3 Agenda Hot Science Duke at the AHA Modern Communication “The grand rounds tomorrow is intended to generate discussion on how to incorporate the late-breaking science into our clinical practice. So please join us and prepare to discuss.” (Tracy Wang, MD - 11/22/10)
5 “It is Rocket Science!” Hot Science ROCKET-AF EMPHASIS-HF ASCEND-HF GRAVITASRACE-ERREVEALDEFINE● sdfjaliex“It is Rocket Science!”
6 Study Design Atrial Fibrillation G w_script.ppt4/14/2017 1:36:46 PMRisk FactorsCHFHypertensionAge 75DiabetesORStroke, TIA or Systemic embolusStudy DesignAt least 2 or 3 required*Atrial FibrillationRivaroxabanRandomizeDouble Blind / Double Dummy(n ~ 14,000)Warfarin20 mg daily15 mg for Cr Cl ml/minINR target - 2.5( inclusive)Monthly MonitoringAdherence to standard of care guidelinesPrimary Endpoint: Stroke or non-CNS Systemic Embolism* Enrollment of patients without prior Stroke, TIA or systemic embolism and only 2 factors capped at 10%
7 Primary Efficacy Outcome Stroke and non-CNS Embolism RivaroxabanWarfarinEvent Rate1.712.16WarfarinRivaroxabanCumulative event rate (%)HR (95% CI): 0.79 (0.66, 0.96)P-value Non-Inferiority: <0.001Days from RandomizationNo. at risk:RivaroxabanWarfarinEvent Rates are per 100 patient-yearsBased on Protocol Compliant on Treatment Population
8 Primary Efficacy Outcome Stroke and non-CNS Embolism RivaroxabanWarfarinEvent RateHR (95% CI)P-valueOn TreatmentN= 14,1431.702.150.79 (0.65,0.95)0.015ITTN= 14,1712.122.420.88 (0.74,1.03)0.117RivaroxabanbetterWarfarin betterEvent Rates are per 100 patient-yearsBased on Safety on Treatment or Intention-to-Treat thru Site Notification populations
9 Key Secondary Efficacy Outcomes RivaroxabanWarfarinEvent RateHR (95% CI)P-valueVascular Death, Stroke, Embolism4.514.810.94 (0.84, 1.05)0.265Stroke Type Hemorrhagic Ischemic Unknown Type0.261.620.150.441.640.140.58 (0.38, 0.89)0.99 (0.82, 1.201.05 (0.55, 2.01)0.0120.9160.871Non-CNS Embolism0.160.210.74 (0.42, 1.320.308Myocardial Infarction1.021.110.91 (0.72, 1.16)0.464All Cause Mortality Vascular Non-vascular Unknown Cause4.522.911.150.464.9220.127.116.110.92 (0.82, 1.03)0.94 (0.81, 1.08)0.94 (0.75, 1.18)0.80 (0.57, 1.12)0.1520.3500.6110.195Event Rates are per 100 patient-yearsBased on Intention-to-Treat Population
10 Primary Safety Outcomes RivaroxabanWarfarinEvent Rate or N (Rate)HR (95% CI)P-valueMajor>2 g/dL Hgb dropTransfusion (> 2 units)Critical organ bleedingBleeding causing death3.602.771.650.820.243.452.261.321.180.481.04 (0.90, 1.20)1.22 (1.03, 1.44)1.25 (1.01, 1.55)0.69 (0.53, 0.91)0.50 (0.31, 0.79)0.5760.0190.0440.0070.003Intracranial Hemorrhage55 (0.49)84 (0.74)0.67 (0.47, 0.94)Intraparenchymal37 (0.33)56 (0.49)0.67 (0.44, 1.02)0.060Intraventricular2 (0.02)4 (0.04)Subdural14 (0.13)27 (0.27)0.53 (0.28, 1.00)0.051Subarachnoid1 (0.01)Event Rates are per 100 patient-yearsBased on Safety on Treatment Population
11 Conclusions Efficacy: Safety: Conclusion: Rivaroxaban was non-inferior to warfarin for prevention of stroke and non-CNS embolism.Rivaroxaban was superior to warfarin while patients were taking study drug.By intention-to-treat, rivaroxaban was non-inferior to warfarin but did not achieve superiority.Safety:Similar rates of bleeding and adverse events.Less ICH and fatal bleeding with rivaroxaban.Conclusion:Rivaroxaban is a proven alternative to warfarin for moderate or high risk patients with AF.
