#AHA22
ISCHEMIA-EXTEND
ISCHEMIA Extended
Follow-Up Interim Report
Judith S. Hochman, MD
on behalf of the ISCHEMIA-EXTEND Research Group
Senior Associate Dean For Clinical Sciences
Co-director, Clinical And Translational Science Institute
Harold Snyder Family Professor and Associate Director of Cardiology
Director, Cardiovascular Clinical Research Center
NYU Grossman School of Medicine
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Judith S. Hochman is PI for ISCHEMIA-EXTEND
Funding from the National Heart, Lung, and Blood Institute of the National
Institutes of Health
Disclosure Page
Cardiovascular Clinical
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Cardiovascular Clinical
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BACKGROUND
Primary Goals of Treatment in Chronic Coronary Disease
(CCD)
To Improve Survival
To Improve Quality of Life (QOL)
The ISCHEMIA trial tested an initial invasive vs conservative strategy for
CCD pts with moderate or severe ischemia
• primary outcome: major adverse clinical events (5 components)
• secondary outcome: angina-related quality of life
Extended follow-up is comparing survival between the two strategies
Subjects at Risk
6 months:
Δ
= 1.9% (0.8%, 3.0%)
4 years:
Δ
= -2.2% (-4.4%, 0.0%)
Absolute Difference INV vs. CON
Subjects at Risk
Original Follow-Up, 3.2 Years (median)
Similar mean event-free time for primary outcome: CV Death, MI, hospitalization for
UA, HF or resuscitated cardiac arrest
15.5%
13.3%
4-year revascularization rate - 80% INV vs 23% CON
Durable improvements in angina control and quality of life
with INV if they had angina
INV:CON Adjusted Hazard Ratio = 0.93 (0.80, 1.08)
P-value = 0.34* * Note non-proportional hazards
Maron, Hochman, Reynolds et al. N Engl J Med 2020
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Cardiovascular Death
Non-Cardiovascular Death*
All-Cause Death
INV:CON Adjusted Hazard Ratio = 1.05 (0.83, 1.32)
P-value = 0.67
INV:CON Adjusted Hazard Ratio = 1.63 (1.06, 2.52)
P value= 0.03
INV:CON Adjusted Hazard Ratio = 0.87 (0.66, 1.15)
P value= 0.33
Sidhu M. et al American Heart J 2022
Original Follow-Up, 3.2 Years (median)
*Predominantly excess malignancy
Shading indicates the half width of the confidence interval for the
difference. Overlap of the lines and shading indicates that the 95% CI for
the difference includes zero.
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OBJECTIVE
The overarching objective of long-term follow-up is to assess
whether there are between-group differences and increase
precision around the treatment effect estimates for:
• All-cause mortality
• Cardiovascular mortality
• Non-cardiovascular mortality
Cardiovascular Clinical
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Long-term follow-up in ISCHEMIA-EXTEND
*ISCHEMIA-CKD EXTEND was reported separately at ESC 2022
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Cardiovascular Clinical
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Anthopolos R et al. Am Heart J 2022;254:228–233
METHODS
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METHODS
• Original trial eligibility:
• Inclusion: moderate or severe ischemia,
• Exclusion: ejection fraction <35%, recent acute coronary syndromes,
unacceptable angina, left main >50% stenosis
• Data obtained through December 2021
• Vital status ascertainment
• 33 countries with direct participant contact by sites (67%) plus central
methods
• 3 countries with central death index search (33% of participants)
• Trial definition of CV mortality was broad and included undetermined cause
of death
• During original trial phase, sensitivity of site-determined CV death was 91%
and the positive predictive value was 96% based on CEC event adjudication
Cardiovascular Clinical
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Anthopolos R et al. Am Heart J 2022;254:228–233
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METHODS
Statistical Analysis
• Intent to treat analysis of 5179 pts based on original randomization
• Analysis of all-cause, cardiovascular, and non-cardiovascular mortality by
randomized strategy, using nonparametric cumulative incidence estimators,
cause-specific Cox regression models
• One country could not provide cause of death (N=22 deaths)
• Bayesian survival modeling to use the posterior distribution of the treatment
effect
• 100’s of thousands of simulations using study data to determine post-study
