1. CVD Critical Pathways Group 2006 Teleconferences March 22, 2006 This activity is supported by an educational grant from the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership.

2. Faculty Gregg C. Fonarow, MD Eliot Corday Professor of Medicine and Cardiovascular Science Director, Ahmanson-UCLA Cardiomyopathy Center UCLA Division of Cardiology UCLA Medical Center Los Angeles, California

3. The Network for Continuing Medical Education requires that CME faculty disclose, during the planning of an activity, the existence of any personal financial or other relationships they or their spouses/partners have with the commercial supporter of the activity or with the manufacturer of any commercial product or service discussed in the activity. Disclosure Statement

4. Gregg C. Fonarow, MD, has served as a consultant to and has received research support and honoraria from Bristol-Myers Squibb Company, GlaxoSmithKline, Merck & Co., Inc., Pfizer Inc, sanofi-aventis, Schering-Plough Corporation, and Scios, Inc. The team from Aurora Health Care reports no such relationships. Faculty Disclosure Statement

6. Highlights From the American College of Cardiology 2006 Annual Scientific Session Gregg C. Fonarow, MD

9. CHARISMA

10. C lopidogrel for H igh A therothrombotic R isk and I schemic S tabilization, M anagement, and A voidance (CHARISMA): Study Design Double-blind treatment up to 1040 primary efficacy events occur* Aspirin 75–162 mg o nce daily Clopidogrel 75 mg o nce daily Placebo 1 tab o nce daily Aspirin 75–162 mg o nce daily Final study visit (fixed study end date) 1-month visit 3-month visit Patients 45 years or older who are at high risk of atherothrombotic events R = randomization. N=15,603 R Bhatt DL, et al. Am Heart J . 2004;148:263-268. *Event-driven trial: primary efficacy outcome of vascular death, MI, stroke Visits every 6 months (12 m, 18 m…), and intermediate phone calls in between (15 m, 21m…) 6-month visit

11. Overall Population: Primary Efficacy Outcome (MI, Stroke, or CV Death) † † First Occurrence of MI (fatal or non-fatal), stroke (fatal or non-fatal), or cardiovascular death *All patients received ASA 75-162 mg/day § The number of patients followed beyond 30 months decreases rapidly to zero and there are only 21 primary efficacy events that occurred beyond this time (13 clopidogrel and 8 placebo) Adapted with permission from Bhatt DL, et al. N Engl J Med. 2 006;354. Placebo + ASA* 7.3% Clopidogrel + ASA* 6.8% RRR: 7.1% [95% CI: -4.5%, 17.5%] P = 0.22 Months since randomization § 0 2 4 6 8 0 6 12 18 24 30 Cumulative event rate (%)

12. Overall Population: Principal Secondary Efficacy Outcome (MI/Stroke/CV Death/Hospitalization) † Placebo + ASA * 17.9% Clopidogrel + ASA * 16.7% RRR: 7.7% [95% CI: 0.5%, 14.4%] P = 0.04 Cumulative event rate (%) 0 5 10 15 20 Months since randomization § 0 6 12 18 24 30 *All patients received ASA 75-162mg/day † First Occurrence of MI, Stroke, CV Death, or Hospitalization for UA, TIA, or Revascularization § The number of patients followed beyond 30 months decreases rapidly to zero and there are only 38 primary efficacy events that occurred beyond this time (23 clopidogrel and 15 placebo) Adapted with permission from Bhatt DL, et al. N Engl J Med. 2 006;354.

13. Overall Population: Secondary Efficacy Results *Intention to treat analysis † First occurrence of MI (fatal or not), stroke (fatal or not), cardiovascular death (including hemorrhagic death), or hospitalization for UA, TIA, or a revascularization procedure ‡ For UA, TIA, or revascularization Bhatt DL, et al. N Engl J Med. 2006;354. 0.02 0.90 (0.82, 0.98) 957 (12.3) 866 (11.1) Hospitalization ‡ 0.05 0.80 (0.65, 0.997) 185 (2.4) 149 (1.9) Stroke 0.10 0.82 (0.66, 1.04) 160 (2.1) 132 (1.7) Ischemic Stroke 0.48 0.92 (0.74, 1.16) 159 (2.0) 147 (1.9) Myocardial Infarction 0.68 1.04 (0.87, 1.25) 229 (2.9) 238 (3.1) Cardiovascular Mortality 0.90 0.99 (0.86, 1.14) 374 (4.8) 371 (4.8) All Cause Mortality 0.04 0.92 (0.86, 0.995) 1395 (17.9) 1301 (16.7) Principal Secondary Endpoint † P value RR (95% CI) Placebo + ASA (n=7801) Clopidogrel + ASA (n=7802) Endpoint* – N (%)