12 Stroke or Systemic Embolism 0.500.751.001.251.50Dabigatran 110 vs. WarfarinDabigatran 150 vs. WarfarinNon-inferiorityp-value<0.001Superiority0.34Margin = 1.46HR (95% CI)
13 All Intracranial Bleeding YearsCumulative Hazard Rates0.00.010.020.030.040.51.01.52.02.5Dabigatran110Dabigatran150Warfarin# at RiskYear 0.5D110D150W601559005771466630061420607659585817473530801451602258875759463229331343
15 EMPHASIS-HF NYHA Class II HF (N=2737) LV EF < 30% EMPHASIS-HF: Major resultsOutcomeEplerenone (%)Placebo (%)Adjusted hazard ratio (95% CI)pCardiovascular death/heart-failure hospitalization18.325.90.63 (0.54–0.74)<0.001Cardiovascular death10.813.50.76 (0.61–0.94)0.01Heart-failure hospitalization12.018.40.58 (0.47–0.70)Hospitalization for hyperkalemia0.30.21.15 (0.25–5.31)0.85NYHA Class II HF (N=2737)LV EF < 30%Eplerenone 25-50mg QD vs. Placebo
16 “a small phase II trial in the eyes of someone in the ACS world” Hot ScienceROCKET-AFEMPHASIS-HFASCEND-HFGRAVITASRACE-ERREVEALDEFINE● sdfjaliex“a small phase II trial in the eyes of someone in the ACS world”
17 BackgroundAcute heart failure is a major health problem responsible for several million hospitalizations worldwide each year.Standard therapy has not changed since 1970s and includes diuretics and variable use of vasodilators or inotropes.In 2001, nesiritide was approved by the FDA to reduce PCWP and improve dyspnea, based on efficacy at 3 hrs.However, in 2005 two meta-analyses raised concerns regarding the risks of mortality and renal injury.Subsequently, an independent panel* was convened by Scios Inc and recommended that a clinical trial be conducted to definitively answer the question of nesiritide’s safety and efficacy.
18 Co-Primary objectives To assess whether nesiritide vs placebo, in addition to standard care provides:Reduction in rate of HF rehospitalization or all-cause mortality through Day 30Significant improvement in self-assessed dyspnea at 6 or 24 hrs using 7-point Likert scale604020% SubjectsMarkedly BetterMinimally WorseModerately BetterModerately WorseMinimally BetterMarkedly WorseNo Change
19 Dyspnea relief at 6 and 24 hrs All-cause mortality at 180 days Study design and drug proceduresNesiritideAcute HF < 24 hrs from IV RX24–168 hrs RxPlaceboCo-primary endpoint:Dyspnea relief at 6 and 24 hrsCo-primaryendpoint:30-day death orHF rehospAll-cause mortality at 180 daysDouble – blind placebo controlledIV bolus (loading dose) of 2 µg/kg nesiritide or placeboInvestigator’s discretion for bolusFollowed by continuous IV infusion of nesiritide 0.01 µg/kg/min or placebo for up to 7 daysUsual care per investigators including diuretics and/or other therapies as neededDuration of treatment per investigator based on clinical improvement
22 End of Treatment Creatinine Discharge or 10 day Creatinine Renal SafetyAnytime Through Day 30Placebo(n=3509)Nesiritide(n=3498)P-value>25% decrease eGFR29.5%31.4%0.11End of Treatment CreatinineCreatinine (mg/dL)Cum Dist24618.104.22.168.22.214.171.124.80.91.0Discharge or 10 day CreatinineNesiritidePlacebo
23 Hypotension Placebo (n=3509) Nesiritide (n=3498) Risk Difference (95% CI)P- valueAny hypotension(Through Day 10/discharge)15.3%(538)26.6% (930)11.3(9.4 to 13.1)<.001Asymptomatic Hypotension12.4%(436)21.4%(748)9.0(7.2 to 10.7)Symptomatic Hypotension4.0%(141)7.1%(250)3.1(2.1 to 4.2)
24 ConclusionsNesiritide did not reduce the rate of recurrent heart failure hospitalization or death at 30 days.Nesiritide reduced dyspnea to a modest degree, consistent with previous findings but did not meet pre-specified protocol criteria for statistical significance at 6 and 24 hours.Nesiritide did not affect 30-day all cause mortality nor did it worsen renal function as had been suggested by prior meta-analyses of smaller studies.
