Daily practice of ACS management in the Gulf: Data from Gulf COAST
|
|
- Berenice Charleen Merritt
- 6 years ago
- Views:
Transcription
1 Daily practice of ACS management in the Gulf: Data from Gulf COAST Mohammad Zubaid, MB, ChB, FRCPC, FACC Professor of Medicine, Kuwait University Head, Division of Cardiology Mubarak Alkabeer Hospital Kuwait 1 st Al Wakra Hospital Medical Conference January 31, 2014 Intercontinental hotel, Doha, Qatar
2 Do we always do what we claim we do? Reperfusion therapy in STEMI patients in hospitals with Primary PCI policy Routinely do Primary PCI Hospitals with primary PCI 7 of 18 hospitals (39%) Reperfused STEMI 329 Thrombolytic therapy 213 (65%) Primary PCI 116 (35%) Al-Zakwani I et al, Int J Clin Pharm Jun;34(3):445-51
3 Clinical trials vs. observational registries Carefully-conducted, observational registries reveal what we do in our daily practice. What we do, not what we know, impacts our patients outcomes. Randomized trials tell us about the efficacy of an agent/intervention in certain protected set up. Randomized trials cannot emulate daily practice.
4 Regional observational ACS registries
5 Gulf COAST Registry Gulf locals with acute coronary Syndrome events Registry The study was approved by the ethics committees of each institution/country.
6 IMPORTANT FEATURES OF GULF COAST DESIGN 1 Prospective 2 Observational 3 Standardized data definitions 4 Consecutive 5 Enrolled locals (citizen) 6 Admitted to hospital (or planned for admission) 7 Discharge diagnosis of the admission event is ACS 8 Follow up: 1, 6 and 12 months
7 Standardized Data Definitions Enhance Data Accuracy and Allow for Better Comparisons Across Studies
8 Why Gulf COAST? Gulf RACE Gulf COAST Year Design Prospective, observational Prospective, observational enrolment 6 months 12 months Countries 6 4 Geographic coverage area At least 80% of each country At least 80% of each country Ethics approval Yes Yes Consent form No Yes Sponsor Sanofi/GHA AstraZeneca/Kuwait University
9 Overview of Gulf RACE and Gulf COAST Gulf RACE Gulf COAST Hospitals Cath labs 18 (29%) 12 (36%) Population Citizens and expatriates Citizens only Inclusion criteria Definitions Data entry consecutive patients admitted and discharged with ACS ACC key data elements and definitions (JACC 2001) Paper CRF centralized data entry at PI Patients 8176 (3184 citizens) consecutive patients admitted and discharged with ACS ACC key data elements and definitions (JACC 2001) Paper CRF online data entry by investigators 4080 All citizens Follow-up Hospital discharge One year
10
11 3 Types of Hospitals and Paper CRFs Hospitals without onsite cath lab e.g. Jahra H, Kuwait; Salmaniya H, Bahrain; Sohar H, Oman; Dibba H, UAE Hospital without onsite cath lab CRF Hospitals with onsite cath lab that both enroll patients and also receive in-hospital transfers for cath e.g. Adan H, Kuwait; BDF H, Bahrain; Royal H, Oman; SKMC H, UAE. Hospital with onsite cath lab CRF Transfer for Cath CRF Non Gulf COAST Hospital Hospital with onsite cath lab that only receives in-hospital transfers for cath Only example: Chest Diseases H, Kuwait Transfer for Cath CRF
12 Data Accuracy: continuous data cleaning from the start Built in data checks in ecrf with alerts immediately displayed to user Site Visits Monthly analysis of data using SPSS Quality Control Reports ed to SO and CSO missing values. out of range values. contradictory entries related to multiple data fields
13 BARC classification for bleeding
14 Internal Data Checks: Alert to 3 Important Outcomes We Don t Want to Miss
15 Sponsor AstraZeneca Gulf Study oversight Kuwait University
16 Distribution of ACS type Discharge diagnosis ACS type Gulf COAST 2012 (n=3896 ) GRACE (n=10,709) GRACE (n=31,982) STEMI (%) NSTEMI (%) UA (%) Steg et al, Am J Cardiol 2002;90: Shaun et al, Am Heart J 2009;158:
