Core Curriculum

• Myocardial Ischemia Redefined: Optimal Care in CAD

VBWG07_MIR.pdf (1.3MB)VBWG07_MIR.pdf (1.3MB)

Myocardial Ischemia Redefined: Optimal Care in CAD

Download VBWG07_MIR_S01.ppt (12 slides - 0.7MB)

Myocardial Ischemia Redefined:Optimal Care in CAD Learning objectives Curriculum overview Chronic ischemic heart disease: Overview Repeat revascularization is common post-PCI/CABG Angina increases cost of care Challenges in selected populations: Pathophysiology and implications of ischemic heart disease in women WISE: Landmark study in women WISE: Persistent chest pain in women predicts future CV events WISE: Persistent chest pain associated with diminished QOL WISE: CAD imposes an economic burden Contemporary clinical practice of ischemic heart disease

Examining the Science Underlying Myocardial Ischemia

Download VBWG07_MIR_S02.ppt (15 slides - 9.6MB)

Examining the Science Underlying Myocardial Ischemia Severe obstruction (angina, no rupture) vs mild obstruction (no angina, likely to rupture) Major cardiac events occur in non-target areas following successful PCI Local determinants of the natural history of individual coronary lesions Proposed classification scheme for atherosclerotic plaque The spectrum of CAD Ventricular arrhythmogenesis in ischemic myocardium Causes and consequences of myocardial ischemia: New understanding Overview of the sodium channel Origin of late INa Myocardial ischemia causes enhanced late INa Role of altered ion currents in adverse consequences of myocardial ischemia Diastolic relaxation failure adversely affects myocardial O2 supply and demand Late INa inhibition blunts Ca2+ accumulation Ranolazine blunts sotalol-induced action potential prolongation in dogs

Clinical Trial Update

Download VBWG07_MIR_S03.ppt (51 slides - 1.2MB)

Clinical Trial Update Issues in chronic myocardial ischemia treatment Stable CAD: Multiple treatment options SAFE-LIFE: Evaluation of intensive lifestyle intervention SAFE-LIFE: Reduction in angina at 1 year with intensive lifestyle intervention Chronic ischemic heart disease: Treatment gaps Novel anti-ischemic strategy Ranolazine clinical trial program Ranolazine clinical trial program in chronic stable angina MARISA, CARISA, ERICA main findings Challenges in selected populations: Experience with ranolazine Antianginal efficacy by gender Antianginal efficacy by gender Antianginal efficacy by age Antianginal efficacy by diabetes status CARISA: Reductions in A1C (diabetes substudy) Summary: Ranolazine in challenging populations ROLE: Long-term safety and tolerability in stable CAD patients MERLIN-TIMI 36: Study design MERLIN-TIMI 36: Effect on primary endpoint MERLIN-TIMI 36: Components of primary endpoint MERLIN-TIMI 36: Efficacy results in major subgroups MERLIN-TIMI 36: Primary arrhythmia endpoints MERLIN-TIMI 36: Reduction in VT lasting ≥8 beats MERLIN-TIMI 36: Incidence of VT ≥8 beats in high-risk subgroups MERLIN-TIMI 36: Ventricular tachycardia events MERLIN-TIMI 36: Major safety outcomes MERLIN-TIMI 36: Sudden cardiac death by subgroup MERLIN-TIMI 36: Summary and implications Stable CAD: Multiple treatment options ACIP: Study design ACIP: Baseline characteristics ACIP: Two-year cumulative all-cause mortality rates for the treatment strategies SWISSI II: Study design SWISSI II: Baseline characteristics SWISSI II: Treatment effect on primary outcome ACIP, SWISSI II: Summary and implications COURAGE: Defining optimal care What is the definitive role of PCI in chronic angina and stable CAD? Patient expectations about elective PCI for stable CAD COURAGE: Study design COURAGE: Lifestyle intervention and risk factor goals COURAGE: Pharmacologic therapy COURAGE: Baseline angiographic data COURAGE: Baseline angina COURAGE: Inducible ischemia at baseline COURAGE: Treatment effect on primary outcome COURAGE: Treatment effect on angina COURAGE: Treatment effect in CV and diabetes subgroups COURAGE: Change in quality-of-life scores COURAGE: Summary and implications

New Guidelines for Myocardial Ischemia Management

Download VBWG07_MIR_S04.ppt (5 slides - 0.6MB)

New Guidelines for Myocardial Ischemia Management AHA Scientific Statement: Pharmacologic treatment of hypertension in stable angina CVD prevention in high-risk women: Class I recommendations CVD prevention in high-risk women: Class II recommendations Optimal patient care in stable CAD: Summary

Risk Stratification In Patients With Chronic Myocardial Ischemia

Download VBWG07_MIR_S05.ppt (7 slides - 0.6MB)

Risk Stratification In Patients With Chronic Myocardial Ischemia Available methods for risk stratification in CAD patients High-risk criteria Intermediate-risk criteria Low-risk criteria Comparison of 3 different risk scores Summary
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