Because the ACC/AHA practice guidelines address patient populations (and healthcare providers) residing in North America, drugs that are currently unavailable in North America are discussed in the ...text without a specific COR. For studies performed in large numbers of subjects outside North America, a writing committee reviews the potential impact of different practice patterns and patient populations on the treatment effect and relevance to the ACC/AHA target population to determine whether the findings should inform a specific recommendation.\n Sabik Content Reviewer--ACC Surgeons' Scientific Council Cleveland Clinic--Department Chair, Thoracic and Cardiovascular Surgery Edwards Lifesciences Medtronic None Abbott Laboratoriesdagger Edwards Lifesciencesdagger None Vikas Saini Content Reviewer The Lown Institute--President None None None None Frank W. Sellke Content Reviewer--ACC/AHA Task Force on Practice Guidelines Brown Medical School and Lifespan--Chief of Cardiothoracic Surgery None None The Medicines Company None William S. Weintraub Content Reviewer Christiana Care Health System--Section Chief, Cardiology Bristol-Myers Squibb Daiichi-Sankyo Eli Lilly None None None Christopher J. White Content Reviewer Ochsner Health System--Director, John Ochsner Heart and Vascular Institute None None None St. Jude Medical (DSMB) Sankey V. Williams Content Reviewer--ACP University of Pennsylvania Health System--Professor of General Medicine None None None None Poh Shuan Daniel Yeo Content Reviewer--AIG Tan Tock Seng Hospital, Department of Cardiology--Cardiologist None None None Boston Scientificdagger Merckdagger Schering-Ploughdagger * No reviewer had a relevant ownership, partnership, or principal position to report.
Purpose of Review
Identification of a reliable discriminatory test to accurately stratify patient responses to antiplatelet therapy following coronary revascularization has become increasingly ...desirable to optimize therapeutic efficacy and safety.
Recent Findings
The expansion of platelet function testing to include genotype assessment has been an evolutionary journey, initially fraught with confounding results. However, more recent and rigorous data analysis suggests that genotype testing- guided, tailored antiplatelet therapy may hold promise in optimizing treatment of patients after coronary intervention.
Summary
Current evidence increasingly supports the use of genotype guided CYP2C19 testing to better match the post coronary intervention patient with the most efficacious and least risky antiplatelet inhibitor. The risk stratification of poor, intermediate, and good metabolizers of these drugs with such testing promises to yield clinical dividends in terms of morbidity, mortality and cost control, in this growing patient population.
Each guideline is considered current unless and until it is updated, revised, or superseded by a published addendum.\n Munger Content Reviewer University of Utah--Professor of Pharmacy Practice None ...None None None None None E. Magnus Ohman Content Reviewer Duke University--Professor of Medicine, Director of Program for Advanced Coronary Disease AstraZeneca Janssen Pharmaceuticalslow * None None Daiichi-Sankyolow * Eli Lillylow * Janssen Pharmaceuticalslow * None None Eric R. Powers Content Reviewer Medical University of South Carolina--Service Line Medical Director None None None None None None Susan J. Pressler Content Reviewer--ACC/AHA Task Force on Clinical Practice Guidelines Indiana School of Nursing--Professor and Sally Reahard Chair; Center of Enhancing Quality of Life in Chronic Illness--Director None None None None None None Sunil V. Rao Content Reviewer Duke University Medical Center--Associate Professor of Medicine None None None None None None Philippe Gabriel Steg Content Reviewer Université Paris-Diderot--Professor AstraZeneca Bristol-Myers Squibblow * Daiichi-Sankyo Eli Lilly Merck None None AstraZenecalow * None None Tracy Y. Wang Content Reviewer Duke University Medical Center--Associate Professor of Medicine AstraZenecalow * Eli Lilly None None AstraZenecalow * Bristol-Myers Squibblow * Eli Lilly/Daiichi-Sankyo Alliancelow * None None black square This table represents the relationships of reviewers with industry and other entities that were disclosed at the time of peer review and determined to be relevant to this document. Names are listed in alphabetical order within each category of review.According to the ACC/AHA, a person has a relevant relationship IF: a) the relationship or interest relates to the same or similar subject matter, intellectual property or asset, topic, or issue addressed in the document; or b) the company/entity (with whom the relationship exists) makes a drug, drug class, or device addressed in the document, or makes a competing drug or device addressed in the document; or c) the person or a member of the person's household has a reasonable potential for financial, professional or other personal gain or loss as a result of the issues/content addressed in the document.AATS indicates American Association for Thoracic Surgery; ACC, American College of Cardiology; ACEP, American College of Emergency Physicians; AHA, American Heart Association; CSL, Coordinated Science Laboratory; DSMB, data safety monitoring board; PCNA; Preventive Cardiovascular Nurses Association; SCA, Society of Cardiovascular Anesthesiologist; SCAI, Society for Cardiovascular Angiography and Interventions; STS, Society of Thoracic Surgeons; and SVM, Society for Vascular Medicine.