17 Risk Profiles
18 Gulf COAST Baseline characteristics NSTEMI (1827) n (%) STEMI (994) n (%) Age (Mean±SD) 62.1± ±13.4 Female 630 (35) 224 (23) Hypertension 1291 (71) 466 (47) Diabetes 1056 (58) 460 (46) Smoking 375 (21) 357 (36) Prior MI 598 (33) 118 (12) Prior PCI 419 (23) 84 (9) Prior CABG 169 (9) 21 (2) Prior TIA 58 (3) 14 (1) Prior stroke 140 (8) 51 (5)
19 Our ACS patients are young Gulf COAST 2012 (n= 3188) GRACE (n= 10,709) GRACE (n=31,982) EHS-ACSII (n=6,385) Age (mean) (median) 64 Male (%) Steg et al, Am J Cardiol 2002;90: Shaun et al, Am Heart J 2009;158: Mandelzweig et al, Euro Heart J 2006;27:
20 Risk Factor profile in ACS patients Gulf COAST 2012 (n=3188) GRACE (n=5,720) GRACE (n=31,982) EHS-ACSII (n=6,385) Current Smoker * 37 Known DM * Current or past smoker 1 Fox et al, JAMA 2007;297: Shaun et al, Am Heart J 2009;158: Mandelzweig et al, Euro Heart J 2006;27:
21 ACS patients risk profile Past medical history Gulf COAST 2012 (n=3188) GRACE (n=5720) GRACE (n=31,982) EHS-ACSII (n=6,385) Angina (%) MI (%) PCI (%) CABG (%) Prior ASA (%) Fox et al, JAMA 2007;297: Shaun et al, Am Heart J 2009;158: Mandelzweig et al, Euro Heart J 2006;27:
22 Adherence to medical therapy
23 Gulf COAST STEMI/NSTEMI Gulf COAST 2012 Gulf RACE 2007¹ EHS-ACS-II 2004² NRMI ³ Aspirin at arrival (%) Aspirin prescribed at discharge (%) Beta- blocker at discharge (%) Statin at discharge (%) Clopidogrel at discharge for medically treated AMI patients (%)
24 In-hospital cardiac catheterization
25 In-hospital catheterization Gulf COAST 2012 Gulf RACE GRACE* GRACE* EHS-ACS-II* NRMI (n=3896) N=5720 N=31,982 3 N= % 20 % 60% 67% 70-86% * derived/recalculated data 1 Zubaid et al, Acta Cardiol 2009;64: Fox et al, JAMA 2007;297: Shaun et al, Am Heart J 2009;158: Mandelzweig et al, European Heart Journal 2006; 27: Peterson et al, Am Heart J 2008;156:
26 In-hospital catheterization Per country Kuwait Oman UAE Bahrain (n=1225) (n=1399) (n=694) (n=578) 33% 24% 68% 51%
27 Gulf COAST In hospital catheterization for NSTEMI patients Hospitals with cath (n=747) n (%) Hospitals without cath (n=1080) n (%) Cath during hospital stay 547 (73) 186 (17) PCI during hospital stay 352 (47) 105 (10) Hospital arrival to cath, Mean ±SD, Median (days) 2.2±2.4 (2) 6.5±6.4 (5)
28 Gulf COAST Inhospital catheterization for STEMI patients Hospitals with cath (n=285) n (%) Hospitals without cath (n=709) n (%) Cath during hospital stay 253 (89) 174 (25) PCI during hospital stay 223 (78) 126 (18) Hospital arrival to cath, Mean ±SD, Median (days) 1.07±2.1 (0) 4.8±9 (4)
29 Gulf COAST PCI indications in STEMI patients N=349 n (%) Primary PCI 104 (30) Rescue PCI (after failed full-dose lytics) 38 (11) PCI Post MI 181 (52) Cardiogenic shock 3 (1) Unstable angina (including Post MI) 16 (4) Elective/physician preference 7 (2)
30 Reperfusion Therapy for STEMI
31 Use of reperfusion in eligible patients (%) Gulf COAST 2012 Gulf RACE GRACE GRACE EHS-ACSII* (n= 822 ) (n= 480) (n=1215) (n=7,107) (n=2,678) PPCI Lysis Shortfall * derived/recalculated data 1 Zubaid et al, Acta Cardiol 2009;64: Eagle et al, European Heart Journal 2008;29: Shaun et al, Am Heart J 2009;158: Mandelzweig et al, Euro Heart J 2006;27:
32 reperfusion in eligible patients Per country Kuwait Oman UAE Bahrain (n=259) (n= 315) (n= 129) (n= 119) PPCI Lysis Shortfall
33 Choice of reperfusion in Hospitals with onsite angiographic facilities Gulf COAST Gulf RACE GRACE* (n=217) (n=686) (n=7,657) Primary PCI 48% 24% 63% Thrombolytic Therapy 52% 76% 37% 1 Zubaid et al, Acta Cardiol 2009;64: Anderson et al, Heart 2007;93:
34 Reperfusion therapy in STEMI Patients Per hospital policy Routinely do Primary PCI No Routine Primary PCI No. of hospitals 6 4 Reperfused STEMI Lytic therapy 48 (37) 65 (75) Primary PCI 82 (63) 22 (25)
