It is undeniable that the increasing costs in healthcare are a concern. Although technological advancements have been made in healthcare systems, the return on investment made by governments and payers has been poor. The current model of care is unsustainable and is due for an upgrade. In developed nations, a law of diminishing returns has been noted in population health standards, whilst in the developing world, westernized chronic illnesses, such as diabetes and cardiovascular disease have become emerging problems. The reasons for these trends are complex, multifactorial and not easily reversed. Personalized medicine has the potential to have a significant impact on these issues, but for it to be truly successful, interdisciplinary mass collaboration is required. We propose here a vision for open-access advanced analytics for personalized cardiac diagnostics using imaging, electrocardiography and genomics.

Conclusions:One in 25 patients underwent surgery in the first year after PCI, requiring DAPT interruption, frequently recommended by non-cardiologists and most commonly due to minor surgery. TCT-502Efficacy and safety of switching from clopidogrel to prasugrel in diabetic patients with acute coronary syndromes treated with drug-elunting stents: results of the ESCAPADA study Background: Prasugrel demonstrated superior efficacy in the reduction of events of acute coronary syndrome (ACS), clopidogrel-naïve, patients treated with percutaneous coronary intervention (PCI), especially in the diabetic (DM) subgroup. The objective of this study is to assess the efficacy and safety of switching from dual antiplatelet treatment with clopidogrel to prasugrel in ACS DM patients being treated with everolimus-eluting stents. Methods: Prospective, observational study conducted in 4 different centers. Patients were included if they met the ADA criteria for established or increased risk for DM. Platelet reactivity was measured before PCI and 1 month after with 2 different analyzers (VerifyNow P2Y12 test and Multiplate ADP-HS test); high on-treatment platelet reactivity (HTPR) was defined as any of the previously demonstrated values: VerifyNow PRU >208, inhibition of platelet aggregation (IPA) < 20% or Multiplate AUC>31. The presence of any complication, especially bleeding events, was recorded both before discharge and at 1-month follow-up. Results: Ninety-six patients were included: 63AE8 years mean age, 77% male, 72% hypertensive, 66% hyperlipidemic, 32% smokers (plus 23% ex-smokers), 80% ACS with positive biomarkers, 58% multivessel disease. Only 16% of patients received insulin. 15% of patients were diagnosed with diabetes and 21% with increased risk for DM in the index admission. 10% of patients were previously treated with prasugrel and 5% were changed back to clopidogrel by their treating physicians. Before the PCI, 71 patients (74%) showed HTPR (67% met the VerifyNow criteria, 37% according to Multiplate results). At 1 month only 14% of patients showed HTPR; 3 of the 4 patients on clopidogrel treatment (75%) still showed HTPR. After 1 month follow-up only 5 bleeding events were recorded: one caused by coronary perforation after PCI, one significant groin hematoma, 3 minor bleedings (epistaxis, skin hematomas), without need of subsequent changes in treatment. Conclusions: Switching from clopidogrel to prasugrel after stent treatment in ACS diabetic patients is associated with a significant reduction in platelet reactivity without a relevant increase in bleeding complications.