Revived indications for thrombus aspiration during primary PCI: Unanswered questions after TAPAS
|
|
|
- Neal Barker
- 5 years ago
- Views:
Transcription
1 Revived indications for thrombus aspiration during primary PCI: Unanswered questions after TAPAS Gregg W. Stone MD Columbia University Medical Center Cardiovascular Research Foundation
2 Disclosures Gregg W. Stone MD Research support from Abbott Vascular, Boston Scientific and Atrium
3 AMI: Pathophysiology Ruptured plaque with occlusive thrombus
4 Impact of Macroscopic Distal Emboli DE occurred in 27 of 178 (15%) pts after primary PTCA ST res Infarct size Mortality PLCX filling defect at primary PCI site Distal thromboemboli Henriques JPS et al. EHJ 2002;23:1112-7
5 Mechanical Approaches to Thrombus Thrombus aspiration (Export, Pronto, Rescue, Diver CE, Rinspirator, etc.) Thrombectomy (AngioJet, X-Sizer) X Distal protection (GuardWire, FilterWire, AngioGuard, etc.) GuardWire, FilterWire, AngioGuard, EmboShield, etc.
6 EMERALD: Primary endpoint ST-Segment Segment Resolution (n=501) Complete STR (%) Last contrast GuardWire (n=233) P= Control (n=216) P=NS for all 30 mins 60 mins 90 mins 120 mins 180 mins 240 mins 1º endpoint Stone GW et al. JAMA 2005;293:
7 Infarct Size: Primary endpoint by Tc-99m 99m-SPECT (N=437) % left ventricle P=0.26 P=0.16 ±19.4 ±19.1 [2, 26] [0, 23.5] 1º endpoint Stone GW et al. JAMA 2005;293:
8 Efficacy Related to Myocardial Salvage 6 Month MACE (LV): Efficacy Death, new onset severe heart failure, new onset sustained hypotension, or rehospitalization for left ventricular failure p=0.57 GuardWire Control 16.1% 14.3% 5 Stone GW et al. JAMA 2005;293:
9 Histology Sub-study 126 consecutive aspirates were collected from 62 pts at different times of the procedure in the roll-in phase and submitted to a core lab (R. Virmani, AFIP) 76% of patients had plaque and/or thrombus
10 Case , Pre-dilatation Sample Major axis 6.28 mm Area 5.00 mm 2
11 AIMI Randomized Trial (N=480) AngioJet Control 75% 60% 68% 50% 25% P= % P< % 0% STR 90 mins Infarct size (mean) Ali A et al. JACC 2006;48:244-52
12 MACE by 30 Days 1 Month Events (%) 8% 6% 4% 2% 0% 4.6% Death P< % AngioJet 0% 0% Reinfarction (Q-wave) 1.7% Control 0.8% 2.1% 0.4% 6.7% P<0.01 Stroke SAT/TLR MACE 1.7% Ali A et al. JACC 2006;48:244-52
13 Reasons Why Thrombus Retrieval May Not Work Reperfusion achieved too late Infarct already too large Multifactorial causes of impaired myocardial recovery Device specific limitations
14 TAPAS: 1,071 pts with STEMI undergoing primary PCI randomized to aspiration (Export) vs. control Consecutive pts with possible STEMI (0.1 mm ST ) Single center: U. Med Cntr Groningen, 1/05 12/06 Anterior (43%) and non anterior MI with symptoms <12º Randomization in ER before anatomy known 1005/1071 (94%) underwent PCI; analysis by ITT Thrombus present in 43%; baseline TIMI-3 3 flow in 26% Aspiration performed in 448/535 (84%) assigned pts; atherothrombotic material retrieved in 73% Svilaas T et al. NEJM 2008;358;
15 TAPAS: 1,071 pts with STEMI undergoing PCI randomized in the ER to aspiration (Export) vs. control Myocardial Blush (1 EP) ST-segment Resolution (~44 post) P<0.001 P<0.001 Thrombus aspiration Conventional PCI Thrombus aspiration Conventional PCI Svilaas T et al. NEJM 2008;358;
16 TAPAS: 1,071 pts with STEMI undergoing primary PCI randomized in the ER to manual aspiration (Export) vs. control Mortality (%) days 4.0% vs. 2.1% P=0.07 Conventional PCI Thrombus-Aspiration Time (days) 1 year 7.6% vs. 4.0% P=0.04 Vlaar et al. Lancet 2008;371:
17 Why the Results of TAPAS are Surprising Patient presentation was relatively late (symptoms <12º) Aspiration was not performed in 16% of pts; even PCI wasn t t performed in 6% There was no reduction in distal embolization with aspiration (5.6% vs. 5.8%) ST resolution was not relatively better in thrombotic lsns and other situations where aspiration should benefit The modest benefits in ST resolution and blush which occurred with aspiration wouldn t t be expected to reduce mortality by an absolute 3.6% (~50% relative decrease)! Svilaas T et al. NEJM 2008;358;
