Academic Faculty

ArmstongPaul2015

Paul W Armstrong

Professor & Director, Canadian VIGOUR Centre

Medicine & Dentistry

Medicine

About Me

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.

Dr Armstrong received his medical degree at Queen's University. After post-graduate training both there and at the University of Toronto, he undertook clinical and research training in cardiology at the Massachusetts General Hospital, Harvard Medical School and St. George's Hospital, London, UK. From 1972 until 1984 he served as the first Director of the Coronary Care Unit at the Kingston General Hospital, Queen's University. In 1984, he assumed the position of Chief of Cardiology at St Michael's Hospital and Professor of Medicine at the University of Toronto. From 1993 to 1999, he served as Professor and Chair of the Department of Medicine, University of Alberta.

Dr. Armstrong's investigative career has developed along two major lines of inquiry. The first involved the study of the pathophysiology and novel therapeutic approaches of congestive heart failure. The second, now his principal focus, involves the pathophysiology, diagnosis and management of acute coronary syndromes. His role as chair of the international VIGOUR group has lead to multiple leadership and executive positions on large scale international clinical trials of novel strategies in acute coronary syndromes that have helped to transform the care of patients world wide.

Dr. Armstrong frequently serves as visiting professor and invited lecturer in institutions and major scientific meetings both in Canada and internationally. He is the author, or co-author, of over 450 peer reviewed publications and a member of a number of editorial boards including the Canadian Medical Association Journal, Circulation, the Journal of the American College of Cardiology, the American Heart Journal and the European Heart Journal. He is a member of the American College of Cardiology/American Heart Association ST Elevation Myocardial Infarction Guidelines writing committee, CIHR's Institute of Circulatory and Respiratory Health's Advisory Board and former member of the FDA Cardiovascular and Renal Advisory Committee and the Board of the Council of the Canadian Academies.

Dr. Armstrong has had a lifelong commitment to the education and training of healthcare professionals. Numerous of his former trainees, residents and research fellows have gone onto to faculty/ academic positions in all regions of the country and internationally. His mentorship of trainees and faculty have been a key signature of his career and recognized both nationally and internationally.

Dr. Armstrong has received numerous awards including the Research Achievement Award of the Canadian Cardiovascular Society in 1993, the Award of Merit from the Heart and Stroke Foundation for contributions to medical research in 1998 and the Robert Beamish leadership award for promoting cardiovascular science and education in 2002. In 2004 he received the Prix Galien Canada Research Award (awarded to the researcher or the research team judged to have made the most significant contribution to pharmaceutical research in Canada). In 2006, he became the first recipient of the University of Alberta Faculty of Medicine & Dentistry's Annual Award for Excellence in Clinical Mentoring. He was chosen by the Canadian Society of Clinical Investigation as the 2006 G. Malcolm Brown Lecturer awarded for excellence in scientific and academic endeavours and was chosen by the University of Freiburg to deliver the 2006 Greats of Cardiology Award Lecture the highest honour their Heart Centre awards to a distinguished person in the cardiovascular field. The University of Alberta awarded him the title of University Professor in 2006 for outstanding distinction in each of the areas of scholarly research, teaching, service to the university and the community at large. In 2007, he received the most prestigious award for excellence in research from the University of Alberta named after J. Gordin Kaplan. In 2008, he received the Christie Award (Canadian Association of Professors of Medicine) - to recognize outstanding contributions to academic medicine.


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).


Teaching