14. Overall Population: Safety Results *Adjudicated outcomes by intention to treat analysis ICH= Intracranial Hemorrhage Bhatt DL, et al. N Engl J Med. 2006;354. <0.001 1.62 (1.27, 2.10) 101 (1.3) 164 (2.1) GUSTO Moderate Bleeding 0.89 0.96 (0.56, 1.65) 27 (0.3) 26 (0.3) Primary ICH 0.17 1.53 (0.83, 2.82) 17 (0.2) 26 (0.3) Fatal Bleeding 0.09 1.25 (0.97, 1.61) 104 (1.3) 130 (1.7) GUSTO Severe Bleeding P value RR (95% CI) Placebo + ASA (n=7801) Clopidogrel + ASA (n=7802) Safety Outcome* – N (%)

15. Primary Efficacy Results (MI/Stroke/CV Death) by Pre-Specified Entry Category Population RR (95% CI) P value Qualifying CAD, CVD or PAD 0.88 (0.77, 0.998) 0.046 (n=12,153) Multiple Risk Factors 1.20 (0.91, 1.59) 0.20 (n=3284) Overall Population* 0.93 (0.83, 1.05) 0.22 (n=15,603) 0.6 0.8 1.4 1.2 Clopidogrel Better Placebo Better 1.6 0.4 * A statistical test for interaction showed marginally significant heterogeneity ( P = 0.045) in treatment response for these pre-specified subgroups of patients Bhatt DL, et al. N Engl J Med. 2006;354.

16. Primary Efficacy Results (MI/Stroke/CV Death)* by Category of Inclusion Criteria Population N RR (95% CI) P value Qualifying CV Disease 12,153 0.88 (0.77, 0.998) 0.046 Coronary 5,835 0.86 (0.71, 1.05) 0.13 Cerebrovascular 4,320 0.84 (0.69, 1.03) 0.09 PAD 2,838 0.87 (0.67, 1.13) 0.29 Multiple Risk Factors 3,284 1.20 (0.91, 1.59) 0.20 Overall Population 15,603 0.93 (0.83, 1.05) 0.22 0.6 0.8 1.4 1.2 Clopidogrel Better Placebo Better 1.6 0.4 * First occurrence of MI (fatal or not), Stroke (fatal or not), or CV Death Bhatt DL. Presented at: 55th Annual Scientific Session of the American College of Cardiology; March 12, 2006; Atlanta, Ga.

17. Multiple Risk Factor Population: Secondary Efficacy Results *Intention to treat analysis † First occurrence of MI (fatal or not), stroke (fatal or not), cardiovascular death (including hemorrhagic death), or hospitalization for UA, TIA, or a revascularization procedure ‡ For UA, TIA, or revascularization Bhatt DL, et al. N Engl J Med. 2006;354. 0.55 0.93 (0.74, 1.18) 147 (9.0) 140 (8.4) Hospitalization ‡ 0.84 0.95 (0.60, 1.52) 36 (2.2) 35 (2.1) Stroke 0.73 0.91 (0.54, 1.54) 29 (1.8) 27 (1.6) Ischemic Stroke 0.45 1.19 (0.75, 1.89) 33 (2.0) 40 (2.4) Myocardial Infarction 0.01 1.74 (1.16, 2.62) 36 (2.2) 64 (3.9) Cardiovascular Mortality 0.04 1.41 (1.02, 1.95) 62 (3.8) 89 (5.4) All Cause Mortality 0.88 1.01 (0.84, 1.22) 216 (13.3) 224 (13.5) Principal Secondary Endpoint † P value RR (95% CI) Placebo + ASA (n=1625) Clopidogrel + ASA (n=1659) Endpoint* – N (%)

18. Multiple Risk Factor Population: Safety Results *Adjudicated outcomes by intention to treat analysis Bhatt DL, et al. N Engl J Med. 2006;354. 0.08 1.60 (0.95, 2.71) 22 (1.4) 36 (2.2) GUSTO Moderate Bleeding 0.81 1.14 (0.38, 3.39) 6 (0.4) 7 (0.4) Primary ICH 0.38 1.71 (0.50, 5.84) 5 (0. 2) 7 (0.4) Fatal Bleeding 0.07 1.67 (0.96, 2.88) 20 (1.2) 34 (2.0) GUSTO Severe Bleeding P value RR (95% CI) Placebo + ASA (n=1625) Clopidogrel + ASA (n=1659) Safety Outcome* – N (%)