26 GRAVITAS Study Design R Elective or Urgent PCI with DES* VerifyNow P2Y12 Test hours post-PCIPRU ≥ 230RHigh-Dose Clopidogrel†clopidogrel 600-mg, thenclopidogrel 150-mg daily X 6 monthsStandard-Dose Clopidogrel†clopidogrel 75-mg daily X 6 monthsPrimary Efficacy Endpoint: CV Death, Non-Fatal MI, Stent Thrombosis at 6 moKey Safety Endpoint: GUSTO Moderate or Severe Bleeding at 6 moPharmacodynamics: Repeat VerifyNow P2Y12 at 1 and 6 months*Peri-PCI clopidogrel per protocol-mandated criteria to ensure steady-state at hrs†placebo-controlledAll patients received aspirin (81-162mg daily)
27 GRAVITAS Patient Flow 5429 patients screened with VerifyNow P2Y12 12-24 hours post-PCI2214 (41%) with high residual platelet reactivity(PRU ≥ 230)3215 (59%) without high residual platelet reactivity(PRU < 230)ClopidogrelHigh DoseN=1109ClopidogrelStandard DoseN=1105
28 Pharmacodynamics: Effect of SD vs HD Clopidogrel Standard-DoseHigh-Dose500P = 0.98P < 0.001400Persistently high 30 days: 62% vs 40%, p<0.001PRUvalue300200100N=1105N=1013N=940N=1109N=1012N=944Post-PCI30 d6 moPost-PCI30 d6 moITT population
29 Primary Endpoint: CV Death, MI, Stent Thrombosis Observed event rates are listed; P value by log rank test.
30 Bleeding Events: Safety Population Severe or life-threatening: Fatal bleeding, intracranial hemorrhage, or bleeding that causes hemodynamic compromise requiring blood or fluid replacement, inotropic support, or surgical interventionModerate: Bleeding that leads to transfusion but does not meet criteria for severe bleedingP by log rank test; observed event rates listed. HD, high-dose; SD, standard dose
31 GRAVITAS: SummaryCompared with standard-dose therapy, high-dose clopidogrel achieved a modest pharmacodynamic effect in patients with high residual reactivity.In patients with high residual reactivity measured after PCI, 6-months of high-dose clopidogrel did not reduce the rate of cardiovascular death, non- fatal MI, or stent thrombosis and did not increase GUSTO severe or moderate bleeding.In summary,
33 Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments – Emergency Response (RACE-ER) Project on behalf of RACE Coordinators, Nurses, Physicians, Paramedics, and Administrators
40 A Randomized, Double-blind, Placebo-controlled Trial of Intravenous Erythropoietin in Patients with ST-Segment Elevation Myocardial Infarction – Primary Results of the REVEAL Trial
41 Infarct size in IRA territory 2-6 days by cMRI STEMI n=110Primary or rescue PCITIMI 0-1 flow in IRASuccessful PCIIV EPOMatching salineplaceboInfarct size in IRA territory 2-6 days by cMRI- Randomize- Study drug within 4 hrs
42 Results: Primary endpoint Mean (SE) infarct size at 2-6 days after study drug admin EPOPlacebo2520EPO vs. placebo15.8% vs. 15.0%, P=NSP-value adjusted for age, infarct location,enrollment phase15Infarct Size (%LV)105
43 ConclusionsThese data, coupled with the lack of efficacy seen in other STEMI trials involving EPO (REVIVAL-31, HEBE III2), do not support the hypothesis that EPO favorably impacts outcome after reperfusion for STEMIWhether earlier administration or alternate dosing provides a cardioprotective effect of EPO in humans remains to be determined1Ott I, et. al. Circ:CV Intv 20102Voors AA, et. al. EHJ 2010
45 Background: CETP inhibition Cholesteryl ester transfer protein (CETP) is a plasma protein that catalyzes the transfer of CE from HDL to apoB-containing lipoproteins (VLDL and LDL-C) in exchange for Trig.LDL / VLDLLDL-RCESR-B1LiverX inhibitionCETPFCCholesteryl ester transfer protein (CETP) is a plasma protein that catalyzes the transfer of CE from HDL to apoB-containing lipoproteins (VLDL and LDL-C)in exchange for triglycerides that are transferred in the reverse direction.CETP inhibitors increase HDL-C and some also lower LDL-C, and therefore have the potential to reduce coronary events.HDL picks up free cholesterol (FC) from extrahepatic tissues.HDL FC is subsequently esterified by LCAT to form cholesteryl esters (CE)The HDL CE may then be delivered to the liver by either of two pathways:1. A direct pathway following binding of HDL to hepatic SR-B12. An indirect pathway involving the CETP-mediated transfer of CE from HDL to VLDL and LDL with subsequent delivery to the liver following binding of LDL to the LDL receptor."After click:Inhibition of CETP prevents the transfer of CE from HDL to the VLDL/LDL fractions and results in an increase in concentration of HDL-C and a decrease in the cholesterol content of the VLDL/LDL.CEHDLLCATBileFree Cholesterol (FC) in Extrahepatic tissuesFC45
