et al. A comparative cohort study on personalised
Suppl. Table : Baseline characteristics of the patients. Characteristic Modified cohort Non-modified cohort P value (n=00) Age years 68. ±. 69.5 ±. 0. Female sex no. (%) 60 (0.0) 88 (.7) 0.0 Body Mass
More informationCOURAGE to Leave Diseased Arteries Alone
COURAGE to Leave Diseased Arteries Alone Spencer King MD MACC, FSCAI St. Joseph s s Heart and Vascular Institute Professor of Medicine Emeritus Emory Univ. Atlanta, USA Conflict: I am an Interventionalist
More informationCABG vs PCI: What do the Guidelines Say?
AATS International Cardiovascular Symposium: Sao Paolo 2017 CABG vs PCI: What do the Guidelines Say? David P Taggart MD PhD FRCS FESC Professor of Cardiovascular Surgery, University of Oxford Conflicts
More informationEvidence-Based Management of CAD: Last Decade Trials and Updated Guidelines
Evidence-Based Management of CAD: Last Decade Trials and Updated Guidelines Enrico Ferrari, MD Cardiac Surgery Unit Cardiocentro Ticino Foundation Lugano, Switzerland Conflict of Interests No conflict
More informationMost Patients with Elective Left Main Disease. Farrel Hellig
Most Patients with Elective Left Main Disease Should be Treated with PCI! Farrel Hellig Sunnnghill and Sunward Park Hospitals Johannesburg South Africa Everything that can be invented has been invented
More informationHow to approach non-infarct related artery disease in patients with STEMI in a limited resource setting
How to approach non-infarct related artery disease in patients with STEMI in a limited resource setting Ahmed A A Suliman, MBBS, FACP, FESC Associate Professor, University of Khartoum Interventional Cardiologist,
More informationΑΓΓΕΙΟΠΛΑΣΤΙΚΗ ΣΤΟ ΔΙΑΒΗΤΙΚΟ ΑΣΘΕΝΗ
ΑΓΓΕΙΟΠΛΑΣΤΙΚΗ ΣΤΟ ΔΙΑΒΗΤΙΚΟ ΑΣΘΕΝΗ Νίκος Μεζίλης MD, FESC Κλινική Άγιος Λουκάς Why diabetes is associated with restenosis endothelial dysfunction metabolic alterations accelerated platelet deposition
More informationPTCA 1979: : I
The SYNTAX Message is Clear: CABG is Preferred in Complex MVD Angioplasty Summit TCTAP 2012 Seoul, Korea April 2012 David R. Holmes, MD Mayo Clinic Rochester, MN Presenter Disclosure Information David
More informationImpact of Chronic Kidney Disease on Long-Term Outcome in Coronary Bypass Candidates Treated with Percutaneous Coronary Intervention
Original Article Print ISSN 1738-5520 On-line ISSN 1738-5555 Korean Circulation Journal Impact of Chronic Kidney Disease on Long-Term Outcome in Coronary Bypass Candidates Treated with Percutaneous Coronary
More informationPathology of percutaneous interventions (PCI) in coronary arteries. Allard van der Wal, MD.PhD; Pathologie AMC, Amsterdam, NL
Pathology of percutaneous interventions (PCI) in coronary arteries Allard van der Wal, MD.PhD; Pathologie AMC, Amsterdam, NL Percutaneous Coronary Intervention (PCI) Definition: transcatheter opening of
More informationComparison of Coronary Artery Bypass Grafting With Drug-Eluting Stent Implantation for the Treatment of Multivessel Coronary Artery Disease
Comparison of Coronary Artery Bypass Grafting With Drug-Eluting Stent Implantation for the Treatment of Multivessel Coronary Artery Disease Jeong Hoon Yang, MD, Hyeon-Cheol Gwon, MD, Soo Jin Cho, MD, Joo
More informationClinical Considerations for CTO
38 RCTs Clinical Considerations for CTO 18,000 pts Revascularization Whom to treat, Who derives benefit and What can we achieve? David E. Kandzari, MD FACC, FSCAI Director, Interventional Cardiology Research
More informationEvolution In Interventional Cardiology. Jawed Polad Jeroen Bosch Hospital s-hertogenbosch The Netherlands
Evolution In Interventional Cardiology Jawed Polad Jeroen Bosch Hospital s-hertogenbosch The Netherlands 25 November 2010 Coronary Atherosclerosis Timeline in interventional cardiology Indications for
More informationSYNTAX III REVOLUTION Trial Press briefing conference. Prof. Patrick W. Serruys MD, PhD Principal Investigator Imperial College of London
SYNTAX III REVOLUTION Trial Press briefing conference Prof. Patrick W. Serruys MD, PhD Principal Investigator Imperial College of London Title: Coronary Computed Tomography Angiography for Heart Team Decision-making
More informationCLINICAL CONSEQUENCES OF THE
CLINICAL CONSEQUENCES OF THE FAME STUDY TCT ASIA Seoul, Korea, april 26 th, 2012 Nico H. J. Pijls, MD, PhD Catharina Hospital, Eindhoven, The Netherlands GUIDELINES ESC SEPTEMBER 2010 FFR UPGRADED TO LEVEL
More informationTRATAMIENTO INVASIVO ENFERMEDAD ISQUEMICA ESTABLE. Jonathan Poveda CLINICA BIBLICA 2015
