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The Year In Cardiology

The Year In Cardiology. John Coyle, M.D. October 8, 2010. The Year In Review Series: The American College Of Cardiology. Atherothrombosis. Cardiac Electrophysiology. Cardiac Imaging. Cardiovascular Surgery. Congenital Heart Disease.

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The Year In Cardiology

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  1. The Year In Cardiology John Coyle, M.D.October 8, 2010

  2. The Year In Review Series: The American College Of Cardiology Atherothrombosis Cardiac Electrophysiology Cardiac Imaging Cardiovascular Surgery Congenital Heart Disease Epidemiology, Health Services Research and Outcomes Research Heart Failure Hypertension Interventional Cardiology Non-ST-Segment Elevation Acute Coronary Syndrome Valvular Heart Disease ACC/AHA Guidelines: New and Revised

  3. Its Who You Know Epidemiology, Health Services Research and Outcomes Research

  4. Six Degrees Of Separation

  5. Three Degrees Of Influence

  6. 2007 2008 2008

  7. Probability That a Subject Will Quit Smoking According to the Type of Relationship with a Contact Who Quits Smoking, in the Social Network of the Framingham Heart Study Christakis NA, Fowler JH. N Engl J Med 2008;358:2249-2258

  8. ACC/AHA Guidelines

  9. … And thirdly, the code is more what you'd call"guidelines" than actual rules… Captain Jack Sparrow

  10. Guidelines And The Law

  11. The Guidelines At YourFingertips

  12. Guidelines Example: Pre-Op Cardiac Evaluation

  13. Guidelines Example: Pre-Op Cardiac Evaluation

  14. New Guidelines: Plavix

  15. Circulation. 2010;122:537-557.

  16. Circulation. 2010;122:537-557.

  17. Circulation. 2010;122:537-557.

  18. A New Anti-Platelet Steps UpTo The Plate

  19. Circulation. 2009;120:2577-2585.

  20. Hypertension

  21. Hypertension And The Renal Artery

  22. Angioplasty For Treatment Of Atherosclerotic Renal Artery Stenosis N Engl J Med 2009; 361:1953-1962

  23. Renal Radiofrequency Sympathetic Ablation For Treatment Of Refractory Hypertension Lancet 2009; 373: 1275–81

  24. Brevity Is The Soul OfEfficacy

  25. ACCOMPLISH Supports Single-Pill Combination Therapy For Patients With More Resistant Hypertension “The data from the ACCOMPLISH study also showed that when patients were transferred to either of the single-pill combinations tested in that study, there was a dramatic improvement in BP control, with >70% achieving their BP target. The reasons for this are not immediately obvious but may in part relate to improved concordance with therapy in a clinical trial setting. It does lend some support to current guideline recommendations of initial therapy with a low-dose, single-pill combination for patients whose BP is >20/10 mm Hg above their target BP.” J. Am. Coll. Cardiol.2010;55;65-73

  26. Is Lower Better?

  27. ACCORD Does Not Support More Aggressive BP Treatment In High-Risk Diabetics N Engl J Med 2010; 362:1575-1585

  28. ACCORD Does Not Support More Aggressive BP Treatment In High-Risk Diabetics N Engl J Med 2010; 362:1575-1585

  29. Cardiac Electrophysiology

  30. Freezing Atrial FibrillationTo Death

  31. Closer, But Still Not A“Real World” Trial

  32. Au Revoir, Coumadin?

  33. Dabigatran: The End Of Warfarin? Plus: A direct thrombin inhibitor. It eliminates the middle-man. No need for coagulation monitoring with blood tests. Reduced risk of intracranial bleeding. No apparent dietary restrictions. As good as warfarin (or better) for prevention of stroke with about the same overall bleeding risk. Minus: Twice-a-day dosing. Needs an acidic environment for absorption. Wrapped in tartaric acid. Risk of GI upset. Increased risk of GI bleeding. Price not yet announced, but inevitably will be higher than warfarin.

  34. Atrial Fibrillation: Is SlowerBetter?

  35. Lenient Versus Strict Rate Control in Patients with Atrial Fibrillation Resting heart rate <80 bpm, <110 bpm during moderate exercise Resting heart rate <110 bpm The primary outcome was a composite of death from cardiovascular causes, hospitalization for heart failure, and stroke, systemic embolism, bleeding, and life-threatening arrhythmic events. N Engl J Med 2010;362:1363-73

  36. Bacteria 1, Eucaryocytes 0

  37. Asymptomatic Bacterial Colonization Of Intravascular Devices/Generators

  38. Asymptomatic Bacterial Colonization Of Intravascular Devices/Generators

  39. Atherothrombosis

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