19. Documented CV Disease Population: Safety Results *Adjudicated outcomes by Intention to treat analysis Bhatt DL, et al. N Engl J Med. 2006;354. <0.001 1.63 (1.23, 2.15) 79 (1.3) 128 (2.1) GUSTO Moderate Bleeding 0.65 0.87 (0.47, 1.60) 21 (0.3) 19 (0.3) Primary ICH 0.28 1.47 (0.73, 2.97) 13 (0.2) 19 (0.3) Fatal Bleeding 0.39 1.14 (0.85, 1.52) 84 (1.4) 95 (1.6) GUSTO Severe Bleeding P value RR (95% CI) Placebo + ASA (n=6091) Clopidogrel + ASA (n=6062) Safety Outcome* – N (%)

22. REACH

24. REACH Registry: >67,000 Patients From 5,473 Sites* in 44 Countries North America Latin America Eastern Europe Middle East Asia (incl. Japan) Australia 27,746 1,931 17,886 846 5,903 2,872 Western Europe 5,048 5,656 *Up to 15 patients/site (up to 20 in the US) Bhatt DL, et al. JAMA . 2006;295:180-189.

26. 1-Year Results: Single vs Multiple and Overlapping Atherothrombotic Locations: The Example of CAD Rates adjusted for age and risk factors *TIA, unstable angina, other ischemic arterial event including worsening of PAD Steg PG. Presented at: 55th Annual Scientific Session of the American College of Cardiology; March 12, 2006; Atlanta, Ga. (%)

27. Major Endpoints as a Function of Single vs Multiple and Overlapping Locations 1 p<0.05; 2 p<0.01; 3 p<0.001 (ref class: CAD alone) 1 p<0.05; 2 p<0.01; 3 p<0.001 (ref class: CAD + CVD) *TIA, unstable angina, other ischemic arterial event including worsening of PAD Steg PG. Presented at: 55th Annual Scientific Session of the American College of Cardiology; March 12, 2006; Atlanta, Ga. Polyvascular disease Single arterial bed 26.9 (3) 7.4 4.0 1.8 3.6 (3) CAD + CVD + PAD 24.4 (1) 7.0 4.8 1.3 1.8 CVD + PAD 23.3 (3) 4.8 (3) 1.3 (3) 1.4 2.9 (2) CAD + PAD 20.0 6.4 3.7 1.6 2.0 CAD + CVD 22.0 6.0 3.1 1.5 2.4 Overall 18.2 (3) 10.0 (3) 13.3 12.8 CV death/MI/ stroke/ hospitalization 2.3 4.5 (3) 3.1 3.4 CV death/MI/stroke 0.6 3.5 (3) 0.9 1.5 Non-fatal stroke 1.0 0.5 (3) 1.4 1.2 Non-fatal MI 1.2 1.4 1.5 1.5 CV death PAD alone CVD alone CAD alone Overall

29. ACUITY

30. Study Design – First Randomization Moderate- high risk ACS Aspirin in all clopidogrel dosing and timing per local practice Moderate-high risk unstable angina or NSTEMI undergoing an invasive strategy (N = 13,800) *Stratified by pre-angiography thienopyridine use or administration Stone GW, et al. Am Heart J . 2004;148:764-775. Angiography within 72h UFH or Enoxaparin + GP IIb/IIIa Bivalirudin + GP IIb/IIIa Bivalirudin alone R* Medical management PCI CABG

31. Study Design – Second Randomization Moderate- high risk ACS Angiography within 72h Aspirin in all clopidogrel dosing and timing per local practice Moderate-high risk unstable angina or NSTEMI undergoing an invasive strategy (N = 13,800) Stone GW, et al. Am Heart J . 2004;148:764-775. Medical management PCI CABG Bivalirudin alone UFH or enoxaparin Routine upstream GPI in all pts GPI started in CCL for PCI only R Bivalirudin R Routine upstream GPI in all pts GPI started in CCL for PCI only

32. Primary Endpoint Measures (ITT) 11.7% 7.3% 5.7% 5.3% 11.8% 7.7% Net clinical outcome Ischemic composite Major bleeding 30 day events (%) UFH/Enoxaparin+GPI (N=4603) Bivalirudin+GPI (N=4604) P NI < 0.0001 P Sup = 0.93 P NI = 0.007 P Sup = 0.39 P NI = 0.0001 P Sup = 0.38 UFH/Enoxaparin + GPI vs Bivalirudin + GPI Stone G. Presented at: 55th Annual Scientific Session of the American College of Cardiology; March 12, 2006; Atlanta, Ga.