18 Microcirculatory Protection Devices in STEMI Meta-analysis analysis of 30 studies, 6415 randomized pts Bavry AA et al. Eur Heart J 2008 Mortality Mean 5 mo FU (range d/c 12 mo) Device: 3.2% Control: 3.7% RR [95%CI] = 0.87 [0.67, 1.13] P=0.29 I 2 = 0 bias = 0.62 P bias TAPAS 12m De Luca 6m Kaltoft 1m REMEDIA 1m PIHRATE H VAMPIRE 8m Noel H EXPIRA 9m NONSTOP H Export 1m AMI 6m X AMINE ST 6m Napadono 1m Beran 1m DEDICATION 1m Tahk 6m MICADO 6m Up Rose? MI 1m PREMIER 6m PROMISE 1m EMERALD 6m DIPLOMATE 1m ASPARAGUS 6m DEAR-MI 1m Florence 1m Ochats 6m Wang H Favors adjunctive device Favors PCI alone 0.61 (0.30, 0.99) 0.20 (0.01, 4.03) 0.33 (0.01, 8.02) 0.08 (0.21, 4.62) 0.02 (0.19, 4.45) 1.04 (0.18, 21.25) 0.36 (0.02, 8.43) 0.11 (0.01, 2.01) 1.00 (0.14, 6.99) 0.86 (0.24, 3.13) 2.00 (1.02, 7.65) 1.51 (0.44, 5.21) 1.00 (0.21, 4.70) 2.00 (0.19, 21.00) 1.01 (0.38, 2.65) 0.19 (0.01, 3.81) 0.31 (0.03, 2.90) 4.81 (0.24, 97.68) 1.25 (0.35, 4.46) 0.67 (0.11, 3.90) 0.99 (0.38, 2.69) 0.29 (0.01, 6.91) 0.99 (0.44, 2.23) (Excluded) (Excluded) (Excluded) (Excluded) 0.87 ( )
19 Microcirculatory protection devices in STEMI Meta-analysis analysis of 30 studies, 6415 randomized pts 13 aspiration catheter thrombectomy studies (n=3026) 5 active mechanical thrombectomy studies (n=934) 12 distal protection device studies (n=2442) Mortality (%) P=0.02 P=0.05 P=0.69 Bavry AA et al. Eur Heart J 2008
20 Microcirculatory protection devices in STEMI Meta-analysis analysis of 30 studies, 6415 randomized pts 13 aspiration catheter thrombectomy studies (n=3026) 5 active mechanical thrombectomy studies (n=934) 12 distal protection device studies (n=2442) Device Mean FU (mos) Stroke RR [95%Cl] RR [95%Cl] Absolute diff P value Aspiration thrombectomy Mechanical thrombectomy Distal protection [0.85, 14] 1.6% [0.71, 10] 1.1% [0.34, 2.92] 0% 0.99 Bavry AA et al. Eur Heart J Favors Device Favors PCI alone
21 Microcirculatory protection devices in STEMI Meta-analysis analysis of 30 studies, 6415 randomized pts 13 aspiration catheter thrombectomy studies (n=3026) 5 active mechanical thrombectomy studies (n=934) 12 distal protection device studies (n=2442) Device Mean FU (mos) Stroke RR [95%Cl] RR [95%Cl] Absolute diff P value Aspiration thrombectomy Mechanical thrombectomy [0.85, 14] [0.71, 10] RR = 3.01 P = 0.02 Distal protection [0.34, 2.92] 0% 0.99 Bavry AA et al. Eur Heart J Favors Device Favors PCI alone
22 AMI: Attempts to Decrease Infarct Size Have been mostly met with frustration The concept of reducing embolic load Infarct size (% LV) Control 18.3 P=0.26 Distal protection or thrombectomy Emerald (n=501) AIMI (n=480) Kaltoft et al (n=225) Distal protection (GuardWire Plus) Stone GW et al. JAMA 2005 P=0.018 Active thrombectomy (AngioJet) P=0.004 Simple thrombus aspiration (Rescue) Ali A et al. JACC 2006 Kaltoft A et al. JAMA 2005
23 TAPAS: Infarct Size Measurement Peak enzyme P=0.24 Control Export aspiration P= Peak CPK Peak CPK-MB Vlaar et al. Lancet 2008;371:
24 EXPIRA: 175 pts with STEMI <9º with TIMI 0-1 flow (44% LAD) undergoing PCI randomized to Export aspiration vs. control; cmri substudy in 75 pts at 2-5 days and 3 months Control Aspiration P-value MBG % 88.6% < complete STR 39.1% 63.6% MVO acute, % 72.9% 31.5% CPK peak, ng/ml 108 ± ± Infarct size acute, %LV 13 ± 7 14 ± Infarct size 3 mos, %LV 11 ± 5 9 ± Death, 9 months 4.6% 0% 0.02 Sardella G et al. JACC 2009;53:309 15