probabilities of between group differences in light of study data
Cardiovascular Clinical
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Anthopolos R et al. Am Heart J 2022;254:228–233
Participant Flow for Long-Term Follow-Up in ISCHEMIA-EXTEND
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Cardiovascular Clinical
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+
Data on all 2588 (INV) and 2591 (CON) are included with varying lengths of follow-up
*Eligible= survived the original trial phase, did not withdraw consent, and did not decline long-term follow-up
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Cardiovascular Clinical
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Baseline
Data
Original ISCHEMIA
Trial Cohort
Surviving, not
withdrawn (eligible);
in Extended Follow-
Up Cohort*
Withdrew during Trial
Phase/Declined Extended
Follow-Up
(N=5179) (N=4825) (N=65)
Treatment
INV 50% 50% 55%
CON 50% 50% 45%
Sex, Male 77% 78% 78%
Age, years Median (Q1, Q3) 64 (58, 70) 64 (57, 70) 67 (61, 72)
Race
White 66% 66% 54%
Black 4% 4% 2%
Asian 29% 29% 43%
Other or multiple race groups 1% 1% 2%
Ethnicity (Hispanic or Latino) 16% 16% 5%
Hypertension 73% 73% 69%
Diabetes 42% 41% 43%
Prior MI 19% 19% 23%
EF Median (Q1, Q3) 60 (55, 65) 60 (56, 65) 62 (58, 65)
History of angina 90% 90% 88%
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Time Point Deaths
After 3.2 years median follow-up 289
Additional deaths during extended follow-
up at 5.7 years median
268
Total deaths at 5.7 years median follow-up 557
RESULTS
Cardiovascular Clinical
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Extended follow-up - 5.7 years median
Cumulative event rate of all-cause death
13
0
5
10
15
20
25
Cumulative Event Rate (%)
All-Cause Death
Years Since Randomization
No. at Risk
Conservative 2591 2564 2517 2479 2381 1701 1139 575 195
Invasive 2588 2544 2512 2480 2375 1702 1120 566 174
Conservative
Invasive
12.7%
13.4%
INV:CON Adjusted HR = 1.00; 95% CI: 0.85, 1.18
P-value= 0.741 (log rank)
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7-Year
rates
0 1 2 3 4 5 6 7 8
All-cause death
~1.9 %
per year
Extended follow-up - 5.7 years median
Cumulative incidence of cardiovascular death
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0
5
10
15
20
25
Cumulative Incidence (%)
Cardiovascular Death
Years Since Randomization
Conservative
Invasive
8.6%
6.4%
INV:CON Adjusted HR = 0.78, 95% CI: 0.63, 0.96
P-value= 0.008 (Fine-Gray)
No. at Risk
Conservative 2591 2564 2516 2477 2378 1699 1137 575 195
Invasive 2588 2544 2509 2476 2373 1697 1116 564 174
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7-Year
rates
0 1 2 3 4 5 6 7 8
CV death
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0
5
10
15
20
25
Cumulative Incidence (%)
Non-Cardiovascular Death
Years Since Randomization
No. at Risk
Conservative 2591 2564 2516 2477 2378 1699 1137 575 195
Invasive 2588 2544 2509 2476 2373 1697 1116 564 174
Conservative
Invasive
4.4%
5.6%
INV:CON Adjusted HR = 1.44, 95% CI: 1.08, 1.91
P-value= 0.016 (Fine-Gray)
Cardiovascular Clinical
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7-Year
rates
Extended follow-up - 5.7 years median
Cumulative incidence of non-cardiovascular death
0 1 2 3 4 5 6 7 8
Non-CV death
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Cardiovascular Clinical
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No interaction
between initial
strategy assignment
and pre-specified
subgroups for:
• All-cause death
• CV death
• Non-CV death
All-Cause Death
Subgroup Analyses
Subset with CCTA evaluable for multivessel (>2 vessels) disease defined by stenoses ≥70%
CCTA subset excludes pts with low eGFR
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CON 765 755 734 722 699 510 347 185 64
INV 764 748 740 731 699 517 356 195 65
0
5
10
15
20
25
Cumulative Event Rate (%)
All-Cause Death
Years Since Randomization
INV:CON Adj. HR 0.97, 95% CI: 0.66, 1.42
CON 768 766 757 750 721 526 377 194 76
INV 750 741 736 729 709 502 332 185 66
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Interaction
p value >0.05
Extended follow-up - 5.7 years median - All-Cause Death
No MVD (≥ 70% stenoses)
0 1 2 3 4 5 6 7 8
0
5
10
15
20
25
Cumulative Incidence (%)
All-Cause Death
Years Since Randomization
0 1 2 3 4 5 6 7 8
MVD (≥ 70% stenoses)
Cox models - the HR for the treatment effect did not differ by presence or absence of MVD
INV:CON Adj. HR 0.89, 95% CI: 0.67, 1.19