35 Was reperfusion administered in time?
36 Reperfusion Timeline Primary PCI Primary PCI Gulf COAST 2012 (n= 107) Gulf RACE (n=16) GRACE Jul Jun (n=1215) GRACE (n=1,592) EHS-ACS-II NRMI Median D2B (min) 67 min 80 min 80 min 110 min 70 min 79 min D2B 90 min (%) Zubaid et al, Acta Cardiol 2009;64: Eagle et al, European Heart Journal 2008;29: Shaun et al, Am Heart J 2009;158: Mandelzweig et al, European Heart Journal 2006; 27: Gibson et al, Am Heart J 2008; 156:
37 Reperfusion Timeline Primary PCI Per country Primary PCI Kuwait Oman UAE Bahrain (n= 17) (n= 6) (n= 46) (n=38 ) Median D2B (min) D2B 90 min (%)
38 Reperfusion Timeline Thrombolysis Thrombolysis Gulf COAST 2012 (n=654 ) Gulf RACE (n=475) GRACE (n=1215) GRACE (n=3,153) EHS- ACS-II NRMI Median D2NT (min) 40 min 44 min 34 min 32 min 37 min 29 min D2NT 30 min (%) Zubaid et al, Acta Cardiol 2009;64: Eagle et al, European Heart Journal 2008;29: Shaun et al, Am Heart J 2009;158: Mandelzweig et al, European Heart Journal 2006; 27: Gibson et al, Am Heart J 2008; 156:
39 Reperfusion Timeline Thrombolysis Per country Thrombolysis Kuwait Oman UAE Bahrain (n=225) (n= 294) (n= 65) (n= 70) Median D2NT (min) D2NT 30 min (%)
40 Reperfusion in elderly with STEMI Variable Gulf COAST 2012 *Gulf RACE 2007 **Euro heart N=305 n (%) N=1325 n (%) N=5534 n (%) Eligible Primary PCI 24 (10) 4 (2) 264 (19) Thrombolytic therapy 186 (77) 150 (82) 533 (38) Short fall 33 (13) 29 (16) 610 (43) *Zubaid et al, Acta Cardiologica 2009; 37: **Rosengren et al, EHJ 2006; 27:
41 Gulf COAST STEMI reperfusion strategy elderly vs. young Variable 65 years old <65 years old N=305 n (%) N=673 n (%) Eligible Primary PCI 24 (10) 80 (14) Thrombolytic therapy 186 (77) 460 (79) Short fall 33 (13) 41 (7) *Zubaid et al, Acta Cardiologica 2009; 37: **Rosengren et al, EHJ 2006; 27:
42 Door to balloon in hospital with and without cath labs in Kuwait Adan Hospital Door to ECG ECG to Cardiology reg Cardiology registrar respons time Door to balloon time Mubarak AlKabeer Hospital Door to ECG ECG to Cardiology reg Cardiology registrar respons time Ambulance notification Ambulance respons time Ambulance trip time Door to balloon time
43 Conclusions It is critical that we examine what we do. Gulf citizens with ACS are much younger than their European and North American peers, yet have a similar if not worse risk profile. They receive good medical therapy at discharge from hospital. The majority of hospitals do not have onsite cath labs and a minority of patients receive inhospital catheterization at those hospitals.
44 Conclusions In hospitals with onsite cath labs, majority of patient receive inhospital cath. However, the use of primary PCI is not widespread. When carried out, primary PCI was performed efficiently in terms of the door to balloon time. Lytic administration is still seeing unacceptable delay. Compared to 2007 Gulf RACE, there are positive signs.
45
Recommendations for criteria for STEMI systems of care: A focus on pharmacoinvasive strategies
Recommendations for criteria for STEMI systems of care: A focus on pharmacoinvasive strategies Mohammad Zubaid, MB, ChB, FRCPC, FACC Professor of Medicine, Kuwait University Chairman, Faculty of Cardiology,
More informationReperfusion Strategy in Europe: Temporal Trends in Performance Measures for Reperfusion Therapy in ST Elevation Myocardial Infarction
Reperfusion Strategy in Europe: Temporal Trends in Performance Measures for Reperfusion Therapy in ST Elevation Myocardial Infarction F. Schiele 1, M. Hochadel 2, M. Tubaro 3, N. Meneveau 1, W. Wojakowski
More informationTransfer in D2B. Scott D Friedman, MD FACC Medical Director, Cardiology Services Shore Health System of Maryland. The Problem
Transfer in D2B Scott D Friedman, MD FACC Medical Director, Cardiology Services Shore Health System of Maryland The Problem NRMI-5: North Carolina, July 2003- June 2004 NC Nation Guidelines N 2,738 79,927
More information4. Which survey program does your facility use to get your program designated by the state?
STEMI SURVEY Please complete one survey for each TCD designation you have in your facility. There would be a maximum of three surveys completed if your facility was designated as a trauma, stroke and STEMI
More informationST-elevation myocardial infarctions (STEMIs)
Guidelines for Treating STEMI: Case-Based Questions As many as 25% of eligible patients presenting with STEMI do not receive any form of reperfusion therapy. The ACC/AHA guidelines highlight steps to improve
More informationMohammad Zubaid, MB, ChB, FRCPC, FACC
Management and one year outcome of atrial fibrillation in Middle Eastern cohort enrolled in the observational Gulf Survey of Atrial Fibrillation Events (Gulf SAFE) Mohammad Zubaid, MB, ChB, FRCPC, FACC
More informationManagement of STEMI in era of Reperfusion. Eagles Peter Moyer, MD, MPH Medical Director Boston EMS, Fire and Police
Management of STEMI in era of Reperfusion Eagles 2007 Peter Moyer, MD, MPH Medical Director Boston EMS, Fire and Police STEMI in US ST Segment Elevation Myocardial Infarction (STEMI) ~500 K per year Thrombolysis
More informationGWTG-CAD: Mission: Lifeline Focus July 2017 PMT FORM SELECTION. Pre-Hospital/Arrival
GWTG-CAD: Mission: Lifeline Focus July 2017 PMT FORM SELECTION Page 1 Legend: BOLD = Required ^ = MLL Data Element Admin (Tab) ^Patient ID: Physician/Provider NPI: DOB: / / ^Arrival Date/Time: Race: Hispanic
More informationTreatment of ST-elevation myocardial infarction in China: Where are we?
Treatment of ST-elevation myocardial infarction in China: Where are we? Associate Professor, Yihong Sun, MD Peking University People s Hospital Beijing, China Disclosure conflict of Interest The Challenges
More informationMedical Department- Faculty of medicine-sanaa university Cardiac Center- Al-thawrah Modern General teaching Hospital
ACS In Yemeni Khat Chewers & Cardiac Bio-markers Trends, Facts From Gulf RACE- I Mohammed Al-Kebsi, MD, PhD, FGHA A-Nasser Munibari MD, FACC & A. Al-Motarreb MD, PhD,FGHA Medical Department- Faculty of
More information2013, American Heart Association
2013, American Heart Association Mission: Lifeline - Data, Reports and ACTION Registry - GWTG THE MISSION: BETTER HEART ATTACK CARE FOR YOUR COMMUNITY THE LIFELINE: THE AMERICAN HEART ASSOCIATION AND YOU
More informationSHOULD A REGIONAL STEMI CENTRE ONLY OFFER PRIMARY PCI?