25 INFUSE-AMI Trial 450 pts with anterior STEMI Anticipated sx to PCI <5 hrs, TIMI 0/1 flow in prox or mid LAD R 1:1 PCI with bivalirudin IC abcx bolus (ClearWay) R 1:1 PCI with bivalirudin Standard of care R 1:1 Aspiration (Export) No aspiration Aspiration (Export) No aspiration Primary endpoint: Infarct size at 30 days (MRI) 2º endpoints: TIMI flow, blush, ST-resolution, MACE (30d, 1 yr) Sponsor and IDE holder: CRF; Funding support: Atrium PI: Gregg W. Stone; Co-PI: C. Michael Gibson
26 Conclusions: Microcirculatory protection Despite completion of 31 randomized trials, we still don t t know with confidence whether microcirculatory protection during PCI in STEMI reduces (or increases) infarct size or improves clinical outcomes, and whether the results vary significantly with different devices We have been unable to identify patients or lesions specifically likely to benefit (or be harmed) The ongoing European Jetstent trial (AngioJet in thrombotic lesions) may be enlightening, and a large, multicenter randomized trial is required to validate the TAPAS results
27 Conclusions: Microcirculatory protection Pending guidance from future clinical trials, it is presently reasonable to: - Use simple catheter-based aspiration for large thrombus burden in proximal coronary vessels - but this is not required for all occluded coronary arteries - Use distal protection devices for diseased saphenous vein grafts
STEMI Primary Percutaneous Coronary Intervention
STEMI Primary Percutaneous Coronary Intervention Abdul Razek Maaty, MD Professor of Medicine Outline Primary PCI Aspiration, manual thrombectomy and distal protection devices Choice of stent Pharmacothaerpy,
Updated and Guideline Based Treatment of Patients with STEMI
Updated and Guideline Based Treatment of Patients with STEMI Eli I. Lev, MD Director, Cardiac Catheterization Laboratory Hasharon Hospital, Rabin Medical Center Associate Professor of Cardiology Tel-Aviv
SYSTEMATIC MANUAL THROMBUS ASPIRATION: PRO
SYSTEMATIC MANUAL THROMBUS ASPIRATION: PRO FRANCESCO BURZOTTA INSTITUTE OF CARDIOLOGY CATHOLIC UNIVERSITY OF THE SACRED HEART ROME, ITALY CONTROVERSIES IN PRIMARY PERCUTANEOUS CORONARY INTERVENTION ESC
ΟΜΑΔΕΣ ΕΡΓΑΣΙΑΣ ΘΕΣ/ΝΙΚΗ 2013
ΟΜΑΔΕΣ ΕΡΓΑΣΙΑΣ ΘΕΣ/ΝΙΚΗ 2013 ΘΡΟΜΒΟΑΝΑΡΟΦΗΣΗ ΣΤΟ STEMI ΕΝΔΕΙΞΕΙΣ - ΑΠΟΤΕΛΕΣΜΑΤΙΚΟΤΗΤΑ!. "#$%µ& ( # MD,Phd )#*+,-. )/0. 123454 6µ7µ# 8& µ9#+,- 7: "#$;,/(/
ACI London Thrombectomy in STEMI. is the evidence clear? Brad Higginson International marketing manager
ACI London 2010 Thrombectomy in STEMI is the evidence clear? Brad Higginson International marketing manager Options for Management of Thrombotic Lesions Pharmacologic Therapies Embolic Protection Devices
Trial Update- TOTAL. Jonathan Byrne
Trial Update- TOTAL Jonathan Byrne No conflicts of interest Background- rationale for thrombectomy Major Limitation of primary PCI: distal embolisation and reduced flow Stonel JACC 2002;39:591-7 Henriques
Thrombus Aspiration before PCI: Routine Mandatory. Professor Clinical Cardiology Academic Medical Center University of Amsterdam
Seoul, 27 April TCT AP 2010 Thrombus Aspiration before PCI: Routine Mandatory Robbert J de Winter MD PhD FESC Professor Clinical Cardiology Academic Medical Center University of Amsterdam AMC Amsterdam
Α-Δ. ΜΑΤΡΟΓΙΑΝΝΗ ΚΑΡΔΙΟΛΟΓΟ AIMOΔΤΝΑΜΙΚΟ ΕΡΓΑΣΗΡΙΟ Γ.Ν.Θ. Γ. ΠΑΠΑΝΙΚΟΛΑΟΤ ΘΕΑΛΟΝΙΚΗ
Α-Δ. ΜΑΤΡΟΓΙΑΝΝΗ ΚΑΡΔΙΟΛΟΓΟ AIMOΔΤΝΑΜΙΚΟ ΕΡΓΑΣΗΡΙΟ Γ.Ν.Θ. Γ. ΠΑΠΑΝΙΚΟΛΑΟΤ ΘΕΑΛΟΝΙΚΗ Angiographic no reflow TIMI grade 0 No antegrade flow beyond the point of obstruction I Contrast material is able
When Aspiration Thrombectomy Does Not Work? A A R O N W O N G N A T I O N A L H E A R T C E N T R E S I N G A P O R E
When Aspiration Thrombectomy Does Not Work? A A R O N W O N G N A T I O N A L H E A R T C E N T R E S I N G A P O R E Thrombus in STEMI Over 70% of STEMI patients has angiographic evidence of thrombus
Impact of Thromboaspiration during Primary PCI on infarcted segmental myocardial function: a Tissue Doppler imaging evaluation. EXPIRA Trial substudy.