33. Primary Endpoint Measures (ITT) 0 1 2 11.7% 11.8% 1.01 (0.90-1.12) <0.001 0.93 Risk ratio ±95% CI Primary endpoint Net clinical outcome Ischemic composite Major bleeding Bivalirudin + IIb/IIIa better UFH/Enox + IIb/IIIa better Bival + IIb/IIIa UFH/Enox + IIb/IIIa RR (95% CI) P value (noninferior) (superior) 7.3% 7.7% 1.07 (0.92-1.23) 0.015 0.39 5.7% 5.3% 0.93 (0.78-1.10) <0.001 0.38 Upper boundary noninferiority UFH/Enoxaparin + GPI vs Bivalirudin + GPI Stone G. Presented at: 55th Annual Scientific Session of the American College of Cardiology; March 12, 2006; Atlanta, Ga.

34. Primary Endpoint Measures (ITT) 11.7% 7.3% 5.7% 3.0% 10.1% 7.8% Net clinical outcome Ischemic composite Major bleeding 30 day events (%) UFH/Enoxaparin+GPI (N=4603) Bivalirudin alone (N=4612) P NI <0.0001 P Sup = 0.015 P NI = 0.011 P Sup = 0.32 P NI <0.0001 P Sup <0.0001 UFH/Enoxaparin + GPI vs Bivalirudin Alone Stone G. Presented at: 55th Annual Scientific Session of the American College of Cardiology; March 12, 2006; Atlanta, Ga.

35. Primary Endpoint Measures (ITT) Bivalirudin alone better UFH/Enox + IIb/IIIa better Risk ratio ±95% CI Primary endpoint Bival alone UFH/Enox + IIb/IIIa RR (95% CI) Net clinical outcome Ischemic composite Major bleeding Upper boundary non-inferiority 11.7% 10.1% 0.86 (0.77-0.97) <0.001 0.015 7.3% 7.8% 1.08 (0.93-1.24) 0.02 0.32 5.7% 3.0% 0.53 (0.43-0.65) <0.001 <0.001 P value (non inferior) (superior) UFH/Enoxaparin + GPI vs Bivalirudin Alone 0 1 2 Upper boundary noninferiority Stone G. Presented at: 55th Annual Scientific Session of the American College of Cardiology; March 12, 2006; Atlanta, Ga.

36. Components of the Ischemic Composite 7.3% 1.3% 4.9% 2.3% 2.7% 2.4% 5.0% 7.7% 1.5% 1.6% 7.8% 5.4% Ischemic composite Death Myocardial infarction Unplanned revasc for ischemia 30 day events (%) UFH/Enox+GPI (N=4603) Bivalirudin+GPI (N=4604) Bivalirudin alone (N=4612) UFH/Enoxaparin + GPI vs Bivalirudin + GPI vs Bivalirudin Alone Stone G. Presented at: 55th Annual Scientific Session of the American College of Cardiology; March 12, 2006; Atlanta, Ga. P Sup = 0.32 P Sup = 0.34 P Sup = 0.35 P Sup = 0.78

37. Major Bleeding Endpoints P Sup = 0.38 P Sup < 0.0001 P Sup = 0.31 P Sup < .001 UFH/Enoxaparin + GPI vs Bivalirudin + GPI vs Bivalirudin Alone 11.8% 5.7% 11.1% 5.3% 3.0% 9.1% All major bleeding Non-CABG major bleeding (primary endpoint) 30 day events (%) Heparin+GPI (N=4603) Bivalirudin+GPI (N=4604) Bivalirudin alone (N=4612) Stone G. Presented at: 55th Annual Scientific Session of the American College of Cardiology; March 12, 2006; Atlanta, Ga.

