in Predicting Acute Coronary Events Armin A Zadeh MD PhD MPH Director Cardiac CT Division of Cardiology Johns Hopkins Hospital Associate Professor of Medicine Johns Hopkins University ID: 931156
Download Presentation The PPT/PDF document "1 Challenges & Opportunities" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
1
Challenges & Opportunities in Predicting Acute Coronary Events
Armin A. Zadeh, MD, PhD, MPHDirector, Cardiac CTDivision of CardiologyJohns Hopkins HospitalAssociate Professor of MedicineJohns Hopkins University
Slide2Coronary Event Pathophysiology
Arbab-Zadeh
A et al. Circulation 2012
Slide3Arbab
-Zadeh A. and
Fuster V. JACC 2015
Prevalence of Asymptomatic Plaque Ruptures
Slide4Insights From Pathology
Mann J and Davies MJ. Heart 1999;82:265
>70% of coronary stenoses contain healed plaque ruptures
Slide5Arbab-Zadeh
A
et al. Circulation 2012Asymptomatic Plaque Ruptures
Slide6Nemetz
et al. Arch Intern Med. 2008;168:264-70
Prevalence of CAD in Normal Populations:425 Autopsies in Non-Natural Deaths in Olmsted County
Mean age 36 ±14 Years
Slide7Arbab
-Zadeh A & Fuster V. JACC 2015
Natural History of Plaque Growth & Rupture
Slide8Arbab
-Zadeh A &
Fuster V. JACC 2015Natural History of Plaque Growth & Rupture
Slide9Arbab-Zadeh
A
et al.
Circulation 2012
The Vulnerable Patient
Slide10Rudnicka
et al.
Circulation 2007Diurnal and Seasonal Variation of Hemostatic Factors
Slide11Slide12Arbab
-Zadeh A.
Circulation 2014Coronary
Calcium Score and Mortality
Slide13Arbab-Zadeh
A
et al.
Circulation 2012
The Vulnerable Patient
Slide14Miller et
al. NEJM 2008, Rochitte
et al. Eur Heart J 2014CORE Studies
CorE64: international, multicenter study (N=371) on the accuracy of CT angiography vs. QCA for the diagnosis of CAD
CORE320:
international, multicenter
study (N=381)
on the accuracy of
CTA/CTP
vs.
QCA and SPECT for
the diagnosis of
flow-limiting CAD
5-10 year follow up for incidence of cardiac death and MI
Comparative effectiveness of imaging characteristics for predicting ACS
Slide15Conclusions
Mechanisms leading to ACS are highly complex and underlie substantial temporal variability which hinder accurate prediction
Integration of CAD characteristics and risk factors for vascular thrombosis into comprehensive models may identify individuals at risk
Clinical studies are needed to isolate metrics of greatest predictive value in comparative analyses