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Extended follow-up - 5.7 years median - CV Death
0
5
10
15
20
25
Cumulative Incidence (%)
CV Death
Years Since Randomization
CON 765 755 734 722 699 510 347 185 64
INV 764 748 740 731 699 514 355 195 65
0
5
10
15
20
25
Cumulative Incidence (%)
CV Death
Years Since Randomization
INV:CON Adj. HR 0.97, 95% CI: 0.57, 1.64
CON 768 766 757 750 721 524 375 194 76
INV 750 741 734 728 709 502 332 185 66
Cardiovascular Clinical
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Interaction
p value >0.05
0 1 2 3 4 5 6 7 8 0 1 2 3 4 5 6 7 8
MVD (≥ 70% stenoses)
No MVD (≥ 70% stenoses)
Subset with CCTA evaluable for multivessel disease defined by stenoses ≥70%
CCTA subset excludes pts with low eGFR
Cox models - the HR for the treatment effect did not differ by presence or absence of MVD
INV:CON Adj. HR 0.68, 95% CI: 0.48, 0.97
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0
5
10
15
20
25
Cumulative Incidence (%)
Non-CV Death
Years Since Randomization
INV:CON Adj. HR 1.52, 95% CI: 0.88, 2.63
CON 765 755 734 722 699 510 347 185 64
INV 764 748 740 731 699 514 355 195 65
0
5
10
15
20
25
Cumulative Incidence (%)
Non-CV Death
Years Since Randomization
INV:CON Adj. HR 0.95, 95% CI: 0.53, 1.72
CON 768 766 757 750 721 524 375 194 76
INV 750 741 734 728 709 502 332 185 66
Cardiovascular Clinical
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Interaction
p value >0.05
0 1 2 3 4 5 6 7 8
0 1 2 3 4 5 6 7 8
MVD (≥ 70% stenoses)
No MVD (≥ 70% stenoses)
Extended follow-up - 5.7 years median - non-CV Death
Cox models - the HR for the treatment effect did not differ by presence or absence of MVD
Subset with CCTA evaluable for multivessel (>2 vessels) disease defined by stenoses ≥70%
CCTA subset excludes pts with low eGFR
Probability that one strategy is better than another for 7-year all-
cause death
Absolute difference in 7- years rates: INV rate – CON rate
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All-Cause Death
Dashed line-
NO between
group difference
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CONTEXT AND LIMITATIONS
• ISCHEMIA-EXTEND was designed as a pragmatic long-term follow-up study of
mortality, with limited data collection
• No data were collected on non-fatal events, use of medications, revascularization
procedures, or quality of life after the initial median 3.2-year follow-up
• The cause of death (cardiovascular vs. non-cardiovascular) was adjudicated during
the original trial phase but not during the extended phase
• The strategy did not test routine revascularization for those with angiographic
findings suitable for revascularization
• We tested routine cardiac catheterization and revascularization compared with
selective use of catheterization and revascularization based on clinical need, e.g.,
acute coronary syndrome or refractory angina
Cardiovascular Clinical
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Extended follow-up of the ISCHEMIA randomized trial over a median
5.7 years demonstrated that an initial invasive strategy compared
with an initial conservative strategy resulted in:
• No difference in all-cause mortality with nearly twice the
number of deaths (557)
• Lower risk of cardiovascular mortality
• Higher risk of non-cardiovascular mortality
CONCLUSIONS
Cardiovascular Clinical
Research Center
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IMPLICATIONS
Cardiovascular Clinical
Research Center
These findings provide evidence for patients with chronic coronary
disease and their physicians as they decide whether to add
invasive management to guideline-directed medical therapy
Follow-up is ongoing
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Hochman et al. Survival After Invasive or Conservative Management of Stable Coronary Disease
CIRCULATIONAHA/2022 On line today
Judith S. Hochman, MD,Rebecca Anthopolos, DrPH, Harmony R. Reynolds, MD,
Sripal Bangalore, MD, MHA, Yifan Xu, MPH, Sean M. O’Brien, PhD, Stavroula
Mavromichalis, MS, Michelle Chang, MPH, Aira Contreras, MA, Yves Rosenberg, MD,
MPH, Ruth Kirby, ASN, Balram Bhargava, MD, DM, Roxy Senior, MD, DM, Ann
Banfield, RGN, BSc, Shaun G. Goodman, MD, MSc, Renato D. Lopes, MD, PhD,
Radosław Pracoń, MD, PhD, José López-Sendón, MD,Aldo Pietro Maggioni, MD,
Jonathan D. Newman, MD, MPH, Jeffrey S. Berger, MD, Mandeep S. Sidhu, MD,
Harvey D. White, DSc, Andrea B. Troxel, ScD, Robert A. Harrington, MD,William E.