Impact of Thromboaspiration during Primary PCI on infarcted segmental myocardial function: a Tissue Doppler imaging evaluation. EXPIRA Trial substudy. GENNARO SARDELLA, MD, FACC,FESC; MASSIMO MANCONE,
Optimal antithrombotic therapy:
Optimal antithrombotic therapy: upstream and during primary PCI. Steen D Kristensen, MD, DMSc, FESC Professor and Consultant Interventional Cardiologist Aarhus University, Denmark UNIVERSITY OF AARHUS
Adjunctive Therapy to Reduce Infarct Size: Current and Future Challenges
Adjunctive Therapy to Reduce Infarct Size: Current and Future Challenges Chang-Hwan Yoon, M.D. Cardiovascular Center, Department of Internal Medicine Bundang Hospital 1 1. 빨리뚫어야한다 2013 ACC/AHA STEMI Guideline
What is new in the Treatment of STEMI? Malcolm R. Bell, MBBS Mayo Clinic Rochester, MN
What is new in the Treatment of STEMI? Malcolm R. Bell, MBBS Mayo Clinic Rochester, MN October 2011 Part 2 Summary of newer antithrombotic and antiplatelet agents in STEMI Role of thrombectomy in PPCI
PCI Update Qesaria 2009
PCI Update Qesaria 2009 Amit Segev Interventional Cardiology Chaim Outline Primary PCI Non-ST elevation ACS Multi-vessel disease Hemodynamic assessment of borderline lesions - FFR Stable AP Non-coronary
M/39 CC D. => peak CKMB (12 hr later) ng/ml T.chol/TG/HDL/LDL 180/150/48/102 mg/dl #
Acute Coronary Syndrome - Case Review - Young-Guk Ko, MD Yonsei Cardiovascular Center Yonsei University College of Medicine Case 1 M/39 #4306212 CC D : Severe squeezing chest pain : 4 hours, aggravated
Bivalirudin should be indicated for all patients with STEMI. Adnan Kastrati Deutsches Herzzentrum, Munich, Germany
Bivalirudin should be indicated for all patients with STEMI Adnan Kastrati Deutsches Herzzentrum, Munich, Germany 1 Heparin+IIb/IIIa, heparin alone or bivalirudin in STEMI: Do we have the answer? 2 Heparin+IIb/IIIa,
For Personal Use. Copyright HMP 2013
Original New Technique Contribution A Novel Application of GuideLiner Catheter for Thrombectomy in Acute Myocardial Infarction: A Case Series Adam T. Stys, MD, Tomasz P. Stys, MD, Naveen Rajpurohit, MD,
Thrombus Aspiration in ST- Elevation myocardial infarction in Scandinavia (TASTE trial)
UCR Uppsala Clinical Research Center Thrombus Aspiration in ST- Elevation myocardial infarction in Scandinavia (TASTE trial) Main results at 30 days Ole Fröbert, MD, PhD - on behalf of the TASTE investigators
STEMI 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
Therapeutic Advances in Cardiology
Page 5 to 11 Volume 1 Issue 1 2016 Review Article Therapeutic Advances in Cardiology Thromboaspiration during Primary PCI. When, Where and How? ISSN: 2575-5161 Athanassios Antonopoulos 1,2 * and Evangelia
Ischemic Postconditioning During Primary Percutaneous Coronary Intervention Mechanisms and Clinical Application Jian Liu, MD FACC FESC FSCAI Chief Phy
Ischemic Postconditioning During Primary Percutaneous Coronary Intervention Mechanisms and Clinical Application Jian Liu, MD FACC FESC FSCAI Chief Physician, Professor of Medicine Department of Cardiology,
Acute 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
Registerbaserade randomiserade kliniska pro vningar Innovativa exempel fra n dagens pa ga ende hja rt- forskning i Sverige
Registerbaserade randomiserade kliniska pro vningar Innovativa exempel fra n dagens pa ga ende hja rt- forskning i Sverige SWEDE HEART Stefan James, Professor Kardiologi Vetenskaplig ledeare UCR, Uppsala
A Large Prospective Randomized Trial of DES vs BMS in Patients with STEMI
HORIZONS-AMI: A Large Prospective Randomized Trial of DES vs BMS in Patients with STEMI Gregg W. Stone MD Columbia University Medical Center Cardiovascular Research Foundation Disclosures Gregg W. Stone
Coronary Interventions Indications, Treatment Options and Outcomes
Coronary Interventions Indications, Treatment Options and Outcomes A talk should be like a woman s skirt long enough to cover the subject, but short enough to keep it interesting. Coronary anatomy Physiology
Primary PCI in STEMI: The Role of Thromboaspiration
HOSPITAL CHRONICLES 2014, VOLUME 9, SUPPLEMENT 1: 1 5 MYOCARDIAL INFARCTION & ISCHEMIA THERAPY UPDATE Primary PCI in STEMI: The Role of Thromboaspiration Sophia Vaina, MD First Department of Cardiology,
The PROSPECT Trial. A Natural History Study of Atherosclerosis Using Multimodality Intracoronary Imaging to Prospectively Identify Vulnerable Plaque
The PROSPECT Trial Providing Regional Observations to Study Predictors of Events in the Coronary Tree A Natural History Study of Atherosclerosis Using Multimodality Intracoronary Imaging to Prospectively
Thrombectomy. how? For whom?