Key Points
Simulation based education (SBE) allows novice cardiology fellows to achieve a right heart catheterization skill level similar to that of a senior cardiology fellow in a short period of ...time.
With SBE, novice fellows acquire knowledge of hemodynamic waveform interpretation and the confidence of a senior level trainee.
SBE (i.e., during the first month of training) prepares fellows before patient contact.
Abstract Background Proteolytically released extracellular matrix (ECM) fragments, matricryptins, are biologically active and play important roles in wound healing. Following myocardial infarction ...(MI), collagen I, a major component of cardiac ECM, is cleaved by matrix metalloproteinases (MMPs). Objectives This study identified novel collagen-derived matricryptins generated post-MI that mediate remodeling of the left ventricle (LV). Methods Recombinant collagen Ia1 was used in MMPs cleavage assays, the products were analyzed by mass spectrometry for identification of cleavage sites. C57BL6/J mice were given MI and animals were treated either with vehicle control or p1158/59 matricryptin. Seven days post-MI, LV function and parameters of LV remodeling were measured. Levels of p1158/59 were also measured in plasma of MI patients and healthy controls. Results In situ, MMP-2 and -9 generate a collagen Iα1 C-1158/59 fragment, and MMP-9 can further degrade it. The C-1158/59 fragment was identified post-MI, both in human plasma and mouse LV, at levels that inversely correlated to MMP-9 levels. We synthesized a peptide beginning at the cleavage site (p1158/59, amino acids 1159 to 1173) to investigate its biological functions. In vitro, p1158/59 stimulated fibroblast wound healing and robustly promoted angiogenesis. In vivo, early post-MI treatment with p1158/59 reduced LV dilation at day 7 post-MI by preserving LV structure (p < 0.05 vs. control). The p1158/59 stimulated both in vitro and in vivo wound healing by enhancing basement membrane proteins, granulation tissue components, and angiogenic factors. Conclusions Collagen Iα1 matricryptin p1158/59 facilitates LV remodeling post-MI by regulating scar formation through targeted ECM generation and stimulation of angiogenesis.
Pulmonary arterial hypertension (PAH) is a devastating cardiovascular disease leading to right heart failure and death if untreated. Medical therapies for PAH have evolved substantially over the last ...decades and are associated with improvements in functional class, quality of life, and survival. PAH-targeted therapies now consist of multiple inhaled, oral, subcutaneous, and intravenous therapies targeting the phosphodiesterase, guanylate cyclase, endothelin and prostacyclin pathways. Patients with congenital heart disease (CHD) are at high risk of developing PAH and growing evidence exists that PAH-targeted therapy can be beneficial in PAH-CHD. However, the PAH-CHD patient population is challenging to treat due to the heterogeneity and complexity of their cardiac lesions and associated comorbidities. Furthermore, most high-quality randomized placebo-controlled trials investigating the effects of PAH-targeted therapies only included a minority of PAH-CHD patients. Few randomized, controlled trials have investigated the effects of PAH-targeted therapy in pre-specified PAH-CHD populations. Consequently, the results of these clinical trials cannot be extrapolated broadly to the PAH-CHD population. This review summarizes the data from high-quality clinical PAH treatment trials with a specific focus on the PAH-CHD population.
The development of an effective AIDS vaccine has been challenging because of viral genetic diversity and the difficulty of generating broadly neutralizing antibodies (bnAbs). We engineered ...trispecific antibodies (Abs) that allow a single molecule to interact with three independent HIV-1 envelope determinants: the CD4 binding site, the membrane-proximal external region (MPER), and the V1V2 glycan site. Trispecific Abs exhibited higher potency and breadth than any previously described single bnAb, showed pharmacokinetics similar to those of human bnAbs, and conferred complete immunity against a mixture of simian-human immunodeficiency viruses (SHIVs) in nonhuman primates, in contrast to single bnAbs. Trispecific Abs thus constitute a platform to engage multiple therapeutic targets through a single protein, and they may be applicable for treatment of diverse diseases, including infections, cancer, and autoimmunity.
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