ACS 1997-2001
General Topics in Unstable Angina
- Free PowerPoint Slides
http://www.clinicaltrialresults.org/ua/general/gp2b3ageneral.htm
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Trial Results
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http://www.clinicaltrialresults.org/
www.timi.org , www.timi.tv
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The access to this Website is free and unrestricted. The primary target
audience is cardiologists, allied healthcare professionals (such as nurses and
lab technicians), internests, family practitioners and primary care physicians.
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strives to have the most up to date and accurate data.
Free Journal
Acute Coronary Syndromes Online -
Remedica
http://www.acs.remedica.com
In ACS online, you can search for up-to-date reviews of recent papers as well as
the leading articles, case studies and meeting reports.
ReMEDICA Communications have created a new weblink on the ACS site that will
give you the opportunity to view the GUSTO V satellite symposium
presented this month at the ESC, Stockholm, Sweden. The
new link will allow you to listen to the speakers, view slides and read key
messages on the rationale, design, efficacy, safety and interpretation of the
GUSTO V trial. This information is brought to you from a symposium chaired by
Drs A Michael Lincoff (Cleveland, OH, USA) and Diego Ardissino (Parma, Italy).
To access this site, visit ASC online at www.acs.remedica.com
and click on the GUSTO V link.
ACC 2001 - Webcast
New Guidelines for Management of Unstable Angina and Non ST-Elevation Myocardial
Infarction
http://www.prous.es/acc2001/newprogram.cfm
NEW GUIDELINES FOR EVALUATING ACUTE CORONARY
SYNDROME
Explore revised ACS guidelines from the
ACC and the AHA, including topics such as oxygen use, fractionated heparin, and
glycoprotein IIb/IIIa inhibitors.
Clinician Reviews 11(1):73-86, 2001.
http://cardiology.medscape.com/35603.rhtml?srcmp=card-033001
ACS global CyberSummit 2001
http://www.theheart.org/index.cfm?doc_id=23205
This CME-accredited enduring material was originally released on July 13, 2001,
and will be available for credit until July 13, 2002.
Chaired by Dr Eugene Braunwald, the ACS global CyberSummit 2001 brings
together Drs Robert Califf, Christopher Cannon, Michael Lincoff,
James Tcheng, Eric Topol, and Frans Van de Werf, to discuss
the significant advances in the management of ACS.
CyberSession
Unstable Coronary Syndromes -- A Current Update
Drs. Romeo Majano and H. Vernon Anderson
created July 28 2001; reviewed 7/31/01; modified 10/18/01
http://www.cyberounds.com/conferences/cardiovascular_medicine/conferences/current/
The Treatment of ACS: An Update
The use of glycoprotein IIb/IIIa inhibitors and angioplasty with stenting
has altered the prognosis associated with AICS.
Current Medical Research and Opinion 17(1):38-40, 2001
http://cardiology.medscape.com/42059.rhtml?srcmp=card-083101
ACC 2001
Acute coronary syndromes: the 360° view
http://www.theheart.org/index.cfm?doc_id=23133
Drs Robert M Califf, Christopher P Cannon, James J Ferguson,
Eric J Topol, and Frans J Van de Werf as they discuss the
highlights of this symposium, presented at ACC 2001 (CME credit: 2 hours,
category 1).
[Supported by an unrestricted educational grant from Aventis Pharmaceuticals]
CARDIOLOGY TREATMENT UPDATES
PLATELET MANAGEMENT AND BEYOND IN ACUTE CORONARY SYNDROMES: TAKING A
MULTIFACTORIAL APPROACH
How has the use of stents and GP IIB/IIIA receptor inhibitors changed the
landscape?
Cardiology Treatment Updates - (C) 2001 Medscape, Inc.
http://cardiology.medscape.com/37773.rhtml?srcmp=card-051801
CURE - Effects of clopidogrel in addition to
aspirin in patients with acute coronary syndromes without ST-segment elevation
Yusuf S, et al.
N Engl J Med 2001;345:494-502
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11519503
The antiplatelet agent clopidogrel has beneficial effects in patients with acute
coronary syndromes without ST-segment elevation. However, the risk of major
bleeding is increased among patients treated with clopidogrel.
Synopsis: http://www.tctmd.com/journal-synopses/one.html?synopsis_id=2281
Benefit of glycoprotein IIb/IIIa inhibition
in patients with acute coronary syndromes and troponin t-positive status: the
paragon-B troponin T substudy
Newby LK, et al.
Circulation 2001;103:2891-6
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11413076
TnT predicts poor short-term outcomes in non-ST-segment elevation ACS. Treatment
benefit with lamifiban is limited almost exclusively to TnT-positive patients,
reducing 30-day adverse outcomes to a rate nearly identical to that of negative
patients.
Relationship between interleukin 6 and
mortality in patients with unstable coronary artery disease: effects of an early
invasive or noninvasive strategy
Lindmark E, et al.