Thrombectomy how? For whom? Marco Zimarino, MD, PhD Institute of Cardiology - University G. d Annunzio, Chieti (Italy) Why Manual Thrombectomy? Pros 1 Extraction of thrombotic material, acute reduction
ĐIỀU TRỊ nhồi máu cơ tim : Có gì mới trong năm 2012 "
ĐIỀU TRỊ nhồi máu cơ tim : Có gì mới trong năm 2012 " Ramesh Daggubati, MD FACC Associate Professor Director of Interventional Cardiology East Carolina Heart Institute Greenville, North Carolina USA Ramesh
The grey zone of coronary interventions: Degenerated saphenous vein grafts
PCI: procedural complications August 26: 14:00 15:30 The grey zone of coronary interventions: Degenerated saphenous vein grafts Prof. Dr. M. Haude Städtische Kliniken Neuss Lukaskrankenhaus GmbH Declaration
Rationale for Prophylactic Support During Percutaneous Coronary Intervention
Rationale for Prophylactic Support During Percutaneous Coronary Intervention Navin K. Kapur, MD, FACC, FSCAI Assistant Director, Interventional Cardiology Director, Interventional Research Laboratories
No-reflow is defined as a failure to restore antegrade normal coronary flow despite appropriate treatment of coronary obstruction. The prevalence of t
No reflow in ACS: Treatment strategies and Developments Jian Liu, MD FACC FESC FSCAI Chief Physician, Professor of Medicine Department of Cardiology, Peking University People s Hospital No-reflow is defined
Primary PCI in patients with STEMI Abbott Vascular. All rights reserved.
Primary PCI in patients with STEMI Primary PCI in patients with STEMI Agenda 2 Primary PCI in patients with STEMI Definition: angioplasty ± stenting without prior or concomitant fibrinolytic therapy Objectives
The PROSPECT Trial. A Natural History Study of Atherosclerosis Using Multimodality Intracoronary Imaging to Prospectively Identify Vulnerable Plaque
The PROSPECT Trial Providing Regional Observations to Study Predictors of Events in the Coronary Tree A Natural History Study of Atherosclerosis Using Multimodality Intracoronary Imaging to Prospectively
Presented by Prof David Erlinge, MD, PhD, On behalf of the RAPID MI-ICE Investigators
Cold saline and endovascular cooling induces rapid hypothermia before reperfusion in STEMI patients treated with primary PCI, is safe and reduces infarct size with a scattered myocardial salvage Presented
The Japanese ASPARAGUS Trial
The Japanese ASPARAGUS Trial ASPirAtion of LibeRated Debris in Acute MI with GUardWire Plus TM System Toshiya Muramatsu, MD Kawasaki social Insurance Hospital, Kawasaki, Japan Reperfusion of the IRA to
No-reflow - microvascular obstruction
Disclosures: Research grant from Medtronic to University of Ferrara Ad Board of Abbott, Medtronic, MEDCO, Eli lilly, Iroko Speaker s bureau from Cordis, Abbott, CID Vascular, Terumo, Medtronic, Astra Zeneca,
Approach to Multi Vessel disease with STEMI
Approach to Multi Vessel disease with STEMI MANAGEMENT OF ST-ELEVATION MYOCARDIAL INFARCTION Dr. Thomas Alexander, M.D; D.M; F.A.C.C. Senior Consultant and Interventional Cardiologist Kovai Medical Centre
Primary 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
Strategies for PCI of SVG
Strategies for PCI of SVG Ron Waksman, MD, FACC Augusto Pichard, MD, FACC Washington Hospital Center, Washington DC OPTIONS FOR IMPROVED OUTCOMES IN SVG PCI Direct Stenting Thrombus Management Embolic
PiCSO to Improve Myocardial Salvage and Reduce Infarct Size in STEMI: Emerging Data
PiCSO to Improve Myocardial Salvage and Reduce Infarct Size in STEMI: Emerging Data Azfar G. Zaman, MD Freeman Hospital, Newcastle upon Tyne, UK Disclosure Statement of Financial Interest Within the past
IMR in acute STEMI and clinical outcomes
IMR in acute STEMI and clinical outcomes Professor Colin Berry Golden Jubilee National Hospital, University of Glasgow. ETP Coronary Physiology 24 April 2015 Disclosures Speaker - Shire Pharmaceuticals,
Αντιαιμοπεταλιακη αγωγη (ποια, πο τε και για πο σο)
Αντιαιμοπεταλιακη αγωγη (ποια, πο τε και για πο σο) Dimitrios Alexopoulos, MD, FESC, FACC Cardiology Department, Patras University Hospital, Patras, Rio, Greece. Patras University Hospital I, Dimitrios
Periprocedural Myocardial Infarction and Clinical Outcome In Bifurcation Lesion
Periprocedural Myocardial Infarction and Clinical Outcome In Bifurcation Lesion Hyeon-Cheol Gwon Cardiac and Vascular Center Samsung Medical Center Sungkyunkwan University School of Medicine Dr. Hyeon-Cheol
ST-Elevation MI: Update on Bivalirudin and DES
ST-Elevation MI: Update on Bivalirudin and DES George D. Dangas, MD, FACC, FSCAI, FAHA Professor of Medicine Director, Cardiovascular Innovation Mount Sinai Medical Center, New York, NY Disclosure Research
Frans Van de Werf, MD, PhD Leuven, Belgium
STEMI Cases and the ESC STEMI Guidelines Frans Van de Werf, MD, PhD Leuven, Belgium The Easy Case 2/21/2011 History and Risk Factors 50-year old male patient Past medical history: Teratoma right testis
Facilitated Percutaneous Coronary Intervention in Acute Myocardial Infarction. Is it beneficial to patients?
