Dr. Paul W Armstrong

Biography

Paul Armstrong is University Professor, Department of Medicine (Cardiology) at the University of Alberta, Edmonton, Alberta, Canada and Director of the Canadian VIGOUR Centre (Virtual Coordinating Centre for Global Collaborative Cardiovascular Research). As founding Director of TORCH (TomorrOw's Research Cardiovascular Health Professionals), a Strategic Training Program Initiative and current member of the Executive Advisory Committee, he is committed to the training of cardiovascular researchers. He is a Senior Attending Cardiologist at the University of Alberta Hospital with particular interest and expertise in acute coronary care and heart failure. He is founding and immediate past President of the Canadian Academy of Health Sciences.

Research Interest

Research Pathophysiology, Diagnosis and Management of Acute Coronary Syndromes Dr. Armstrong has been actively involved as a member and Canadian lead investigator of a variety of International Steering Committees conducting multi-national mega trails which have substantially impacted on our understanding, investigation and management of acute ischemic syndromes. These studies, initiated in 1990 with the GUSTO-I trial (1) have extended through a series of collaborative investigations of fibrinolytics, anti-thrombotics and novel glycoprotein IIb/IIIa anti-platelet agents. (2-12) A perspective on this collaboration and work was published by our group in a sentinel article in Circulation (13). Examples of the novel contributions include: i) Establishing the importance of the open artery hypothesis as it relates to reperfusion therapy in man with acute myocardial infarction (14), ii) Defining the time dependence of myocardial salvage and its impact on outcome (15;16), iii) Discovering the key role of cardiac markers i.e. troponin in the diagnosis of patients with acute coronary syndromes (17-19), iv) Establishing the importance of ST segment monitoring in the evaluation of reperfusion and silent recurrent ischemia after acute myocardial infarction (20), v) Creating models for the accurate assessment of prognosis and evaluation of risk amongst patients presenting with acute coronary syndromes and elucidating the powerful impact of recurrent ischemia on outcome (21), vi) Developing new therapeutic strategies for patients with acute coronary syndromes(22-26). In addition to these initiatives, my colleagues and I have evaluated various components of health care delivery i.e. cost efficacy, impact on quality of life, how co-interventions such as cardiac catheterization and revascularization affect outcomes. We found that despite major differences in interventional cardiac procedural use i.e. greater in the United States versus Canada, there was no increase in 30-day or 1-year mortality in Canadian versus U.S. patients (27). There was however a substantial difference in frequency of recurrent ischemia and impairment in quality of life. We have recently demonstrated comparable results over a 7-year period using GUSTO 3 data (28) in this cohort. Interestingly (and importantly as it related to healthcare policy initiatives and resource allocation) amongst patients with non-ST elevation acute coronary syndromes this difference does result in increased death and re-infarction amongst Canadians versus Americans (29). The intersection between the process and the content of care has been a subject of my recent research focus as well. Issues that have been explored include the influence of participating in a positive clinical on subsequent medical practice (30) and the critical importance of delay in time to fibrinolytic therapy for acute myocardial infarction (31;32).