SHOULD A REGIONAL STEMI CENTRE ONLY OFFER PRIMARY PCI? Kurt Huber, MD 3 Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria Disclosures DISCLOSURE
More informationDashboard and Outcomes Report with Case Studies
Dashboard and Outcomes Report with Case Studies Kim Hustler Clinical Quality Consultant, American College of Cardiology The following relationships exist: Kim Hustler: No Disclosures Section F- Procedures
More information1 a) Please confirm or deny whether your Trust has admitted patients for acute myocardial infarction in 2008/09, 2009/10 or 2010/11
May 2011 1 a) Please confirm or deny whether your Trust has admitted patients for acute myocardial infarction in 2008/09, 2009/10 or 2010/11 Yes b) If confirmed please provide details on the number of
More informationThe Window for Fibrinolysis. Frans Van de Werf, MD, PhD Leuven, Belgium
The Window for Fibrinolysis Frans Van de Werf, MD, PhD Leuven, Belgium ESC STEMI Guidelines : December 2008 Reperfusion Therapy: Fibrinolytic Therapy Recommendations Class LOE In the absence of contraindications
More informationPharmaco-Invasive Approach for STEMI
Pharmaco-Invasive Approach for STEMI Michael C. Kontos, MD Medical Director, Coronary Intensive Care Unit Director, Chest Pain Evaluation Center Associate Professor Departments of Internal Medicine (Cardiology),
More informationWilliam D. Salerno, M.D. Director, Coronary Care Unit Hackensack University Medical Center Clinical Associate Professor of Medicine, UMDNJ
William D. Salerno, M.D. Director, Coronary Care Unit Hackensack University Medical Center Clinical Associate Professor of Medicine, UMDNJ PROBLEM: blood supply to the heart has been compromised and heart
More informationPlatelet function testing to guide P2Y 12 -inhibitor treatment in ACS patients after PCI: insights from a national program in Hungary
Platelet function testing to guide P2Y 12 -inhibitor treatment in ACS patients after PCI: insights from a national program in Hungary Dániel Aradi MD PhD Interventional Cardiologist Assistant professor
More informationIschemic Heart Disease Interventional Treatment
Ischemic Heart Disease Interventional Treatment Cardiac Catheterization Laboratory Procedures (N = 89) is a regional and national referral center for percutaneous coronary intervention (PCI). A total of
More informationA Randomized Trial Evaluating Clinically Significant Bleeding with Low-Dose Rivaroxaban vs Aspirin, in Addition to P2Y12 inhibition, in ACS
A Randomized Trial Evaluating Clinically Significant Bleeding with Low-Dose Rivaroxaban vs Aspirin, in Addition to P2Y12 inhibition, in ACS Magnus Ohman MB, on behalf of the GEMINI-ACS-1 Investigators
More informationThe Role of DHMC as an ST Elevation Myocardial Infarction Receiving Center in a Regional STEMI Care Network:
The Role of DHMC as an ST Elevation Myocardial Infarction Receiving Center in a Regional STEMI Care Network: Nathaniel Niles, MD CREST Symposium November 7th, 28 STEMI = Acute Coronary Thrombosis STEMI
More informationQuality assessment in STEMI patients: the Belgian STEMI registry :
Quality assessment in STEMI patients: the Belgian STEMI registry : 2007-2014 Belgian Interdisciplinary Working Group on Acute Cardiology (BIWAC) College of Cardiology Lethality of AMI 2000-2003: MKG data
More informationKeywords: Age, acute coronary syndrome, ST-elevation myocardial infarction, non-st-elevation myocardial infarction, unstable angina, death.
60 The Open Cardiovascular Medicine Journal, 2012, 6, 60-67 Open Access Effect of Age on Clinical Presentation and Outcome of Patients Hospitalized with Acute Coronary Syndrome: A 20-Year Registry in a
More informationThe PAIN Pathway for the Management of Acute Coronary Syndrome
2 The PAIN Pathway for the Management of Acute Coronary Syndrome Eyal Herzog, Emad Aziz, and Mun K. Hong Acute coronary syndrome (ACS) subsumes a spectrum of clinical entities, ranging from unstable angina
More informationIschemic Heart Disease Interventional Treatment
Ischemic Heart Disease Interventional Treatment Cardiac Catheterization Laboratory Procedures (N = 11,61) is a regional and national referral center for percutaneous coronary intervention (PCI). A total
More informationAcute Coronary Syndrome in Phrae Hospital
Acute Coronary Syndrome in Phrae Hospital Cardiovascular Unit, Department of Medicine, Phrae hospital, Phrae Thailand. Objective: To study the epidemiology, management and outcome of patients with acute
More informationKnow the Quality of our Care at Every Step. Kansas City ACS Summit BI-State Cardiovascular Education Consortium
Know the Quality of our Care at Every Step Kansas City ACS Summit BI-State Cardiovascular Education Consortium Welcome to the Kansas City ACS Summit Objectives: Follow the flow and care of an ACS patient
More informationRegional STEMI Transfer Systems: the Mayo and NC RACE Experiences
Regional STEMI Transfer Systems: the Mayo and NC RACE Experiences Dr. Henry H. Ting, Mayo Clinic College of Medicine Dr. James G. Jollis,, Duke University Medical Center Mayo Clinic STEMI System for Transferred
More informationPatient characteristics Intervention Comparison Length of followup