46 Anacetrapib Orally active, potent, selective CETP inhibitor Robust lipid efficacy in Phase I-II studiesNo effects on blood pressure, electrolytes, and aldosterone in preclinical and Phase I-II clinical studiesIn vitro HDL functional assays: HDL particles isolated from anacetrapib-treated patients demonstrate preserved (and possibly enhanced) cholesterol efflux propertiesDose of 100 mg selected based on PK/PD modeling: minimal dose to achieve maximal effects on HDL and LDL
47 Study Design R Study drug stopped if LDL-C<25mg/dL during treatment Randomization1:1 RatioStudy drug stopped ifLDL-C<25mg/dL during treatmentAge: yearsNCEP ATPIII goal < 100 mg/dLStatin ± other lipid modifying therapyAnacetrapib 100 mg n=750R12 week follow-upPlacebo n=750Stable dose-regimen of lipid-modifying therapyRandomized, double-blind, placebo-controlled trialEligible patients at screening had the following:CHD or CHD risk equivalentsWere on a statin with or without other lipid drugshad LDL-C <100.Major Exclusion CriteriaChronic heart failureUncontrolled hypertensionHepatic diseaseSevere renal impairmentTreatment with warfarin, digoxin or potent inhibitors/inducers of CYP3A4Patients entered a 2 week single blind placebo run-in periodPatients were randomized to anacetrapib, 100 mg, or placebo for 18 months, followed by a 3-month, poststudy follow-up.At the time the study started there was uncertainty on the safety of very low LDL-C.Patients with LDL-C<25 mg/dL (2 consecutive measurements) during the study were discontinued.WeekVisitReversibilityPhasePlaceboRun-inScreeningTreatment Phase
48 Effects on LDL-C and HDL-C Study WeekBaselineWk 6Wk 12Wk 18Wk 24Wk 30Wk 46Wk 62Wk 76HDL-C (mg/dL) (SE)20406080100120AnacetrapibPlaceboAnacetrapib n =776757718687647607572543Placebo n =76676174174473671169166620406080100-39.8% (p<0.001)+138.1% (p<0.001)LDL-C (mg/dL) (SE)The point estimates are for wk 24AnacetrapibPlaceboBaselineWk 6Wk 12Wk 18Wk 24Wk 30Wk 46Wk 62Wk 76Anacetrapib n =804771716687646604568540Placebo n =803759741743735711691666Study Week
49 LS Mean Percent (95% CI) Placebo-Adjusted Lipid ParametersParameterLS Mean Percent (95% CI) Placebo-AdjustedChange from BaselineWeek 24Week 76Non-HDL-C-31.7* (-33.6, -29.8)-29.4* (-31.6, -27.3)Apo B-21.0* (-22.7, -19.3)-18.3* (-20.2, -16.4)Apo A-144.7* (42.8, 46.5)42.3* (40.5, 44.1)TC13.7* (12.0, 15.3)15.6* (13.8, 17.3)TG(-9.9, -3.9)(-8.9, -1.7)Lp(a)(-40.7, -32.3)(-44.5, -33.9)ApoE29.2* (24.7, 33.7)35.3* (30.6, 40.1)*p<0.001; means for all variables except for triglycerides, lipoprotein(a), for which medians are shown
50 Anacetrapib had no effect on BP SBPDBPSystolic blood pressure (mmHg)Diastolic blood pressure (mmHg)Baseline61284357A=nacetrpibBPloWeekL
51 Anacetrapib treatment had robust effects on HDL-C, LDL-C, non HDL-C and Lp(a) with sustained effects over 18 months.Anacetrapib had an acceptable side-effect profile with no effects on blood pressure, electrolytes or aldosterone.Within the power of the study, anacetrapib did not exhibit adverse cardiovascular effects seen with a prior CETP inhibitorThe long term safety and efficacy of anacetrapib will now be tested in a large clinical outcomes trial.
52 30,000 patients with occlusive arterial disease in North America, Europe and Asia Background LDL-lowering with atorvastatinRandomized to anacetrapib 100 mg vs. placeboScheduled follow-up: 4 yearsPrimary outcome: Coronary death, myocardial infarction or coronary revascularization
54 PI3K Regulates 2-Adrenergic Receptor Stimulated EGFR Transactivation Kevin M. Alexander, Supachoke Mangmool, Chetan B. Patel, Kunhong Xiao, and Howard A. RockmanDuke University Medical CenterDurham, NC
55 β-AR Mediated EGFR Transactivation Noma et. al. (2007) J. Clin. Invest. and Engelhardt (2007) J. Clin. Invest.