TRATAMIENTO INVASIVO ENFERMEDAD ISQUEMICA ESTABLE Jonathan Poveda CLINICA BIBLICA 2015 COURAGE First coronary angioplasty lesion (circles) two days before (A), immediately after (B), and one month after
More informationThe MAIN-COMPARE Registry
Long-Term Outcomes of Coronary Stent Implantation versus Bypass Surgery for the Treatment of Unprotected Left Main Coronary Artery Disease Revascularization for Unprotected Left MAIN Coronary Artery Stenosis:
More informationCOMPARE Trial Elvin Kedhi Maasstad Ziekenhuis Rotterdam The Netherlands
COMPARE Trial Elvin Kedhi Maasstad Ziekenhuis Rotterdam The Netherlands TCTAP 2010 Seoul, Korea Disclosures Research Foundation of the Cardiology Department has received unrestricted research grants from:
More informationEmergency surgery in acute coronary syndrome
Emergency surgery in acute coronary syndrome Teerawoot Jantarawan Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
More information1. Whether the risks of stent thrombosis (ST) and major adverse cardiovascular and cerebrovascular events (MACCE) differ from BMS and DES
1 Comparison of Ischemic and Bleeding Events After Drug- Eluting Stents or Bare Metal Stents in Subjects Receiving Dual Antiplatelet Therapy: Results from the Randomized Dual Antiplatelet Therapy (DAPT)
More informationReview. Open Access. Beom Jun Lee 1, Peter Herbison 2, Cheuk-Kit Wong 1. 1 Introduction
Journal of Geriatric Cardiology (2014) 11: 83 89 2014 JGC All rights reserved; www.jgc301.com Review Open Access Is the advantage of coronary bypass graft surgery over percutaneous coronary intervention
More informationTLR des Stents Actifs
TLR des Stents Actifs No Conflict of Interest Target Lesion Revascularization DES vs BMS Stettler C et al. Lancet 2007;370:937-48 N=18,023 58% 70% SES vs BMS: HR=0.30 (0.24-0.37), p
More informationLe# Main Interven-on: When Is It Appropriate. Femi Philip, MD Assistant Professor Of Medicine UC Davis
Le# Main Interven-on: When Is It Appropriate Femi Philip, MD Assistant Professor Of Medicine UC Davis Nil Disclosures Outline What is the LMCA? Should we revascularize severe LMCA disease? What revascularizacon
More informationCindy L. Grines MD FACC FSCAI
Cindy L. Grines MD FACC FSCAI Hofstra Northwell School of Medicine Chair, Cardiology Academic Chief of Cardiology, Northwell Health North Shore University Hospital, Manhasset NY Multivessel Disease in
More informationCoronary Revascularization for Patients with Severe Coronary Artery Disease: An Overview of Current Evidence and Treatment Strategies
Review J Jpn Coron Assoc 2015; 21: 267-271 Coronary Revascularization for Patients with Severe Coronary Artery Disease: An Overview of Current Evidence and Treatment Strategies Hiroki Shiomi, Takeshi Kimura
More information3/23/2017. Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate Europace Oct;14(10): Epub 2012 Aug 24.
Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate 2017 Explain the efficacy and safety of triple therapy, in regards to thromboembolic and bleeding risk Summarize the guideline recommendations
More informationSupplementary Online Content
Supplementary Online Content Valle JA, Tamez H, Abbott JD, et al. Contemporary use and trends in unprotected left main coronary artery percutaneous coronary intervention in the United States: an analysis
More informationPrevention of Coronary Stent Thrombosis and Restenosis
Prevention of Coronary Stent Thrombosis and Restenosis Seong-Wook Park, MD, PhD, FACC Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea 9/12/03 Coronary
More informationAngelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate 2017
Angelika Cyganska, PharmD Austin T. Wilson, MS, PharmD Candidate 2017 Explain the efficacy and safety of triple therapy, in regards to thromboembolic and bleeding risk Summarize the guideline recommendations
More informationROLE OF CORONARY PRESSURE & FFR IN MULTIVESSEL DISEASE
ROLE OF CORONARY PRESSURE & FFR IN MULTIVESSEL DISEASE Angioplasty Summit TCT ASIA Seoul, Korea, april 24th, 2008 Nico H. J. Pijls, MD, PhD Catharina Hospital, Eindhoven, The Netherlands A rather common
More informationManagement of High-Risk CAD : Surgeons Perspective
Management of High-Risk CAD : Surgeons Perspective Steven F. Bolling, M.D. Professor of Cardiac Surgery University of Michigan Conflict : Cardiac Surgeon! High Risk CABG 77 year old with prior large anterior
More informationChapter 29 Left Main Intervention in the Light of EXCEL and NOBLE Trials
Chapter 29 Left Main Intervention in the Light of EXCEL and NOBLE Trials DEBDATTA BHATTACHARYYA AYAN KAR The incidence of angiographically significant left main stenosis described in various studies has
More information