ISCHAEMIA TESTING CHAPTER TESTING FOR MYCOCARDIAL ISCHAEMIA VERSUS NOT TESTING FOR MYOCARDIAL ISCHAEMIA Ref ID: 4154 Reference Wienbergen H, Kai GA, Schiele R et al. Actual clinical practice exercise ing
More informationCurrent Advances and Best Practices in Acute STEMI Management A pharmacoinvasive approach
Current Advances and Best Practices in Acute STEMI Management A pharmacoinvasive approach Frans Van de Werf, MD, PhD University Hospitals, Leuven, Belgium Frans Van de Werf: Disclosures Research grants
More information2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non ST-Elevation Myocardial Infarction
2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non ST-Elevation Myocardial Infarction Ramzi Khalil MD FACC Assistant Professor Allegheny Gen.Hospital AHN Speakers
More informationContinuing Medical Education Post-Test
Continuing Medical Education Post-Test Based on the information presented in this monograph, please choose one correct response for each of the following questions or statements. Record your answers on
More informationAcute Coronary Syndrome
Acute Coronary Syndrome Clinical Manifestation of CAD Silent Ischemia/asymptomatic Stable Angina Acute Coronary Syndrome (Non- STEMI/UA and STEMI) Arrhythmias Heart Failure Sudden Death Pain patterns with
More informationCoronary Artery Disease in Women
Coronary Artery Disease in Women by Wael Almahmeed MD, FCCP, FRCPC, FRCPE, FACP, FACC, FESC Clinical Associate Professor of Medicine, UAE University Consultant Cardiologist at Cleveland Clinic, Abu Dhabi
More informationMission: Lifeline Addressing the System of STEMI Care
Mission: Lifeline Addressing the System of STEMI Care Alice K. Jacobs, M.D. Boston University Medical Center Boston, MA, USA ACC West Virginia Chapter, April 2017 Disclosure Information FINANCIAL DISCLOSURE:
More informationManagement of Acute Myocardial Infarction
Management of Acute Myocardial Infarction Prof. Hossam Kandil Professor of Cardiology Cairo University ST Elevation Acute Myocardial Infarction Aims Of Management Emergency care (Pre-hospital) Early care
More informationData Elements and Definitions with Case Studies. Interpreting Your Outcomes Reports. Kim Hustler, Clinical Quality Consultant, NCDR
Data Elements and Definitions with Case Studies Interpreting Your Outcomes Reports Kim Hustler, Clinical Quality Consultant, NCDR Beth Pruski, Program Manager, NCDR The following relationships exist: Beth
More informationConflits d intérêt Astra-Zeneca, BMS, MSD, Novartis, Pfizer, Daiichi-Sankyo, Servier, CRAM, AFSSAPS, ARH Région de Bourgogne Clos Vougeot
Conflits d intérêt Astra-Zeneca, BMS, MSD, Novartis, Pfizer, Daiichi-Sankyo, Servier, CRAM, AFSSAPS, ARH Région de Bourgogne Clos Vougeot Agrément FMC N 100 437 Popul. millions Area km2 Density inha/km2
More informationThe NCDR and Clinical Practice Guideline Development
The NCDR and Clinical Practice Guideline Development Gregory J. Dehmer, MD, FACC, FACP, FSCAI Professor of Medicine Texas A&M HSC College of Medicine Director, Cardiology Division Baylor Scott & White
More informationDISCUSSION QUESTION - 1
CASE PRESENTATION 87 year old male No past history of diabetes, HTN, dyslipidemia or smoking Very active Medications: omeprazole for heart burn Admitted because of increasing retrosternal chest pressure
More informationQuality Standards for Patients Treated by PCI. Peter F Ludman
Quality Standards for Patients Treated by PCI Peter F Ludman NO CONFLICT OF INTEREST TO DECLARE Quality Standards for Patients treated by PCI Caution about standards Overall Structure for assessing outcomes
More informationSTEMI update. Vijay Krishnamoorthy M.D. Interventional Cardiology
STEMI update Vijay Krishnamoorthy M.D. Interventional Cardiology OVERVIEW Current Standard of Care in Management of STEMI Update in management of STEMI Pre-Cath Lab In the ED/Office/EMS. Cath Lab Post
More informationRegistry and benchmarking as tool for Quality assessment in STEMI patients
Registry and benchmarking as tool for Quality assessment in STEMI patients Belgian Interdisciplinary Working Group on Acute Cardiology (BIWAC) College of Cardiology April 2007 Background Reperfusion strategy
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 informationCoronary Catheterization and Percutaneous Coronary Intervention in China 10-Year Results From the China PEACE-Retrospective CathPCI Study
Coronary Catheterization and Percutaneous Coronary Intervention in China 10-Year Results From the China PEACE-Retrospective CathPCI Study Xin Zheng, MD, PhD; Jeptha P. Curtis, MD; Shuang Hu, PhD; YongfeiWang,
More informationAcute Coronary Syndrome. Sonny Achtchi, DO
Acute Coronary Syndrome Sonny Achtchi, DO Objectives Understand evidence based and practice based treatments for stabilization and initial management of ACS Become familiar with ACS risk stratification
More informationPatient and System Time Delay
Quality Indicators in the Management of ST-elevation Myocardial Infarction Patient and System Time Delay Jacob Thorsted Sorensen, MD, PhD Department of Cardiology Aarhus University Hospital, Denmark Disclosures
More informationNew Jersey Cardiac Catheterization Data Registry, Version 2.0 (Please report data only for patients 16 years or older.)