56 PI3K is Required for 2AR Mediated EGFR Transactivation β2AR stable HEK-293 cellsSrc ActivityEGFR PhosphorylationBoth the lipid and protein kinase activity of PI3K are necessaryfor 2AR mediated EGFR transactivation.PI3K protein kinase activity appears to lead to Src activation.
57 PI3K is Required for 2AR-EGFR Complex Formation Fluorescence Resonance Energy Transfer (FRET) Inhibition
58 Quantification of Src Phosphorylation Using Stable Isotope Labelling with Amino Acids in Cell Culture (SILAC)Grow two populations of HEK-293 cells expressing HA-Src and β2AR“Light” medium“Heavy” mediumL-ArgL-Lys HCl[13C6, 15N2 ]-L-Lys HCl (+8)[13C6, 15N4]-L-Arg (+10)LY + ISOISOMix, IP, trypsin digest, and IMAC phosphopeptide enrichmentPhosphopeptide analysis by LC-MS100100Extracted IonChromatogram(XIC)Lightpeptide Apeptide Bpeptide Cpeptide Dpeptide Epeptide FRelative AbundanceRelative AbundanceHeavyMeasure area under the curve
65 Duke Presentations Saturday November 13th 5 Sunday November 14th 23 Monday November 15th 57Tuesday November 16th 52Wednesday November 17th 18Total 155
66 Duke Fellow Presentations (5) Gerald BloomfieldStudying Non-Communicable Cardiovascular Diseases in sub-Saharan Africa: One Fellow's JourneyEarly Career: Global Cardiovascular Research Training, Opportunities and ExperiencesTodd Kiefer, Lawrence Park, Christophe Tribouilloy, Claudia Cortes, Riccardo Utilli, Andrew WangHeart Failure Complicating Infective Endocarditis: An Analysis of In-Hospital Mortality from the International Collaboration on Endocarditis Prospective Cohort StudyValvular Heart Disease: Diagnosis, Pathophysiology and Medical Management IIRobin Mathews, Eric D. Peterson, Anita Y. Chen, Tracy Wang, Chee T. Chin, Gregg C. Fonarow, Christopher P. Cannon, Matthew T. Roe, Karen P. AlexanderPrediction of In-Hospital Major Bleeding Among Patients With Acute Myocardial Infarction: Results From 90,273 Patients in the Acute Coronary Treatment Intervention Outcomes Network Registry®- Get With the Guidelines™ (AR-G)Best of AHA Specialty Conferences Poster Session: QCOR 2010Robb D. Kociol, Li Liang, Adrian F. Hernandez, Lesley H. Curtis, Paul A. Heidenreich, Clyde W. Yancy, Gregg C. Fonarow, Eric D. PetersonAre We Targeting the Right Economic Metric for Heart Failure? Association of Hospital 30-Day Heart Failure Readmission Rates and Total Inpatient DaysSumeet Subherwal, Eric D. Peterson, Anita Y. Chen, Richard G. Bach, Brian F. Gage, Deepak L. Bhatt, Stephen D. Wiviott, Jeffrey B. Washam, Matthew T. Roe, Karen P. Alexander, Tracy Y. WangIs Bleeding Risk Augmented With Acute Therapies Across Increasing INR Levels Among NSTEMI Patients on Home Warfarin Therapy?Atrial Fibrillation/Arrhythmias: Epidemiology, Quality of Care and Outcomes
67 Duke Fellow Presentations (9) Chee Tang Chin, John C Messenger, Lisa A Kaltenbach, Michael A Kutcher, H Vernon Anderson, Matthew T Roe, Tracy Y WangComparison of Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention for Previously Stented versus De Novo Culprit Lesions: Insights from the National Cardiovascular Data Registry CathPCI RegistryAcute Coronary Syndromes and Percutaneous Coronary Intervention: Quality of Care and OutcomesSergio Leonardi, Amanda Stebbins, Renato D Lopes, Yuliya Lokhnygina, Deepak L Bhatt, Gregg W Stone, Michael A Lincoff, Harold L Dauerman, C. Michael Gibson, Harvey D White, Keyur Parick, Luis Gruberg, Howard C Herrmann, Brent T McLaurin, Shaun Goodman, Robert A Harrington, Kenneth W MahaffeyPre-Treatment With Thienopyridines Reduces The Amount of Myonecrosis in Acute Coronary Syndrome Patients Invasively Managed: Insights from the CHAMPION trialsWhat's New in the Treatment of Patients with Acute Coronary Syndromes?Kevin M Alexander, Supachoke Mangmool, Chetan B Patel, Kunhong Xiao, Howard A RockmanPhosphoinositde 3-Kinase Regulates β2-Adrenergic Receptor Stimulated Epidermal Growth Factor Receptor TransactivationVascular SignalingThomas T Tsai, John C Messenger, J Matthew Brennan, Uptal D Patel, David Dai, Robert Piana, Kevin J Anstrom, Eric L Eisenstein, Rachel S Dokholyan, Eric D Peterson, Pamela S DouglasContemporary Risk of Follow-up Adverse Events in Older Patients with Chronic Kidney Disease and Dialysis Undergoing Percutaneous Coronary Interventions: A Report from the Merged NCDR CMS RegistryThe Role of Comorbidities in Cardiovascular Disease