Facilitated Percutaneous Coronary Intervention in Acute Myocardial Infarction Is it beneficial to patients? Seung-Jea Tahk, MD. PhD. Suwon, Korea Facilitated PCI.. background Degree of coronary flow at
Primary PCI State of the Art. A/Prof Michael Nguyen Fremantle Hospital/Fiona Stanley Hospital Perth Australia JCR Meeting Busan 2014
Primary PCI State of the Art A/Prof Michael Nguyen Fremantle Hospital/Fiona Stanley Hospital Perth Australia JCR Meeting Busan 2014 Content Evidence of Primary PCI vs Thrombolysis When, Why, How Transfer
Minimalist immediate mechanical intervention in acute ST-segment elevation myocardial infarction: is it time to redefine targets?
Editorial Minimalist immediate mechanical intervention in acute ST-segment elevation myocardial infarction: is it time to redefine targets? Philip Francis Dingli, Javier Escaned Department of Interventional
Journal of the American College of Cardiology Vol. 56, No. 16, by the American College of Cardiology Foundation ISSN /$36.
Journal of the American College of Cardiology Vol. 56, No. 16, 2010 2010 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2010.06.011
Update from the Tryton IDE study
Update from the Tryton IDE study Maciej Lesiak EBC 2015 - Athens The Tryton Bifurcation Trial: A randomized comparison of a provisional one-stent vs. a dedicated two-stent strategy for true bifurcation
Current 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
ACC Rockies New Role For An Old Friend: Contemporary Insights From The ECG
ACC Rockies 2012 New Role For An Old Friend: Contemporary Insights From The ECG Paul W. Armstrong, MD Monday March 12 2012 2012 Disclosure Statement Paul W. Armstrong MD Details available @ http://www.vigour.ualberta.ca
Cardiovascular Research Foundation and Columbia University Medical Center, New York.
Virtual Histology Intravascular Ultrasound Analysis of Non-culprit Attenuated Plaques Detected by Grayscale Intravascular Ultrasound in Patients with Acute Coronary Syndromes Xiaofan Wu, Akiko Maehara,
Is the myocardial blush grade scored by the operator during primary PCI of prognostic value in patients with STEMI in routine clinical practice?
Is the myocardial blush grade scored by the operator during primary PCI of prognostic value in patients with STEMI in routine clinical practice? Marthe A. Kampinga Department of Cardiology, The Netherlands
Pathophysiology of ischemia-reperfusion injury (and how to protect against it )
Pathophysiology of ischemia-reperfusion injury (and how to protect against it ) Dr Derek J Hausenloy Reader in Cardiovascular Medicine BHF Senior Clinical Research Fellow Honorary Consultant Cardiologist
Management of ST-elevation myocardial infarction Update 2009 Late comers: which options?
European Society of Cardiology Annual Session 2009 Management of ST-elevation myocardial infarction Update 2009 Late comers: which options? Antonio Abbate, MD Assistant Professor of Medicine Virginia Commonwealth
Clinical Value of OCT. Guidance for Coronary Stenting. Giulio Guagliumi, MD
Clinical Value of OCT Guidance for Coronary Stenting Giulio Guagliumi, MD 100 % Endovascular Imaging Indications of use 87.5 % 75 % 57.5 % 50 % 45 % 25 % 15 % 0 Lesion morphology Stent optimization Lesion
OCT Guided Atherectomy: Initial Results of the VISION Trial Using the Pantheris Catheter. Patrick Muck, MD
OCT Guided Atherectomy: Initial Results of the VISION Trial Using the Pantheris Catheter Patrick Muck, MD Chief, Division of Vascular Surgery Good Samaritan Hospital Cincinna
Three-Year Clinical Outcomes with Everolimus-Eluting Bioresorbable Scaffolds: Results from the Randomized ABSORB III Trial Stephen G.