A. ADMINISTRATIVE New Jersey Cardiac Catheterization Data Registry, Version 2.0 (Please report data only for patients 16 years or older.) 1. Facility Code: 2. Facility Name: 3. Procedure Type (Choose only
More informationTHE BRIDGE-ACS TRIAL
A Multifaceted Intervention to Narrow the Evidence-Based Gap in the Treatment of Acute Coronary Syndromes: THE BRIDGE-ACS TRIAL Presenter: Otavio Berwanger (MD; PhD) on Behalf of the BRIDGE-ACS Steering
More informationVersion 4.4. Institutional Outcomes Report 2014Q3. National Outcomes Report Aggregation Date: Jan 12, :59:59 PM
Version 4.4 Institutional Outcomes Report 2014Q3 National Outcomes Report 999997 Aggregation Date: Jan 12, 2015 11:59:59 PM Publish Date: Jan 29, 2015 If User desires to publish or otherwise distribute
More informationSTEMI, Non-STEMI, Chest Pain?
Minnesota Chest Pain / Acute Coronary Syndrome Tool-Kit Patient with Chest Pain Or Potential Acute Coronary Syndrome STEMI, n-stemi, Chest Pain? Follow MN STEMI Guideline Follow MN n-stemi Guideline Follow
More informationLevel One STEMI Connecting the Dots changing Points of Care into Systems of Care
Level One STEMI Connecting the Dots changing Points of Care into Systems of Care Myron Bloom MD MMM Medical Director Rural Healthcare Quality Network RHQN.org drmbloom@msn.com The Eastern Washington Level
More informationControversies on Primary angioplasty in STEMI
Controversies on Primary angioplasty in STEMI 원주의대이승환 Case ( 51/M) CC C.C: ongoing squeezing chest pain D : for 2 hours Risk factors Current smoker ( 40 PYs) Hypercholesterolemia (+) Case ( 51/M) Physical
More informationCLINICIAN INTERVIEW RECOGNIZING ACS AND STRATIFYING RISK IN PRIMARY CARE. An interview with A. Michael Lincoff, MD, and Eric R. Bates, MD, FACC, FAHA
RECOGNIZING ACS AND STRATIFYING RISK IN PRIMARY CARE An interview with A. Michael Lincoff, MD, and Eric R. Bates, MD, FACC, FAHA Dr Lincoff is an interventional cardiologist and the Vice Chairman for Research
More informationSTEMI Management in Belgium
STEMI Management in Belgium Results of Belgian STEMI registry Prof dr M Claeys University Hospital Antwerp Belgian Working Group of Acute cardiology Lethality of AMI 2-23: MKG data N= 44782 AMI in hospital
More informationThe Strategic Reperfusion Early After STEMI study Implications for clinical practice
The Strategic Reperfusion Early After STEMI study Implications for clinical practice Robert C. Welsh, MD, FRCPC Associate Professor of Medicine Director, Adult Cardiac Catheterization and Interventional
More informationHospital-Acquired Anemia: Epidemiology, Prevention and Management in Patients with Acute Coronary Syndromes
Hospital-Acquired Anemia: Epidemiology, Prevention and Management in Patients with Acute Coronary Syndromes Adam C. Salisbury, MD, MSc January 23, 2012 Case 64 year old woman with no cardiac history, medical
More informationChest pain and troponins on the acute take. J N Townend Queen Elizabeth Hospital Birmingham
Chest pain and troponins on the acute take J N Townend Queen Elizabeth Hospital Birmingham 3 rd Universal Definition of Myocardial Infarction Type 1: Spontaneous MI related to atherosclerotic plaque rupture
More informationProf. Adel El Etriby Ain Shams Faculty of Medicine
Prof. Adel El Etriby Ain Shams Faculty of Medicine Reperfusion Options for STEMI Patients Step One: Assess Time and Risk. Time Since Symptom Onset Risk of STEMI Risk of Fibrinolysisi i Time Required for
More information10-Year Mortality of Older Acute Myocardial Infarction Patients Treated in U.S. Community Practice
10-Year Mortality of Older Acute Myocardial Infarction Patients Treated in U.S. Community Practice Ajar Kochar, MD on behalf of: Anita Y. Chen, Puza P. Sharma, Neha J. Pagidipati, Gregg C. Fonarow, Patricia
More informationB. Paudel *, 1, K. Paudel* *Department of Medicine, Gandaki Medical College - Charak Hospital, Pokhara, Nepal 1
Original Article: Western Nepal acute coronary syndrome (WestNP-ACS) registry: Characteristics, management and in- hospital outcome of patients admitted with acute coronary syndrome in western Nepal. B.