Jama 2001;286:2107-13
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11694151
In the fast revascularisation during instability in coronary artery disease II (FRISC
II) study, high IL-6 (which induces C-reactive protein and fibrinogen, systemic
markers of inflammation) concentrations during acute coronary syndrome were
associated with high risk of cardiovascular events up to 12 months later.
Therefore, circulating IL-6 identifies patients who benefit most from a strategy
of early invasive management.
Review
Implications of troponin testing in clinical medicine
Britta U Goldmann, Robert H Christenson, Christian W Hamm, Thomas Meinertz
and E Magnus Ohman
Curr Controlled Trials Cardiovasc Med 2001,
http://cvm.controlled-trials.com/content/2/2/075
Website
Vulnerable Plaque
http://www.VulnerablePlaque.org
Increased local temperature in human
coronary atherosclerotic plaques: an independent predictor of clinical outcome
in patients undergoing a percutaneous coronary intervention
Stefanadis C, et al.
J Am Coll Cardiol 2001;37:1277-83
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11300435
Increased local temperature in atherosclerotic plaques is a strong predictor of
an unfavorable clinical outcome in patients with coronary artery disease
undergoing percutaneous interventions.
Current concepts of the pathogenesis of the
acute coronary syndromes
Libby P.
Circulation 2001;104:365-72
http://www.circulationaha.org/cgi/content/full/104/3/365
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11457759
Revisiting
ACS, post ESC
CME credit: 1 hour, category 1
Robert M Califf MD, Marc Cohen MD, and Frans J Van de Werf
MD PhD discuss the implications of recent clinical data in the treatment of ACS.
[Supported by an educational grant from Aventis Pharmaceuticals Inc.]
ESC 2001 Meeting Coverage
AHA 2001 Meeting Coverage
Non-ST Elevation ACS: The
Moving Target of Anti-Thrombotic Therapies
by Eugene Braunwald, MD
This is a review of the data on anti-thrombotic therapies particularly for
non-ST elevation ACS, as well as the controversies surrounding those
therapies.
Click here to view
TCT 2001 Meeting Coverage
TCT 2001 Abstracts
TCT 2001 Symposia (Expert Presentations)
Harmonizing Pharmacological and Mechanical Strategies in Unstable Angina and Acute Myocardial Infarction
Non-Q-wave myocardial infarction following
thrombolytic therapy: a comparison of outcomes in patients randomized to
invasive or conservative post-infarct assessment strategies in the Veterans
Affairs non-Q-wave Infarction Strategies In-Hospital (VANQWISH) Trial
Wexler LF, et al.
J Am Coll Cardiol 2001;37:19-25. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11153737
Rationale and design of the GRACE (Global
Registry of Acute Coronary Events) Project: a multinational registry of patients
hospitalized with acute coronary syndromes
Am Heart J 2001;141:190-9. http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11174331
Comparison of early invasive and
conservative strategies in patients with unstable coronary syndromes treated
with the glycoprotein IIb/IIIa inhibitor tirofiban
Cannon CP, et al. for the TACTICS-TIMI 18 Investigators
N Engl J Med 2001;344:1879-87
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11419424
Comment-1 Comment-2 Comment-3
Troponin Level Identifies Aggressive
Treatment Responders
JAMA 2001;286:2405-2412,2461-2462.
Click
here to read the comment
Use of risk stratification to identify
patients with unstable angina likeliest to benefit from an invasive versus
conservative management strategy
Solomon DH, et al.
J Am Coll Cardiol 2001;38:969-76
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11583866
Risk stratification may be an effective method for identifying those patients
with unstable angina or NQMI most likely to benefit from early invasive
management. Selective use of early invasive management can have a substantial
impact in reducing morbidity and mortality in higher risk patients, but may not
be warranted in lower risk patients.
Editorial
Should we catheterize all patients with unstable angina? No--only the ones
with coronary artery disease
Kussmaul WG.
J Am Coll Cardiol 2001;38:977-8
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11583867
Early coronary angiography improves
long-term survival in unstable angina
Mathew V, et al.
Am Heart J 2001;142:768-74 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11685161
Unstable coronary plaque and its relation to
coronary calcium
Schmermund A, et al.
Circulation 2001;104:1682-7
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11581149
Mechanical and structural characteristics of
vulnerable plaques: analysis by coronary angioscopy and intravascular ultrasound
Takano M, et al.
J Am Coll Cardiol 2001;38:99-104
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11451303
Free Journal
Acute Coronary Syndromes
Online - Remedica
http://www.acs.remedica.com
In ACS online, you can search for up-to-date reviews of recent papers as well as
the leading articles, case studies and meeting reports.
Click here to see all the free full
articles published in the year 2000
CME Cybersession
Risk stratification for acute coronary syndromes
http://cme.cybersessions.org/dukeu-port02aug00/index.html
August 2, 2000
Drs E Magnus Ohman (chair), Brian Gibler, and Matthew T Roe examine how the use
of risk stratification for patients presenting at the emergency department, CCU
and cath lab with chest pain can maximize the benefits of pharmacologic and
invasive therapies.