Boden, MD, Gregg W. Stone, MD, Daniel B. Mark, MD, MPH, John A. Spertus, MD,
MPH, David J. Maron, MD on behalf of the ISCHEMIA-EXTEND Research Group
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ISCHEMIA
-
EXTEND Study Organization
Cardiovascular Clinical
Research Center
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Clinical Coordinating Center Faculty and Staff
at NYU Grossman School of Medicine/Stanford University School of Medicine:
David Maron, MD, Harmony Reynolds, MD, Sripal Bangalore, MD, MHA, Stavroula Mavromichalis, MS,
Michelle Chang, MPH, Aira Contreras, MA, Shari Esquenazi-Karonika, PhD(c), MPH, MS, Margaret
Gilsenan, Ewelina Gwiszcz, Samaa Mohamed, Anna Naumova, MA, Arline Roberts, RN, Kerri VanLoo
Statistical and Data Coordinating Center (SDCC):
NYU Grossman School of Medicine: Rebecca Anthopolos, DrPH, Yifan Xu, MS, Andrea Troxel, ScD
Collaborating Statistical Center
Duke Clinical Research Institute (DCRI): Sean M. O’Brien, PhD, Zhen Huang, MS,
Samuel Broderick, MS
NHLBI Program Staff: Ruth Kirby, ASN, Yves Rosenberg, MD, MPH
OSMB Members: Gervasio Lamas, MD (Chair), Pamela Ouyang, MD, Jeffrey Anderson, MD,
Mary Putt, PhD, ScD
SPECIAL THANKS TO
Cardiovascular Clinical
Research Center
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Argentina: Luis Guzmán, MD, PhD
Australia: Joseph Selvanayagam, MBBS, DPhil
Brazil (BCRI): Renato D. Lopes, MD, PhD
Canada: Shaun G. Goodman, MD, MSc
France: Gabriel Steg, MD, Jean-Michel Juliard, MD
Germany: Rolf Doerr, MD
Hungary: Matyas Keltai, MD, PhD, MSc
India: Balram Bhargava, MD, MSc
Israel: Tali Sharir, MD, Eugenia Nikolsky, MD, PhD
Italy (ANMCO): Aldo P. Maggioni, MD
Japan: Shun Kohsaka, MD
Mexico: Jorge Escobedo, MD, MSc
New Zealand: Harvey D. White, DSc
Poland: Radosław Pracoń, MD, PhD
Russia: Olga Bockeria, MD, PhD
Spain (FIBHULP): José López-Sendón, MD
Sweden: Claes Held, MD, PhD
United Kingdom: Roxy Senior, MD, DM, Ann Banfield, RGN, BSc
Academic Research Organizations (AROs)/Country Leaders/Country Coordinators
SPECIAL THANKS TO
Cardiovascular Clinical
Research Center
… and to Site Principal Investigators Conducting Extended Follow-Up
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Argentina
Instituto Medico DAMIC: Luis Guzmán, MD, PhD
Australia
Royal Perth Hospital: Graham Hillis, MBChB, PhD
John Hunter Hospital: Suku Thambar, MBBS
Flinders Medical Centre: Majo Joseph, MBBS
Flinders Medical Centre: Joseph Selvanayagam, MBBS, DPhil
Queen Elizabeth Hospital: John Beltrame, BMBS, PhD
Austria
University of Vienna Allgemeines Krankenhaus: Irene Lang, MD, PhD
LKH Graz West Austria: Herwig Schuchlenz, MD
Wilhelminen Hospital Vienna: Kurt Huber, MD
Belgium
University Hospital Gasthuisberg: Kaatje Goetschalckx, MD
Brazil
Heart Instituto do Coração - University of São Paulo: Whady Hueb, MD, PhD
Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sol: Paulo Ricardo
Caramori, MD
Instituto de Cardiologia de Porto Alegre: Alexandre de Quadros, MD
Instituto Dante Pazzanese de Cardiologia: Paola Smanio, MD
Hospital Pró Cardiaco: Claudio Mesquita, MD
University Federal Hospital of São Paulo: Renato D. Lopes, MD, PhD