More informationGeriatric Grand Rounds. Geriatric Grand Rounds. Heart Disease in the Elderly: Pitfalls and Practicalities. Objectives. Conflict of Interest Disclosure
Geriatric Grand Rounds Tuesday, January 22, 2008 12:00 noon Dr. Bill Black Auditorium Glenrose Rehabilitation Hospital To receive the poster, and handouts via email, subscribe to our E-mailing list at
More informationOvercoming the Risk-Treatment Paradox in Non-STE ACS: It s Time! Christopher Granger, MD
Overcoming the Risk-Treatment Paradox in Non-STE ACS: It s Time! Christopher Granger, MD Disclosures Research contracts: AstraZeneca, Bayer, Novartis, GSK, Sanofi-Aventis, BMS, Pfizer, The Medicines Company,
More informationThe Burden & Management of Ischaemic Heart Disease in Kenya
The Burden & Management of Ischaemic Heart Disease in Kenya Dr Harun A Otieno FACC Tuesday, October 6th: Session X PASCAR & CSM Joint Congress 2015, Mauritius Disclosures With regards to this presentation,
More informationSTREAM - ONE YEAR MORTALITY STRATEGIC REPERFUSION EARLY AFTER MYOCARDIAL INFARCTION. STREAM 1Y AHA 2013 P Sinnaeve
STREAM - ONE YEAR MORTALITY STRATEGIC REPERFUSION EARLY AFTER MYOCARDIAL INFARCTION PCI Hospital Ambulance/ER STREAM design STEMI
More informationMyocardial Infarction In Dr.Yahya Kiwan
Myocardial Infarction In 2007 Dr.Yahya Kiwan New Definition Of Acute Myocardial Infarction The term of myocardial infarction should be used when there is evidence of myocardial necrosis in a clinical setting
More informationInstitutional Outcomes Report 2012Q2 Sample Hospital
Version 2.2 Institutional Outcomes Report 2012Q2 If User desires to publish or otherwise distribute or use, in whole or in part, any aggregate data or reports provided by ACCF, or produced in connection
More informationGET WITH THE GUIDELINES- PAST AND FUTURE
GET WITH THE GUIDELINES- PAST AND FUTURE Amy Graham, RN, BS, CEN, NREMT-P Director, Quality & Systems Improvement Kentucky and Southwest Ohio American Heart Association 1 DISCLOSURE SLIDE I AM THE QUALITY
More informationMode of admission and its effect on quality indicators in Belgian STEMI patients
2015 Mode of admission and its effect on quality indicators in Belgian STEMI patients Prof dr M Claeys National Coordinator STEMI registry 29-6-2015 Background The current guidelines for the management
More informationSTEMI in the State of Jefferson ASSET - 5 Years Later. Brian W. Gross, MD, FACC Mary Barnum, RN, BSN Karen Bales, RN, BSN Rogue Valley Medical Center
STEMI in the State of Jefferson ASSET - 5 Years Later Brian W. Gross, MD, FACC Mary Barnum, RN, BSN Karen Bales, RN, BSN Rogue Valley Medical Center Sept 22, 2008 Percent # Procedures Performed Coronary
More informationThis House believes that experience and size is not relevant
This House believes that experience and size is not relevant Providing a primary angioplasty service Hotly debated topics Treatment of MI Stewed prunes vs warmed milk Treatment of MI early mobilisation
More informationAPPENDIX F: CASE REPORT FORM
APPENDIX F: CASE REPORT FORM Instruction: Complete this form to notify all ACS admissions at your centre to National Cardiovascular Disease Registry. Where check boxes are provided, check ( ) one or more
More informationSanford Chest Pain Network: Improving Rural STEMI Outcomes
Sanford Chest Pain Network: Improving Rural STEMI Outcomes Naveen Rajpurohit, MD Cardiovascular Fellow Sanford Cardiovascular Institute Sanford Heart Hospital The University of South Dakota Sioux Falls,
More informationDevice Registry in Saudi Arabia: What Have We Learned. Ahmad Hersi
Device Registry in Saudi Arabia: What Have We Learned Ahmad Hersi GULF IMPLANTABLE CARDIOVERTER- DEFIBRILLATOR STUDY (Gulf ICD) Gulf ICD Steering Committee Alawi Alsheikh-Ali (Co-PI) Adel Khalifa [Co-PI]
More informationThe ESC Registry on Chronic Ischemic Coronary Disease
EURObservational Research Programme The ESC Registry on Chronic Ischemic Coronary Disease Prof. Fausto J. Pinto, FESC, FACC, FASE, FSCAI Immediate Past-President, ESC University Hospital Sta Maria University
More informationDIFFERENTIATING THE PATIENT WITH UNDIFFERENTIATED CHEST PAIN
DIFFERENTIATING THE PATIENT WITH UNDIFFERENTIATED CHEST PAIN Objectives Gain competence in evaluating chest pain Recognize features of moderate risk unstable angina Review initial management of UA and
More informationBeta-blockers in Patients with Mid-range Left Ventricular Ejection Fraction after AMI Improved Clinical Outcomes
Beta-blockers in Patients with Mid-range Left Ventricular Ejection Fraction after AMI Improved Clinical Outcomes Seung-Jae Joo and other KAMIR-NIH investigators Department of Cardiology, Jeju National
More informationPatient Transfer. Mark de Belder The James Cook University Hospital Middlesbrough
Patient Transfer Mark de Belder The James Cook University Hospital Middlesbrough Current Management Strategies for ACS ACS No ST Elevation ST ST Elevation Elevation Early Invasive Early Conservative Fibrinolysis
More informationAdvancing the One Acute Care Network and Our Strategic Aims Regional Cardiac Services. December 2009
Advancing the One Acute Care Network and Our Strategic Aims Regional Cardiac Services December 2009 Patient Story No local access to PCI results in more extensive heart damage for patients. A 62 year old
More informationNon ST Elevation-ACS. Michael W. Cammarata, MD
Non ST Elevation-ACS Michael W. Cammarata, MD Case Presentation 65 year old man PMH: CAD s/p stent in 2008 HTN HLD Presents with chest pressure, substernally and radiating to the left arm and jaw, similar
More informationINTRODUCTION. Key Words:
Original Article Acta Cardiol Sin 2017;33:377 383 doi: 10.6515/ACS20170126A Percutaneous Coronary Intervention Predictors of Mortality in Elderly Patients with Non-ST Elevation Acute Coronary Syndrome
More informationREFERRAL HOSPITAL. The Importance of Door In Door Out Time DIDO
REFERRAL HOSPITAL The Importance of Door In Door Out Time DIDO Jean Skonhovd,RN,BSN,MSAS Emergency Department Director Avera Heart Hospital of South Dakota Time to Treatment is critical for STEMI patients
More informationSubsequent management and therapies
ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation Subsequent management and therapies Marco Valgimigli, MD, PhD University of Ferrara ITALY
More informationThis House believes that coronary angioplasty should take place in a limited number of high volume centres: avoiding the American example.