68 Duke Fellow Presentations (14) Jonathan P Piccini, Bradley G. Hammill, Moritz F. Sinner, Paul N. Jensen, Adrian F. Hernandez, Susan R. Heckbert, Emelia J. Ben, Lesley H. CurtisIncidence of Atrial Fibrillation and Associated Mortality among Medicare Beneficiaries from 1993 to 2007Epidemiology and Outcomes in Atrial FibrillationRobin Mathews, Anita Y Chen, Chee T Chin, Tracy Y Wang, Kevin L Thomas, Matthew T Roe, Eric D PetersonShort- and Long-term Outcomes Among Black vs. White Patients with Non-ST-segment Elevation Myocardial InfarctionDiagnosis and OutcomesChee Tang Chin, Robert V Kelly, Mauricio G Cohen, Marc Cohen, J Richard Trout, Gregg W Stone, Jan T Christenson, Robert J Freedman Jr, Ramachandra C Reddy, Debra Joseph, E Magnus OhmanThe Impact of Anticoagulation During Intra-Aortic Balloon Counterpulsation Pump Placement on In-Hospital Outcomes in 18,875 Patients Undergoing Cardiac RevascularizationHeart Failure: Pacing and Other Therapeutic DevicesSergio Leonardi, L. Kristin Newby, E. Magnus Ohman, Paul W ArmstrongLack of Implementation of ESC/ACC Definition of Myocardial Infarction in Contemporary Randomized Clinical TrialsFrom Acute Thrombotic to Chronically Occluded Coronary ArteriesZubin J Eapen, Shelby D Reed, Lesley H Curtis, Adrian F Hernandez, Eric D PetersonDo Heart Failure Disease Management Programs Make Financial Sense Under a Bundled Payment System?Heart Failure: Disease Management, Quality of Care, Anemia
69 Duke Fellow Presentations (18) Rajendra H Mehta, Jonathan P Piccini, James T Tcheng, Martin Fahy, Roxana Mehran, Gregg W Stone, On Behalf of HORIZONS-AMI InvestigatorsPrognostic Significance of Post-Procedural Sustained Ventricular Tachycardia or Fibrillation in Patients Undergoing Primary Percutaneous Coronary Intervention: Insights from the HORIZONS AMI TrialFrom Acute Thrombotic to Chronically Occluded Coronary ArteriesRobin Mathews, Eric D. Peterson, Shuang Li, Matthew T. Roe, Stephen D. Wiviott, Jorge F. Saucedo, Elliott M. Antman, Tracy Y. WangUnder-utilization of Emergency Medical Service Transport Among Contemporary Patients with ST Elevation Myocardial Infarction: Findings from the National Cardiovascular Data Registry ACTION - Get With The GuidelinesJ. Matthew Brennan, Eric D Peterson, Yue Zhao, Sean O'Brien, Rachel Dokholyan, Pamela S Douglas, Fred H EdwardsPredictors of Bioprosthetic Aortic Valve Failure: Results in 73,616 Patients from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery National DatabaseCardiac Surgery: Valvular Heart Disease (Not Including Percutaneous Valves) IVJonathan P. Piccini, Jennifer A. White, Rajendra H. Mehta, Sana M. Al-Khatib, Pierluigi Tricoci, Charles V. Pollack Jr, Gilles Montalescot, Frans Van de Werf, C. Michael Gibson, Robert A. Harrington, L. Kristin NewbySustained Ventricular Tachycardia and Ventricular Fibrillation are Infrequent Events but are Associated with Increased Arrhythmic and All-cause Death Following Non-ST-Segment Elevation Acute Coronary SyndromesNoninvasive Arrhythmia Testing/Risk Assessment
70 Late Breaking Clinical Trials Duke LBCT & LBSSLate Breaking Clinical TrialsROCKET-AFASCEND-HFLate Breaking Sciences SessionsRACE-ERREVEAL
71 Interviews at the DCRI Reception “The Duke Reception”SponsorsDuke Heart CenterDuke Division of CardiologyDuke Clinical Research InstituteInterviews at the DCRI ReceptionNetworkingCurrent Faculty & FellowsHeart Center, Division, DCRI StaffFormer FellowsAcademic & Industry Collaborators
75 44 Shows Broadcast in Real Time Duke TV Temporarily Shut Down for “Internet Abuse”Internet Abuse Shutdown Nov 15 13:55 Hello Michael, Your server's switchport has been shutdown due to broad/multi casted traffic affecting multiple clients on our network and saturating their switchports. We request a response from you with an explanation for the large amount of traffic. If we do not receive a response in a timely manner we may need to terminate your account for violation of our acceptable use policy agreement.
