136 - THE STRUGGLE IS REAL: HOW TO MANAGE ACS WHEN THE EVIDENCE YOU WANT AND NEED JUST ISN'T THERE

Friday, October 28, 2022

8:30 AM – 9:15 AM EDT

Location: Room 210

Target Audience: Critical care practitioners, Clinical cardiologists, Trainee (clinical)

Co-Chair(s)

Maude Peretz-Larochelle, MDCM, FRCPC

Cardiologist and Intensivist
CANCARE
McGill University
Montreal, Quebec, Canada
Graham C. Wong, MD MPH

Regional Medical Lead, Acute Cardiac Care, Vancouver Coastal Health Authority
CANCARE
CANCARE
Vancouver, British Columbia, Canada

Presenter(s)

Kimesh Chetty, MD

Cardiology Fellow
University of Calgary
Calgary, Alberta, Canada
Mena Gewarges

Cardiology Fellow
University of Toronto
University of Toronto
Toronto, Ontario, Canada
JM

Janane Maheswaran

Cardiology Resident
McGill University
Montreal, Quebec, Canada
Peter Lugomirski, MD, FRCPC

Critical Care Cardiologist
Southlake Regional Health Centre
University of Toronto
Newmarket, Ontario, Canada
Rebecca Mathew, MD, FRCPC

Critical Care Cardiologist
University of Ottawa Heart Institute
University of Ottawa Heart Institute
Ottawa, Ontario, Canada
Chris Overgaard, MD (he/him/his)

Director, Complex PCI Program, Southlake Regional Healthcare Centre
Southlake Regional Healthcare Centre
CANCARE
Toronto, Ontario, Canada
Thomas M. Roston, MD, PhD, FRCPC

Cardiologist
UBC
University of British Columbia
Vancouver, British Columbia, Canada
Greg Schnell, MD FRCPC

Assistant Professor of Medicine
Libin Cardiovascular Institute
Libin Cardiovascular Institute
Calgary, Alberta, Canada

Planning Committee Member(s)

Craig Ainsworth, n/a

Associate Professor of Medicine
CANCARE
McMaster University
Hamilton, Ontario, Canada
MB

Madeleine Barker

Cardiology Fellow
Vancouver, British Columbia, Canada
Christopher B. Fordyce, MD, MHS, MSc

Cardiologist
University of British Columbia
University of British Columbia
Vancouver, British Columbia, Canada
Sean Van Diepen, MD, MSc

Physician
University of Alberta
University of Alberta
Edmonton, Alberta, Canada

Learning Objectives:

At the conclusion of this session, participants will be able to:

understand the pros and cons of preloading ACS patients with P2Y12 inhibitors prior to angiography;
understand the uncertainty regarding the timing of surgical management of multivessel disease in STEMI;
have a practical approach to the diagnosis and management of an undifferentiated shock state in a patient who presents with an acute coronary syndrome and review the options for mechanical cardiac support in an emergency scenario; and
understand the pros and cons of transfusion therapy in the context of ACS in the anemic patient.

Evidence based Practice Guidelines and Critical Pathways can aid in the acute management of acute coronary syndromes (ACS). Indeed, adherence to guideline based treatment algorithms has been associated with improved patient outcomes.

However, many aspects of ACS management have a paucity of evidence underpinning their use. Moreover, unexpected complications of ACS may lead to situations in which what would be considered “best practice” remains unclear. It is in these situations that “clinical judgement” is often called upon to generate an optimal treatment strategy.

Using an entertaining, highly interactive case-based format, this workshop will gather national academic thought and clinical care leaders to outline unusual presentations of ACS and unexpected clinical twists that can complicate what appears to be a straight forward ACS presentation. The Workshop will utilize unusual or atypical presentations of ACS patients in order to highlight the limitations of the available evidence and emphasize the need to utilize best clinical judgement to guide “best practice”. The Workshop will emphasize audience participation and make use of the clinical expertise of the Workshop panel.

Using an entertaining, highly interactive case-based format, this workshop will gather national thought and clinical care leaders to outline unusual presentations of ACS for which there may be a dearth of evidence or guideline support for a particular intervention. The Workshop will utilize unique ACS cases in order to highlight the limitations of the available evidence and emphasize the need to utilize best clinical judgement to guide “best practice”. The Workshop will emphasize audience participation with ample time for interaction and make use of the clinical expertise of the Workshop panel.

The diverse nature of unstable coronary syndromes and the unpredictable and variable impact of extracardiac factors limits the ability to apply Practice Guidelines to all cases of ACS. We believe that this Workshop will help frame a number of issues for the clinical cardiologists that have a paucity of high-quality evidence yet remain important clinical problems that require thoughtful decision making. The proposed format will allow audience members to seek the advice of national and international thought leaders in a safe, nonjudgmental, comprehensive, yet entertaining presentation style.

The Chairs and Speakers represent both academic and community thought leaders. 50% of our presenters are female and trainees figure heavily as presenters. We believe that our interactive case based format will be an attractive venue to allow participants to understand the clinical thinking of clinical experts.