This House believes that coronary angioplasty should take place in a limited number of high volume centres: avoiding the American example. Volume vs outcome Primary PCI Surgical cover off site vs on site
More informationDecision for fibrinolysis or primary PCI in the prehospital phase
Decision for fibrinolysis or primary PCI in the prehospital phase Nicolas Danchin, Hôpital Européen Georges Pompidou, Paris, France Disclosures Research grants: Astrazeneca, Eli-Lilly, GSK, Merck, Novartis,
More informationGuide to GRACE manuscripts (1999 to 2006)
Guide to GRACE manuscripts (1999 to 2006) # Topic Year of publication (enrollment period) Patient group N Summary Reference 1. Overview: study design 2001 All ACS Aim: To explain the rationale behind GRACE
More informationManagement of Cardiogenic shock. Prof. Christian JM Vrints
Management of Cardiogenic shock Prof. Christian JM Vrints none conflicts Management of Cardiogenic Shock Incidence and trends Importance of early revascularization Multivessel disease Left main disease
More informationQ1 Contact Information
Q1 Contact Information Answered: 25 Skipped: 0 ANSWER CHOICES Hospital Name of Person Completing Survey Email RESPONSES 100.00% 25 100.00% 25 100.00% 25 # HOSPITAL DATE 1 Research Medical Center 9/26/2018
More informationAcute Coronary Syndrome. Emergency Department Updated Jan. 2017
Acute Coronary Syndrome Emergency Department Updated Jan. 2017 Goals and Objectives To reduce mortality and morbidity for people who have cardiovascular disease, with a focus on those who experience an
More informationJournal of the American College of Cardiology Vol. 35, No. 4, by the American College of Cardiology ISSN /00/$20.
Journal of the American College of Cardiology Vol. 35, No. 4, 2000 2000 by the American College of Cardiology ISSN 0735-1097/00/$20.00 Published by Elsevier Science Inc. PII S0735-1097(99)00643-9 Early
More informationJACC: CARDIOVASCULAR INTERVENTIONS VOL. 2, NO. 10, PUBLISHED BY ELSEVIER INC. DOI: /j.jcin
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 2, NO. 10, 2009 2009 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/09/$36.00 PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2009.07.008 Outcomes
More informationCE: Satish ED: Maitreyee Op: Sampath MCA 11568: LWW_MCA_11568
CE: Satish ED: Maitreyee Op: Sampath MCA 11568: LWW_MCA_11568 Pathophysiology and natural history 1 AQ1 Prevalence and prognosis of congestive heart failure in Saudi patients admitted with acute coronary
More informationEagles 2007 Focused Quality in EMS The Five Required Actions
Eagles 2007 Focused Quality in EMS The Five Required Actions Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Prior
More informationPractitioner Education Course
2015 Practitioner Education Course ST Elevation Myocardial Infarction 2 Pathology Concept of vulnerable plaque Mild Atheroma Diagnosis IVUS OCT 3 Diagnosis This is based on : Clinical History ECG Changes.
More informationI have no financial relationships to disclose
I have no financial relationships to disclose Networking decreases mortality Vasil Velchev,MD,PhD UH St. Anna Sofia time = myocardium = life Transfer for angioplasty vs. Immediate Thrombolysis (hospital
More informationAcute Coronary Syndrome (ACS) Initial Evaluation and Management
Acute Coronary Syndrome (ACS) Initial Evaluation and Management Symptoms of Possible ACS Chest discomfort with or without radiation to the arm(s), jaw, or epigastrium Short of breath Weakness Diaphoresis
More informationPPCI in STEMI. ESC at the 22nd Annual Conference of the Saudi Heart Association February 21th, 2011
PPCI in STEMI Dr Hassan Mhish Interventional Cardiology Consultant Cardiology Fellowship Program Director Prince Salman Heart Center King Fahd Medical City Riyadh, KSA ESC at the 22nd Annual Conference
More informationPrimary Percutaneous Coronary Intervention
The big 5 in PCI Primary Percutaneous Coronary Intervention W. Wijns (Aalst, BE) Disclosures Consulting Fees: on my behalf go to the Cardiovascular Research Center Aalst Contracted Research between the
More informationRisk Stratification of ACS Patients. Frans Van de Werf, MD, PhD University of Leuven, Belgium
Risk Stratification of ACS Patients Frans Van de Werf, MD, PhD University of Leuven, Belgium Which type of ACS patients are we talking about to day? 4/14/2011 STEMI and NSTEMI in the NRMI registry from
More informationWhat oral antiplatelet therapy would you choose? a) ASA alone b) ASA + Clopidogrel c) ASA + Prasugrel d) ASA + Ticagrelor
76 year old female Prior Hypertension, Hyperlipidemia, Smoking On Hydrochlorothiazide, Atorvastatin New onset chest discomfort; 2 episodes in past 24 hours Heart rate 122/min; BP 170/92 mm Hg, Killip Class
More information