CME Cybersession
Evolving treatment strategies for ACS and PCI
http://cme.cybersessions.org/dukeu-port13sep00/index.html
September 13, 2000
Drs Robert M Califf (chair), Kristin Newby, and Eric Topol MD discuss how costs
influence therapy selection for patients with symptomatic coronary artery
disease and how risk stratification can be used to maximize the therapeutic
potential of invasive cardiac procedures and antiplatelet agents for patients
with acute coronary syndromes.
TCTMD Factoids
Acute Coronary Syndromes and MI
Click
here for short summaries of key journal articles in PowerPoint slide format.
Factoids can be downloaded. Create your own slide library or download slides for
your next talk.
ACC/AHA guidelines for the management
of patients with unstable angina and non-ST-segment elevation myocardial
infarction. A report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines (Committee on the Management of
Patients With Unstable Angina)
Braunwald E et al.
J Am Coll Cardiol 2000;36:970-1062
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010987629
Click
here to view the slides
Click here to view
the full article
Guideline
Guideline for the management of patients with acute coronary syndromes
without persistent ECG ST segment elevation
British Cardiac Society Guidelines
Heart 2001;85 133-142 http://www.heartjnl.com/cgi/content/full/85/2/133
TCT 2000 Expert Presentation Slides
Outline
The unstable ischemic pattern: changes in concept and therapy over the past 7
years
by John A Ambrose
ACC Current Journal Review 2000; 9(6):50-51
Click
here to view the full article
Management of patients with ACS in the
US by platelet glycoprotein IIb/IIIa inhibition. Insights from PURSUIT trial
Lincoff AM et al.
Circulation 2000;102:1093-100
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010973836
Platelet glycoprotein IIb/IIIa receptor blockade with eptifibatide reduces the
incidence of death or myocardial infarction among patients treated for acute
ischemic syndromes without ST-segment elevation within the United States Click
here to view the article synopsis
Late-Breaking Clinical Trial
GUSTO IV ACS
Presented by Califf R at ESC 2000
Click
here or here
to see the slides Click
here for additional comments
No ACS Benefit for Abciximab in GUSTO IV-ACS. This trial enrolled 7,800 patients
with ACS, with patients randomized to either placebo or abciximab. Treatment
with abciximab for either 24 or 48 hours on top of aspirin and unfractionated or
low molecular weight heparin does not reduce death or MI in patients with ACS
not undergoing early revascularization
Click
here to view the full article.
Late-Breaking Clinical Trial
TACTICS-TIMI 18 Trial (Treat Angina with Aggrastat® and determine Cost
of Therapy)
Presented by Cannon C at AHA 2000
Click
here to view the slides
GP IIb/IIIa inhibitors and stents may make early invasive care the choice
for ACS - TACTICS-TIMI 18 is only the latest of many randomized trials to test
whether routine invasive management or a more conservative, ischemia-driven
approach to cardiac catheterization yields better outcomes for patients with
unstable angina or non-ST-elevation MI. But it's probably the first to be
performed in the era of widespread coronary stenting with adjuvant GP IIb/IIIa
inhibition. This time, early invasive care that included tirofiban and, as
needed, stenting, showed clear and significant survival advantages, with
reductions in cardiac events, at both 30 days and at six months. According to
TIMI investigator Christopher Cannon, MD, "This should change the clinical
management of patients with unstable angina, with broader use of an early
invasive strategy incorporating GP IIb/IIIa inhibition."
Click
here to view the full article.
Outcome at 1 year after an invasive
compared with a non-invasive strategy in unstable coronary-artery disease: the
FRISC II invasive randomised trial
Wallentin L Lagerqvist B Husted S et al.
Lancet 2000 Jul 1; 356(9223):9-16
Click
here to view the article synopsis
One-year results from the Scandinavian-based FRISC II trial indicate that
invasive treatment for unstable coronary artery disease (CAD) substantially
reduces the long-term risk of death or MI. The short-term benefit of dalteparin,
described by the FRISC II investigators in an earlier report, does not appear to
have any lasting effects beyond the initial 3-month treatment period.
Prognostic value of recurrent episodes of
creatine kinase-MB elevation following repeated catheter-based coronary
interventions
Kornowski R, et al.
Catheter Cardiovasc Interv 2000;51:131-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11025563
Impact of new pharmacologic agents in the
treatment of acute thrombotic syndromes
Stone GW.
Am J Cardiol 1999;83:16E-20E.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10357577
Cardiac troponin I levels and clinical
outcomes in patients with acute coronary syndromes: the potential role of early
percutaneous revascularization
Fuchs S, et al.
J Am Coll Cardiol 1999;34:1704-10.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10577560
Non-Q-wave infarction and ostial left
coronary obstruction due to giant Lambl's excrescences of the aortic valve
Dangas G, et al.
Circulation 1999;99:1919-21.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10199892
Correlation of angiographic morphology and
clinical presentation in unstable angina
Dangas G, et al.
J Am Coll Cardiol 1997;29:519-25.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9060887