76 Dr. Hisao Ogawa reviews: ROCKET-AF and RELY, A Japanese Perspective in Japanese. Dr. Robert Harrington, Dr. Robert Califf, Dr. C. Michael Gibson present: AHA 2010 wrap-up.Dr. Robert Califf, Dr. Manesh Patel, Dr. Kenneth Mahaffey, and Dr. Keith Fox discuss: Stroke Prevention Using the Oral Direct Factor Xa Inhibitor Rivaroxaban Compared with Warfarin in Patients with Nonvalvular Atrial Fibrillation (ROCKET-AF).Dr. Matthew Price presents: Standard Versus High-Dose Clopidogrel According to Platelet Function Testing After PCI: Results of the GRAVITAS Trial.Dr. Robert Califf, Dr. Adrian Hernandez, Dr. Christopher O'Connor and Dr. Randy Starling discuss: Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Dr. Clyde Yancy presents ASCEND: Historical perspective, implications for patients Failure Trial (ASCEND-HF).Dr. Anthony Furlan and Dr. Duane Pinto discuss: CLOSURE I Trial: A Prospective, Multicenter, Randomized Controlled Trial to Evaluate the Safety and Efficacy of the STARFlex Septal Closure System Versus Best Medical Therapy in Patients with a Stroke or Transient Ischemic Attack due to Presumed Paradoxical Embolism through a Patent Foramen Ovale.
77 Dr. Renato Lopes, Dr. Alexandre Quadros, Dr Dr. Renato Lopes, Dr. Alexandre Quadros, Dr. Antonio Carlos Carvalho and Dr. Roberto Giraldez: AHA wrap-up in Portuguese.Dr. Hisao Ogawa and Dr. Yoshihiko Saito: An AHA 2010 wrap-up in Japanese.Professor Murray Esler and Dr. Duane Pinto discuss: Symplicity HTN-2: International, Multicenter, Prospective, Randomized, Controlled Trial Of Endovascular Selective Renal Sympathetic Denervation For The Treatment Of Hypertension.Dr. Jonathan Piccini and Dr. Duane Pinto discuss: Sustained Ventricular Tachycardia and Ventricular Fibrillation Are Infrequent Events but are Associated with Increased Arrhythmic and All-Cause Death Following Non-ST-Segment Elevation Acute Coronary Syndromes.Dr. Stephen Nicholls and Dr. Ravi Karra discuss the results of the ASSERT study, the first major clinical trial of an oral agent inducing Apo A1 synthesis: A new approach to HDL raising and CV risk modification.Dr. Magnus Ohman and Dr. C. Michael Gibson discuss LVADs: Improving Outcomes.Dr. Matthew Brennan and Dr. C. Michael Gibson discuss: Anticoagulation Following Bioprosthetic Aortic Valve Replacement.
78 Dr. Christopher Granger, Mayme Roettig, RN, MSN, and Dr Dr. Christopher Granger, Mayme Roettig, RN, MSN, and Dr. Ravi Karra discuss: Mission Lifeline Update 2010.Dr. Peter Kowey provides and expert opinion on ROCKET AF and RELY.Dr. Robert Harrington presents: Beyond 2010, The Future of Antithrombic Therapy - Old Agent Replacement, Combination Therapy, and the Impact of Generics. Dr. Kristin Newby and Dr. Duane Pinto discuss: An EARLY-ACS Update. Dr. Chistopher Cannon presents: Primary Results of the DEFINE trial: Determining the EFficacy and Tolerability of CETP INhibition with AnacEtrapib. Dr. Peter Kowey discusses: Efficacy And Safety Of Prescription Omega-3-Acid Ethyl Esters (P-OM3) For The Prevention Of Recurrent Symptomatic Atrial Fibrillation (AF). Dr. Magnus Ohman reviews: TRILOGY: An Update. Dr. Karen Alexander and Dr. Duane Pinto describe: The Coming Tsunami: Cardiovascular Disease in the Elderly.