Three-Year Clinical Outcomes with Everolimus-Eluting Bioresorbable Scaffolds: Results from the Randomized ABSORB III Trial Stephen G. Ellis MD Dean J. Kereiakes MD and Gregg W. Stone MD for the ABSORB
Novel Anticoagulation Therapy in Acute Coronary Syndrome
Novel Anticoagulation Therapy in Acute Coronary Syndrome Soon Jun Hong Korea University Anam Hospital 1 Thrombus Formation Cascade Coagulation Cascade Platelet Cascade TXA2 Aspirin R Inhibitor Fondaparinux
Annie Chou Internal Medicine PGY3 University of British Columbia. Rocky Mountain Internal Medicine Conference November 24, 2011
Annie Chou Internal Medicine PGY3 University of British Columbia Rocky Mountain Internal Medicine Conference November 24, 2011 Role of the ECG in STEMI Diagnosis of myocardial infarction Localization of
Intraaortic Balloon Counterpulsation- Supportive Data for a Role in Cardiogenic Shock ( Be Still My Friend )
Intraaortic Balloon Counterpulsation- Supportive Data for a Role in Cardiogenic Shock ( Be Still My Friend ) Stephen G. Ellis, MD Section Head, Interventional Cardiology Professor of Medicine Cleveland
When and how to use distal protection devices for lower extremity revascularization. Peter A. Schneider, MD Kaiser Foundation Hospital, Honolulu
When and how to use distal protection devices for lower extremity revascularization Peter A. Schneider, MD Kaiser Foundation Hospital, Honolulu Disclosure Peter A. Schneider Potential conflicts of interest
Bivalirudin Clinical Trials Update Evidence and Future Perspectives
Bivalirudin Clinical Trials Update Evidence and Future Perspectives Andreas Baumbach Consultant Cardiologist/ hon. Reader in Cardiology Bristol Heart Institute University Hospitals Bristol MY CONFLICTS
STREAM - 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
A case of post myocardial infarction ventricular septal rupture CHRISTOFOROS KOBOROZOS, MD
A case of post myocardial infarction ventricular septal rupture CHRISTOFOROS KOBOROZOS, MD NAVAL HOSPITAL OF ATHENS case presentation Female, 81yo Hx: diabetes mellitus, hypertension, chronic anaemia presented
Effect of Intravascular Ultrasound- Guided vs. Angiography-Guided Everolimus-Eluting Stent Implantation: the IVUS-XPL Randomized Clinical Trial
Effect of Intravascular Ultrasound- Guided vs. Angiography-Guided Everolimus-Eluting Stent Implantation: the IVUS-XPL Randomized Clinical Trial Myeong-Ki Hong, MD. PhD on behalf of the IVUS-XPL trial investigators
Strategies in mechanical interventions for acute MI: facilitated and rescue PCI
NORMAL INTERVENTIONAL TC-99M MIBI STRATEGY MYOCARDIAL FOR PERFUSION ACUTE MI Strategies in mechanical interventions for acute MI: facilitated and rescue PCI Farrel Hellig Sunninghill, Sunward Park and
Are Asian Patients Different? - Updates Of Biomatrix Experience In Regional Settings: BEACON II (3 Yr F up) &
Are Asian Patients Different? - Updates Of Biomatrix Experience In Regional Settings: BEACON II (3 Yr F up) & Biomatrix TM Single Center Experience (Indonesia)(Final 5 Yr F up) T. Santoso University of
ACUTE CORONARY SYNDROME PCI IN THE ELDERLY
ACUTE CORONARY SYNDROME PCI IN THE ELDERLY G.KARABELA MD.PhD ATHENS NAVAL HOSPITAL INTERVENTIONAL CARDIOLOGY DEPARTMENT NO CONFLICT OF INTEREST TO DECLAIRE Risk stratification in Αcute Coronary Syndrome.
The DAWN of a New Era for Wake-up Stroke
The DAWN of a New Era for Wake-up Stroke Alan H. Yee, D.O. Stroke and Critical Care Neurology Department of Neurology University of California Davis Medical Center Objectives Review Epidemiology and Natural
Can IVUS Define Plaque Features that Impact Patient Care?
Can IVUS Define Plaque Features that Impact Patient Care? A Pichard L Satler, K Kent, R Waksman, W Suddath, N Bernardo, N Weissman, M Angelo, D Harrington, J Lindsay, J Panza. Washington Hospital Center
Cover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/21543 holds various files of this Leiden University dissertation Author: Dharma, Surya Title: Perspectives in the treatment of cardiovascular disease :
MISTRAL. Myocardial Infarction with ST-elevation Treated by Primary Percutaneous Intervention Facilitated by Early Reopro Administration in ALsace
Les Hôpitaux Universitaires de STRASBOURG MISTRAL Myocardial Infarction with ST-elevation Treated by Primary Percutaneous Intervention Facilitated by Early Reopro Administration in ALsace Pre-hospital
Culprit PCI vs MultiVessel PCI for Acute Myocardial Infarction
Culprit PCI vs MultiVessel PCI for Acute Myocardial Infarction Dipti Itchhaporia, MD, FACC, FESC Trustee, American College of Cardiology Director of Disease Management, Hoag Hospital Robert and Georgia
Pharmaco-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),
What about aborted infarction?