Quanta Diagnóstico e Terapia: João Vitola, MD, PhD
Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São
Paulo: José Marin-Neto, MD, PhD
Hospital Samaritano Paulista: Expedito Ribeiro da Silva, MD, PhD
Hospital São Vicente de Paulo: Rogério Tumelero, MD
Hospital Da Bahia: Marianna Andrade, PhD
Fundação Bahiana de Cardiologia: Alvaro Rabelo Alves Junior, MD
Hospital Maternidade e Pronto Socorro Santa Lúcia: Frederico Dall'Orto, PhD
Hospital de Clinicas de Porto Alegre: Carisi Polanczyk, PhD
Hospital Vera Cruz: Estevão Figueiredo, MD
Canada
Foothills Medical Centre: Andrew Howarth, MD
Montreal Heart Institute: Gilbert Gosselin, MD
Saint Michael's Hospital: Asim Cheema, MD, PhD
University of Alberta Hospital: Kevin Bainey, MD, MSc
CSSS du Sud de Lanaudière: Denis Phaneuf, MD
Centre Hospitalier Régional de Trois-Rivières: Ariel Diaz, MSc, MD
University Hospital: Pallav Garg, MBBS, MSc
Hamilton General Hospital: Shamir Mehta, MD, MSc
Vancouver General Hospital: Graham Wong, MD MPH
West Lincoln Memorial Hospital: Andy Lam, MD
James Cha, MD
Corcare Cardiovascular Research: Paul Galiwango, MD
University Health Network: Amar Uxa, MD
University of Ottawa Heart Institute: Benjamin (Ben) Chow, MD
Saint Catharines General Hospital: Adnan Hameed, MD
Women's College Hospital: Jacob Udell, MD, MPH
Dixie Medical Group:
Asim
Cheema, MD, PhD
Universitätsklinikum Bonn: Georg Nickenig, MD
Robert Bosch Hospital: Raffi Bekeredjian, MD, Udo Sechtem, MD
University Hospital Jena: P. Christian Schulze, MD, PhD
Hungary
Semmelweis University: Bela Merkely, MD, PhD, MSc, DSc
George Gottsegen National Institute of Cardiology: Geza Fontos, MD
Szent Istvan Hospital: András Vértes, PhD
University of Szeged: Albert Varga, MD, DSc
India
All India Institute of Medical Sciences: Balram Bhargava, MD, DM
Sree Chitra Tirunal Institute for Medical Sciences and Technology: Ajit Kumar, PhD
Government Medical College: Rajesh G Nair, MD, DNB, DM
Ruby Hall Clinic: Purvez Grant, MD
Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore-Karnataka:
Cholenahally Manjunath, MD, Nagaraja Moorthy, MD
Jawaharlal Institute of Postgraduate Medical Education and Research:
Santhosh Satheesh, MD, DM
Ram Manohar Lohia Hospital: Ranjit Kumar Nath, MD, DM
Hero DMC Heart Institute Unit Dayanand Medical: Gurpreet Wander, DM
Gurunanak CARE Hospital: Johann Christopher, MD, PhD
King George's Medical University: Sudhanshu Dwivedi, MD, DM
Apollo Hospitals: Abraham Oomman, DM, MD
Fortis Escorts Heart Institute: Atul Mathur, PhD
KEM Hospital: Milind Gadkari, MD, MRCP
Apollo Health City Campus: Sudhir Naik, MD
MOSC Medical College Hospital, Kolenchery: Eapen Punnoose, MD, DM
Fortis Healthcare Fl.t Lt. Rajan Dhall Hospital: Ranjan Kachru, MD
CARE Hospital, CARE Nampally: Johann Christopher, MBBS, MD, DNB
Batra Hospital and Medical Research Center: Upendra Kaul, MD, DM
Israel
Assuta Medical Centers: Tali Sharir, MD
Rambam Medical Center: Arthur Kerner, MD
Italy
University of Padua: Giuseppe Tarantini, PhD
Ospedali Riuniti of Ancona: Gian Piero Perna, MD
Azienda Ospedaliera Santa Croce e Carle: Emanuela Racca, PhD