79 Dr. Tracy Wang and Dr. Duane Pinto discuss: Under-Utilization of Emergency Medical Service Transport Among Contemporary Patients with ST-Elevation Myocardial Infarction – Findings from the National Cardiovascular Data Registry ACTION, Get with the Guidelines.Dr. Sara Pasquali and Grendel Burrell discuss: The Impact of Intensive Care Unit Structure on Post-operative Outcomes Following Congenital Heart Surgery: Analysis of a Multi-institutional Database.Dr. Jennifer Li, Dr. C. Michael Gibson, and Grendel Burrell discuss: Lessons from Pediatric Cardiovascular Drug Trials.Dr. Dominick Angiolillo presents: Commentary on GRAVITAS.Dr. Christopher Granger and Dr. Ravi Karra discuss: Reperfusion of Acute Myocardial Infarction in Carolina Emergency Departments - Emergency Response (RACE-ER) Project.Bradi Granger RN, PhD and Dr. Ravi Karra discuss: The Duke Translational Nursing Institute.Dr. Otavio Berwanger and Dr. Duane Pinto discuss: Acetylcystein for the Prevention of Contrast-Induced nephropaThy (ACT) Trial: a Pragmatic Multicenter Randomized Trial to Evaluate the Efficacy of Acetylcysteine for the Prevention of Renal Outcomes in Patients Undergoing Coronary and Vascular Angiography.
80 Dr. Christoph Kaiser and Dr Dr. Christoph Kaiser and Dr. Duane Pinto discuss: The BASKET PROspective Evaluation Examination (BASKET PROVE): Late Cardiac Clinical Death and Myocardial Infarction Associated With Late Stent Thrombosis in Large Vessel Stenting After 1st or 2nd Generation Drug-eluting Compared to Bare-metal Stents.Dr. William Weintraub and Dr. Ravi Karra discuss: Top 100 Vocabulary Project. Dr. Richard Becker and Dr. Ravi Karra discuss: Pathways in Anticoagulation: What's Most Efficacious, Safest. Karen Pieper and Dr. Duane Pinto present: Insights from Plato: Proton Pump Inhibitor Use Is Likely a Marker for, Rather than a Cause of, a Higher Risk of Cardiovascular Events. Dr. Thomas Povsic and Dr. Duane Pinto discuss: A Prospective RADAR Pharmacokinetic and PharmacodynamicSubstudy: Pegnivacogin (RB006), a Direct Factor IXa Inhibitor, Results in Consistent and Near Complete Inhibition of Factor IX Activity in Patients with Acute Coronary Syndromes.Dr. Sunil Rao and Dr. Ravi Karra discuss: The Primary Results of the REVEAL Trial: A Randomized Placebo Controlled Trial of Intravenous Erythropoietin to Reduce Infarct Size After ST-Segement Elevation Myocardial Infarction.
81 Dr. Kristin Newby and Dr. Duane Pinto discuss: MURDOCK Study Progress and Substudies. Dr. Keith Aaronson and Dr. Duane Pinto discuss: Evaluation of the Heartware HVAD Left Ventricular Assist Device System for the Treatment of Advanced Heart Failure: Results of the ADVANCE Bridge to Transplant Trial.Dr. James Daubert and Dr. Duane Pinto discuss: QTc Prolongation During Therapeutic Hypothermia: Does it Deserve Attention? Dr. David Cohen and Dr. Duane Pinto discuss: PARTNER Trial (Cohort B): Health-Related Quality of Life After Transcatheter Aortic Valve Implantation vs. Non-Surgical Therapy Among Inoperable Patients With Severe Aortic Stenosis. Dr. Karen Alexander discusses: Frail Older Adults at Risk for Loss of Independence Following MI.Dr. Kenneth Ellenbogen and Dr. Duane Pinto discuss: SMART AV: Comparison of AV Optimization Methods Used in Cardiac Resynchronization Therapy (CRT).Dr. Deepak Voora and Dr. Duane Pinto discuss: A Whole Blood RNA Signature Accurately Classifies Multiple Measures of Platelet Function on Aspirin in Healthy Volunteers and Highlights a Common Underlying Pathway.
82 Dr. James Januzzi and Dr. Duane Pinto discuss: PROTECT: Use of NT-proBNP Testing to Guide Heart Failure Therapy in the Outpatient Setting. Dr. Chris O'Connor, Dr. Randy Starling, and Dr. Clyde Yancy provide historical perspective and discuss the results/implications for ASCEND.Dr. Christopher O'Connor and Dr. Zubin Eapen discuss Duke's Presence at AHA, What's Happening, What to Expect.Dr. Rob Califf talks with Dr. Zubin Eapen about a Cardiology Fellow's Perspective from AHA 2010.