Unanswered Qs in STEMI management Q3 What about aborted infarction? Is there consensus on the definition? Aborted infarction and TIME to treatment Aborted MI as an outcome measure? Conclusions By Dr Jason
Φαινόμενο No-Reflow. Απεικόνιση με CMR, κλινική συσχέτιση και προγνωστική σημασία
Φαινόμενο No-Reflow. Απεικόνιση με CMR, κλινική συσχέτιση και προγνωστική σημασία Θεόδωρος. Καραμήτσος MD PhD Honorary Consultant in Cardiology University of Oxford Centre for Clinical Magnetic Resonance
Adjunctive Antithrombotic for PCI. SCAI Fellows Course December 9, 2013
Adjunctive Antithrombotic for PCI SCAI Fellows Course December 9, 2013 Theodore A Bass, MD FSCAI President SCAI Professor of Medicine, University of Florida Medical Director UF Shands CV Center,Jacksonville
Blinded Physiological Assessment of Residual Ischemia after Successful Angiographic PCI Allen Jeremias, MD, MSc
Blinded Physiological Assessment of Residual Ischemia after Successful Angiographic PCI Allen Jeremias, MD, MSc On behalf of Justin Davies, Manesh Patel, Gregg Stone and the DEFINE PCI Investigators Disclosure
ACUTE LIMB ISCHEMIA Table of Contents
ACUTE LIMB ISCHEMIA Table of Contents PERIPHERAL ARTERIAL DISEASE (PAD)... 1 INTERMITTENT CLAUDICATION (IC)... 1 CRITICAL LIMB ISCHEMIA (CLI)... 1 ACUTE LIMB ISCHEMIA (ALI)... 2 Risk Factors...2 Associated
Embolization of atherothrombotic debris occurs commonly
Randomized Comparison of Distal Protection With a Filter-Based Catheter and a Balloon Occlusion and Aspiration System During Percutaneous Intervention of Diseased Saphenous Vein Aorto-Coronary Bypass Grafts
CTO Angioplasty Lessons from the Summit
CTO Angioplasty Lessons from the Summit Gregg W. Stone, MD Columbia University Medical Center The Cardiovascular Research Foundation New York City The 1 st International CTO Summit January 2004 47 faculty
Abciximab plus Heparin versus Bivalirudin in Patients with NSTEMI Undergoing PCI. ISAR-REACT 4 Trial
Abciximab plus Heparin versus Bivalirudin in Patients with NSTEMI Undergoing PCI ISAR-REACT 4 Trial Adnan Kastrati, MD Deutsches Herzzentrum, Technische Universität, Munich, Germany On behalf of F.-J.
Myocardial 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
LV Functional Recovery after CTO PCI.
LV Functional Recovery after CTO PCI. Serial CMR substudy of the Explore trial. CTO PCI after STEMI On behalf of the EXPLORE Trial investigators José P.S. Henriques Academic Medical Center University of
Patient 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
EXCEL 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
CLINICAL 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
presenters 2010 Sameh Sabet Ain Shams University
Guidelines for PCI in late STEMI presenters 2010 Sameh Sabet Assistant Professor of Cardiology Ain Shams University 29% of MI patients have STEMI. NRMI 4 (Fourth National Registry of Myocardial Infarction),
DECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Multivessel disease and cardiogenic shock: CABG is the optimal revascularization therapy. Contra Prof. Christian JM Vrints Cardiogenic Shock Spiral Acute Myocardial
Reducing Thrombotic Burden in Arterial Interventions. Mario Galli, MD Cardiovascular Interventional Unit S. Anna Hospital, Como, Italy
Reducing Thrombotic Burden in Arterial Interventions Mario Galli, MD Cardiovascular Interventional Unit S. Anna Hospital, Como, Italy Disclosure Speaker name: Mario Galli... I have the following potential
Cover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/21543 holds various files of this Leiden University dissertation Author: Dharma, Surya Title: Perspectives in the treatment of cardiovascular disease :
ECG in coronary artery disease. By Sura Boonrat Central Chest Institute
ECG in coronary artery disease By Sura Boonrat Central Chest Institute EKG P wave = Atrium activation PR interval QRS = Ventricle activation T wave= repolarization J-point EKG QT interval Abnormal repolarization
Effect of upstream clopidogrel treatment in patients with ST-segment elevation myocardial infarction undergoing primary PCI
Effect of upstream clopidogrel treatment in patients with ST-segment elevation myocardial infarction undergoing primary PCI Dr Sasha Koul, MD Dept of Cardiology, Lund University Hospital, Lund, Sweden
Management 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
CASE REPORTS: Filters to Prevent Distal Embolization during Coronary Artery Stenting: The Risk of Mousetrap
Page 1 / 5 CASE REPORTS: Filters to Prevent Distal Embolization during Coronary Artery Stenting: The Risk of Mousetrap - Ugo Limbruno, MD, Alberto Genovesi Ebert, MD, Michele Galli, MD We describe a case
CORONARY CHRONIC TOTAL OCCLUSIONS IN THE SETTING OF ACUTE MYOCARDIAL INFARCTION
CORONARY CHRONIC TOTAL OCCLUSIONS IN THE SETTING OF ACUTE MYOCARDIAL INFARCTION *Bimmer Claessen, Loes Hoebers, José Henriques Department of Cardiology, Academic Medical Center, University of Amsterdam,
MULTIcentre evaluation of Single high-dose. acute myocardial infarction study
MULTIcentre evaluation of Single high-dose Tirofiban bolus TiRofiban vs. versus with sirolimus eluting stent or barein metal stent in during primary PCI STEMI acute myocardial infarction study M. Valgimigli,