Policlinico di Monza: Andrea Mortara, MD
Istituto Clinico Humanitas: Lorenzo Monti, MSc
Clinica Mediterranea: Carlo Briguori, MD, PhD
Osepdale Regionale Umberto Parini: Gianpiero Leone, MD
UO Cardiologia Ospedale SS Cosma e Damiano: Roberto Amati, MD
Ospedale Casa Sollievo della Sofferenza: Mauro Salvatori, MD
Ospedale Civile S. Antonio Abate: Antonio Di Chiara, MD
Second University of Naples - Monaldi Hospital: Paolo Calabro, MD, PhD
Ospedale GB Morgagni L. Pierantoni di Forli: Marcello Galvani, MD
Ospedale di Circolo e Fondazione Macchi: Stefano Provasoli, MD
Japan
Keio University Hospital: Keiichi Fukuda, MD, PhD, Shun Kohsaka, MD
Saitama Medical University: Shintaro Nakano, MS
Lithuania
Auckland City Hospital: Ralph Stewart, MD
Peru
Instituto Neuro Cardiovascular de las Americas: Walter Mogrovejo Ramos, MD
Poland
Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw: Marcin
Demkow, MD
Portugal
Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE: Nuno Ferreira, PhD
CHLN - Hospital Santa Maria: Fausto Pinto, MD, PhD
Hospital de Santa Marta: Ruben Ramos, MD
Romania
Emergency Institute of Cardiovascular Diseases: Bogdan Popescu, PhD
County Emergency Hospital Baia Mare: Calin Pop, MD, PhD
Russia
Bakulev Scientific Center for Cardiovascular Surgery: Leo Bockeria, MD, Olga Bockeria, MD, PhD
Almazov National Medical Research Centre: Elena Demchenko, MD, PhD
E. Meshalkin National Medical Research Center of the Ministry of Health of the Russian
Federation: Alexander Romanov, MD
North Western State Medical University: Leonid Bershtein, MD, PhD
Saudi Arabia
King Abdullah International Medical Research Center (KAIMRC): Ahmed Jizeeri, MD
Serbia
Clinical Center of Serbia: Goran Stankovic, MD, PhD
Clinic for cardiovascular diseases, Clinical Center Nis: Svetlana Apostolovic, MD, PhD
Institute of Cardiovascular Diseases, Vojvodina - Sremska Kamenica: Nada Cemerlic Adjic, MD
University Hospital Center Bezanijska Kosa: Marija Zdravkovic, MD
Cardiology Clinic at Clinical Center of Serbia: Branko Beleslin, MD, PhD
University Clinical Hospital Zvezdara: Milica Dekleva, MD, PhD
Clinical Center Kragujevac: Goran Davidovic, MD
Singapore
National Heart Centre Singapore: Terrance Chua, MD
Tan Tock Seng Hospital: David Foo, MD
National University Heart Centre: Kian Keong Poh, MD
South Africa
Groote Schuur Hospital: Mpiko Ntsekhe, MD
Spain
Hospital de Sant Pau Barcelona: Alessandro Sionis, MD
Hospital Virgen de la Arrixaca: Francisco Marin, MSc
Hospital Universitario y Politecnico La Fe: Vicente Miró, MD
Hospital Universitario La Paz: José López-Sendón, MD
Hospital de Bellvitge: Montserrat Gracida Blancas, MD
Hospital Clinico Universitario de Santiago: José González-Juanatey, MD
Hospital General Universitario Gregorio Maranon: Francisco Fernández-Avilés, MD, PhD
Complejo Hospitalario Universitario A Coruña: Jesús Peteiro, MD
Hospital Universitario Miguel Servet: Jose Enrique Castillo Luena, MD
Sweden
Uppsala University: Claes Held, MD, PhD
Danderyds Hospital: Johannes Aspberg, MD
Switzerland
Ticino:
Mariagrazia
Rossi, PhD
#AHA22
THANK YOU
Cardiovascular Clinical
Research Center