Innovation in Precision Interventional Cardiology The present The

Innovation in Precision Interventional Cardiology The present & The future Roxana Mehran, MD ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI, NEW YORK

Disclosures Affiliation/Financial Relationship Company Consultant/Advisory/Speaking Engagements Boston Scientific, Medscape, Siemens Medical Solutions, Roivant Sciences Inc, Sanofi, Janssen, Abbott Laboratories, Medtelligence (Janssen Scientific Affairs), Idorsia Pharmaceuticals Ltd. (no fee), Regeneron Pharmaceuticals (no fee), Abiomed (spouse), The Medicines Company (spouse), Abbott Laboratories (to institution), Spectranetics/Philips/Volcano Corp (to institution) Research Funding to Institution Abbott Laboratories, Astra Zeneca, Bayer, Beth Israel Deaconess, BMS, CSL Behring, DSI, Medtronic, Novartis, Orbus. Neich Scientific Advisory Board Medtelligence (Janssen Scientific Affairs), Bristol-Myers Squibb (to institute), Equity, <1% Claret Medical, Elixir Medical DSMB membership paid to the institution Watermark Research Partners Associate Editor ACC, AMA

It represents a new strategy in the approach to care by considering individual differences in genetics, exposures, and lifestyle and health factors that are determinants of a person’s disease phenotype. What is Precision Medicine It is based on large amounts of detailed data that is curated from standard clinical, imaging, and laboratory testing to next-generating sequencing, metabolomics, and proteomic studies to historical health record data The evolution of precision medicine and its application to cardiovascular diseases holds the promise of improving health as well as revolutionizing prevention and treatment options similar to what has occurred in the field of oncology. Leopold, Jane A et al. Circulation Research (2018)

Centre for Proteomic & Genomic Research 2015

Concept Behind Precision Medicine Reenita Das Forbes 2017

A PRECISION MEDICINE MODEL Antman, Elliott M et al. Nature Reviews Cardiology 13. 10 (2016): 591.

Definitive Healthcare The Future of the Precision Medicine Market: 2019 Study Results

Pubmed indexed precision medicine publications by organ system Mukherjee, Rajarshi, et al. Precision Clinical Medicine 2. 2 (2019)

Currently Available Avenues of Precision Medicine in Cardiology Dainis et al. JACC: Basic to Translational Science 2018

Torkamani, Ali, et al Nature Reviews Genetics 2018

A vision to the future of precision medicine in cardiology

Evolving Avenues of Precision Medicine in Cardiology Wang J. , et al. Circulation Research 2016

Evolving Avenues of Precision Medicine in Cardiology Zeggini, Eleftheria, et al. Science 2019

Joseph Loscalzo CVCT 2019.

Califf, Robert M. et al JACC 2018

…a step towards Personalized Medicine Ginsburg GS et al. JACC 2005

Integrating Precision Medicine into Training Pathways Vaduganathan et al. JACC 2017

Requires demonstration of efficacy Data curation with a focus on perpetual updating BARRIERS Socio-political barriers Blurring boundaries between clinical practice and research Antman, Elliott M et al. Nature Reviews Cardiology 2016 Involvement of all stakeholders

Limited reach Martin AR. , et al. Nature genetics 2019

Challenges associated with integration of Precision Medicine • • • Supercomputing • Advances in analytics • Systems biology/network analysis Technology advances Scalability & Cost Assess Cross-talk with data platform OMICs • • Data Accuracy Data Privacy Accessibility & Portability Translation into practical information Data Management Data Analysis Community Acceptance Leopold et al. Circulation Research (2018) • Education • Policy change • Broad representation • Input from all stakeholders • Redefining medical encounters

Challenges associated with integration of Precision Medicine Kohane, Isaac S. Science 349. 6243 (2015)

Conclusions • Precision medicine is an emerging concept in medicine with prospects of delivering efficacious healthcare by identifying novel subject stratifications and lowering overall costs • It presents as an intermediary between traditional and personalized medicine, with avenues for overall population welfare as well as individualized healthcare delivery • However, current infrastructure needs remodeling, with development of novel data curation techniques, establishment of targeted networks and reinforcement of legal policies behind data sharing