38. Conclusions: Primary Results NI = noninferiority; Sup = superiority Stone G. Presented at: 55th Annual Scientific Session of the American College of Cardiology; March 12, 2006; Atlanta, Ga. P Value Rate P Value Rate Rate Observed <0.001 Sup 3.0% 0.001 NI 5.3% 5.7% Major bleeding 0.011 NI 7.8% 0.007 NI 7.7% 7.3% Ischemic events 0.015 Sup 10.1% <0.001 NI 11.8% 11.7% Net clinical outcome Endpoint Bivalirudin alone Bivalirudin + GP IIb/IIIa UFH/Enox + GP IIb/IIIa

40. ExTRACT-TIMI 25

41. Protocol Design STEMI < 6 h Lytic eligible Lytic choice by MD (TNK, tPA, rPA, SK) UFH 60 U / kg bolus (4000 U) Inf 12 U / kg / h (1000 U / h) Duration: at least 48 h Cont’d at MD discretion ENOX < 75 y: 30 mg IV bolus SC 1.0 mg / kg q 12 h (Hosp DC) ≥ 75 y: No bolus SC 0.75 mg / kg q 12 h (Hosp DC) CrCl < 30: 1.0 mg / kg q 24 h Double-blind, double-dummy ASA Day 30 1 ° Efficacy Endpoint: Death or Nonfatal MI 1° Safety Endpoint: TIMI Major Hemorrhage Antman EM, et al. N Engl J Med . 2006;354.

42. Primary End Point (ITT) Death or Nonfatal MI Primary End Point (%) ENOX UFH Relative Risk 0.83 (0.77 to 0.90) P <0.001 Days after Randomization 9.9% 12.0% Lost to follow-up = 3 17% RRR Adapted with permission from Antman EM, et al. N Engl J Med . 2006;354.

43. Major Secondary End Point Death or Nonfatal MI or Urgent Revascularization (ITT) Secondary End Point (%) Days ENOX UFH 11.7% (1199) 14.5% (1479) 5.3% 6.1% RR 0.88 (0.79 to 0.98) P =0.02 48 h UFH ENOX 280 events 19% RRR RR 0.81 (0.75 to 0.87) P <0.001 12% RRR Adapted with permission from Antman EM, et al. N Engl J Med . 2006;354.

44. Death or Nonfatal MI – Day 30 Major Subgroups Adapted with permission from Antman EM, et al. N Engl J Med . 2006;354.    > Median < Median Fibrin-specific Streptokinase Prior MI No Prior MI DM No DM Other Anterior 0.5 1 2 PRIOR MI OVERALL DIABETES FIBRINOLYTIC INFARCT LOCATION ENOX Better UFH Better Relative Risk TIME TO Rx 20,479 11 23 17 21 17 20 13 18 23 12 17 Reduction In Risk (%) > 75 < 75 AGE (y) 20 6 Female Male SEX 18 16 All Interaction Tests P = NS P < 0.0001

45. Bleeding Endpoints (TIMI) 30 Days UFH ENOX % Events Major Bleed (fatal + nonfatal) ICH ARD 0.7% RR 1.53 P<0.001 ARD 0.1% RR 1.27 P = 0.14 Nonfatal Major Bleed ARD 0.4% RR 1.39 P = 0.014 Antman EM, et al. N Engl J Med . 2006;354.

46. Net Clinical Benefit at 30 Days 1 1.25 0.9 0.8 Death or Nonfatal MI or Nonfatal ICH Death or Nonfatal MI or Nonfatal Major Bleed Death or Nonfatal MI or Nonfatal Disabl. Stroke ENOX Better UFH Better RR UFH (%) ENOX (%) RRR (%) 12.3 10.1 18 12.8 11.0 14 12.2 10.1 17 Prespecified Definitions P <0.001 P <0.001 P <0.001 Antman EM, et al. N Engl J Med . 2006;354.

47. Clinical Implication A strategy of enoxaparin is preferable to the current standard of unfractionated heparin as the antithrombin to support fibrinolysis, the most common form of reperfusion for STEMI used worldwide.

