Mee$ng  Highlights  and  Summary

Robert  C.  Welsh,  MD,  FRCPC  Professor  of  Medicine  

Director,    Adult  Cardiac  Catheteriza$on  and  Interven$onal  Cardiology  

Co-­‐Chair,  Vital  Heart  Response    Co-­‐director,  U  of  A  Chest  Pain  Program  

Chest Pain and Minimal CAD – T. AndersonResults – Survivor analysis for Women

Prac%cal  Recommenda%ons    Atrial  Fibrilla$on  

Plus  ACS  or    Coronary  Artery  Stent  

High  Risk  of  Stroke?  (CHADS2>  1)    

High  Risk  of  Bleeding?  

Triple  Therapy  

Warfarin  and  Clopidogrel  

ADAPTED  from  :  Circula$on  2010;  121:  2067-­‐2070  

Yes  

No  

Yes  

No  Dual  An$platelet  Therapy  

GEMINI  ACS  1  Randomized,  Double-­‐blind,  Double-­‐dummy,  Ac%ve-­‐controlled,  Parallel-­‐group,  Mul%center  Study  to  Compare  the  Safety  of  Rivaroxaban  versus  Acetylsalicylic  Acid  in  Addi%on  to  Either  Clopidogrel  or  Ticagrelor  Therapy  in  Subjects  with  Acute  

Coronary  Syndrome  Biomarker  posi%ve  ACS  Managed  with  DAPT  

ASA  +  Clopidogrel   ASA  +  Ticagrelor  

ASA  100mg  

Rivaroxaban    2.5  mg  bid  

ASA  100  mg  

Rivaroxaban    2.5  mg  bid  

Primary  safety  endpoint:  Combined  TIMI  bleeding    Exploratory  efficacy  endpoint:  composite  of  CV  death,  MI,  ischemic  stroke,  and  stent  

thrombosis.  

N=3000

R  1:1  

R  1:1  

TicagrelorClopidogrel

Post Angiography and PCI

30 Days or 30 Months – What is the Optimal

Duration of Dual Antiplatelet Therapy

(DAPT)?

Shaun Goodman

Improving Care Through Systems Re-engineering

Christopher Granger, MD

ESCAPE  Outcomes  

2015-­‐02-­‐11   www.escapetrial.org   7  

COAPT  Trial    Clinical  Outcomes  Assessment  of  the  MitraClip  Percutaneous  Therapy  for  High  Surgical  Risk  Pa$ents  

•   High  surgical  risk  pa$ent  with  Mod-­‐Sev  /  Severe  Func$onal  MR    

•   Randomized  to  OMT  vs  MitraClip  +  OMT  •   Primary  Endpoint:  12  month  composite:  

–  death  (all-­‐cause),  stroke  (major  and  minor),  new  onset  or  worsening  of  kidney  dysfunc$on,  le_  ventricular  assist  device  (LVAD)  implant,  and  heart  transplant  

Transcatheter Aortic Replacement: Advances in Technology,

Procedure and Patient Selection

Alexander (Sandy) Dick, MD ACC Rockies, 2015

4187 4212

4056 4051

3891 3860

3282 3231

2478 2410

1716 1726

1005 994

280 279

LCZ696 Enalapril

Enalapril (n=4212)

LCZ696 (n=4187)

HR = 0.84 (0.76-0.93) P<0.0001

Kap

lan-

Mei

er E

stim

ate

of

Cum

ulat

ive

Rat

es (%

)

Days After Randomization Patients at Risk

360 720 1080 0 180 540 900 1260 0

16

32

24

8

835

711

PARADIGM-­‐HF:  All  cause  mortality  

McMurray NEJM 2014

All-Cause Mortality

Hemorrhagic Stroke

0.90 (0.85 - 0.95)

0.49 (0.38 - 0.64)

Risk Ratio (95% CI)

p=0.0003

p<0.0001

Favors NOAC Favors Warfarin

 

0.2   0.5   1   2  

Overview of 4 Trials of Novel Agents vs Warfarin in 72,000 Patients (Lancet December 2013)

Heterogeneity p=NS for all outcomes Ruff CT, et al. Lancet 2013 [in-press]

AVERROES  Study:  Bleeding  Analysis  Bleeding  events  

ICH: 11 apix, 13 ASA

Flaker G. Stroke. 2012;43:3291-7

IMPROVE-IT vs. CTT: Ezetimibe vs. Statin Benefit

CTT Collaboration. Lancet 2005; 366:1267-78; Lancet 2010;376:1670-81.

IMPROVE-IT

PCSK9 Outcome Trials Alirocumab Evolocumab Bococizumab

Trial ODYSSEY Outcomes (secondary prevention)

FOURIER (secondary prevention)

SPIRE1 (secondary prevention)

SPIRE2 (primary prevention)

No of patients 18000 22500 12000 6300 Dosage s/c, Q2W s/c, Q2W or Q4W s/c, Q2W s/c, Q2W

Start date Oct 2012 Jan 2013 Oct 2013 Oct 2013

Expected End date Mar 2018 Feb 2018 Aug 2017 Aug 2017 Primary endpoint

•   CHD death •   non-fatal MI •   fatal and non-fatal ischemic stroke •   high risk UA

requiring hospitalization

•   CV death •   MI •   Stroke •   hospitalization for

UA •   coronary

revascularization

•   CV death •   non-fatal MI •   non-fatal stroke •   hospitalization for

UA needing urgent revascularization

•   CV death •   non-fatal MI •   non fatal stroke •   hospitalization for

UA needing urgent revascularization

Duration Up to Month 64 Up to 5 years Up to Month 60 Up to Month 60

Population Patients 4 to 52 wks post ACS •   LDL-C ≥70 (1.8)

History of clinically evident CVD: MI, stroke or symptomatic PAD and ≥1 major RF or ≥ 2 minor RFs •   LDL-C ≥70 (1.8) or

High risk patients •   LDL-C ≥70 (1.8) and

<100 (2.6) or

High risk subjects •   LDL-C ≥100 (2.6) or

Heart  Failure  Anthracyclines  

Trastuzumab  Suni%nib  

High  dose    cyclophosphamide  

Thrombosis  

Tamoxifen  

Cispla$n  

Hypertension  

Bevaci-­‐  zumab  

Ischemia  

5-­‐FU/Capecitabine  

Sorafenib  

Taxanes  Anastrazole  

Bortezomib  

Cardiovascular Effects of Common Cancer Treatments

Chest    Irradia%on  

     

Mee$ng  Highlights  and  Summary

CCS  Stable  Ischemic  Heart  Disease  Workshop  CCS  Atrial  Fibrilla$on  Workshop  

CVC  Research  Symposium  Diabetes  Workshop    

Evalua%ons  

•   Please  complete  your  evalua$ons!  •   CCS  workshops  •   Cer$ficates  of  par$cipa$on  can  be  picked  up  from  Hospitality  Desk  upon  submission  of  completed  evalua$on  form  

25 credits

Section 1 - Accredited group learning activity Maintenance of Certification Royal College of Physicians and Surgeons of Canada

Acknowledgments    ACC  Rockies  CommiRees  

•   Scien%fic  CommiRee  –  Drs.  T.  Anderson,  J.  Genest,  B.  Gersh,  J.  Kornder,  &  R.  Welsh  

•   Organizing  CommiRee  –  Drs.  J.  Genest  &  R.  Welsh,  Evidence  Based  Marke$ng  (Karen  and  Clay  Earl)    

•   Rimrock  Resort  Hotel