48. OASIS-6

58. ISAR-REACT 2

60. ISAR REACT 2: Cumulative Incidence of Death, MI, or Urgent TVR Adapted with permission from Kastrati A, et al. JAMA . 2006;295. Published online March 13, 2006. 20 15 10 5 0 0 5 10 15 20 25 30 Days After Randomization Cumulative Rate of Primary End Point, % Placebo Group Abciximab Group Log-Rank P =.03

61. ISAR REACT 2: 30-Day Ischemic Events Abbreviations: CI, confidence interval; MI, myocardial infarction; RR, relative risk. Adapted with permission from Kastrati A, et al. JAMA . 2006;295. Published online March 13, 2006. No. (%) 0.64 (0.25-1.63) 11 (1.1) 7 (0.7) PCI 2.99 (0.24-157) 1 (0.1) 3 (0.3) Aortocoronary bypass surgery 0.83 (0.36-1.92) 12 (1.2) 10 (1.0) Urgent target vessel revascularization 0.78 (0.36-1.72) 14 (1.4) 11 (1.1) Q-wave MI 0.77 (0.59-1.02) 106 (10.5) 82 (8.1) MI 0.69 (0.32-1.47) 16 (1.6) 11 (1.1) Death 0.75 (0.57-0.97) 116 (11.5) 87 (8.6) Death or MI 0.75 (0.58-0.97) 120 (11.9) 90 (8.9) Death, MI, or urgent target vessel revascularization RR (95% CI) Placebo (n=1010) Abciximab (n=1012) Event

62. ISAR REACT 2: Cumulative Incidence of Death, MI, or Urgent TVR in Subsets With and Without Elevated Troponin Levels (>0.03 µg/L) Adapted with permission from Kastrati A, et al. JAMA . 2006;295. Published online March 13, 2006. 20 15 10 5 0 0 5 10 15 20 25 30 Days After Randomization Cumulative Rate of Primary End Point, % Placebo Group Abciximab Group Troponin >0.03 µg/L Log-Rank P = .02 Troponin < 0.03 µg/L Log-Rank P = .98

63. ISAR REACT 2: 30-Day Incidence and Relative Risk of Death, MI, or Urgent TVR in Subgroups Error bars indicate 95% confidence intervals. Adapted with permission from Kastrati A, et al. JAMA . 2006;295. Published online March 13, 2006. Abciximab Placebo All Participants 90/1012 (8.9) 120/1010 (11.9) Troponin Level >0.03 µg/L 67/513 (13.1) 98/536 (18.3) ≤ 0.03 µg/L 23/499 (4.6) 22/474 (4.6) Clopidogrel Pretreatment Duration >3 h 27/475 (5.7) 35/461 (7.6) ≤ 3 h 63/537 (11.7) 85/549 (15.5) Diabetes Yes 26/252 (10.3) 32/284 (11.3) No 64/760 (8.4) 88/726 (12.1) Primary End Point, No. of Events/Total No. (%) 0.4 1 2 Relative Risk

64. ISAR-REACT 2 Trial: Secondary Endpoint In-hospital Major and Minor Bleeding (%) p=NS Kastrati A, et al. JAMA . 2006;295. Published online March 13, 2006.

66. ASTEROID

69. ASTEROID: Example of Regression of Atherosclerosis in a Patient in the Trial Adapted with permission from Nissen S, et al. JAMA . 2006;295. Published online March 13, 2006.

75. Relationship Between Mean LDL-C Levels and Median Change in % Atheroma Volume for Several Intravascular Ultrasound Trials Adapted with permission from Nissen S, et al. JAMA . 2006;295. Published online March 13, 2006. REVERSAL Pravastatin CAMELOT Placebo A-Plus Placebo REVERSAL Atorvastatin ASTEROID Rosuvastatin r 2 = 0.97 P <.001

78. Featured Institution Aurora Health Care Milwaukee, Wisconsin

80. Progress Checklist: Immediate Goals Circulate discharge plan and other tools to all cardiology, ED, and CV nursing staff for comments  Circulate pathways to all cardiology, ED, and CV nursing staff for comments  Develop draft pathways  Assemble team and set up meeting of working group 

81. Progress Checklist: Short-term Goals/Activities Grand rounds/conference: Cardiology/IM  Grand rounds/conference: Emergency Dept.  Grand rounds/conference: Nursing  Circulate memo  Launch critical pathways  Finalize critical pathways 

82. Progress Checklist: Long-term Goals/Activities  NRMI  AHA Get With The Guidelines  ACC National Cardiovascular Data Registry  CRUSADE  GRACE  REACH  Other Monitor data: which registry? 

83. Question-and-Answer Session

84. Concluding Remarks Gregg C. Fonarow, MD Next program: Wednesday, April 19, 2006 - 3PM ET (12N PT) Topic: Preliminary Findings From the REACH Registry Faculty: Gregg C. Fonarow, MD