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PL. Temporelli
Fondazione Salvatore Maugeri, IRCCS, Fondazione Salvatore Maugeri, IRCCS, Divisione di Cardiologia Riabilitativa, VerunoDivisione di Cardiologia Riabilitativa, Veruno
DALLE NUOVE LINEE GUIDA:LE TRE DIAPOSITIVE PIÙ IMPORTANTI ED
INNOVATIVE SU
Cardiopatia ischemica cronica
Ischemia
Popolazione
generale
Coronaropatia
Pregresso IMA,
pregressa PTCA,
pregresso CABG
Angina
“Cardiopatia Ischemica Cronica”
Prevalenza dell’angina stabile
5.000.000
Coronaropatici
* Popolazione di età compresa tra i 65 e 74 anni
Da 11% a 20%*
Da 10% a 15%*
1.500.000
angina stabile
Ital Heart J 2004; 5 (Suppl 3): 49S-92S
Eur Heart J 2006; 27: 1341-81
Osservatorio Epidemiologico
Cardiovascolare Italiano
Prevalenza dall’angina stabile:
30.000/mllione di ab.
Rosamond W, et al. Heart Disease and Stroke Statistics – 2008 Update. Circulation. 2008;117:e25-e146.
9.1 milioni di adulti americani soffrono di angina
Daly C, et al. The impact of guideline compliant medical therapy on clinical outcome in patients with stable angina: findings from the Euro Heart Survey of stable angina. Eur Heart J 2006;27:1298-304.
Circa 10 milioni di adulti europeisoffrono di angina
1°
Pretest Likelihood of CAD in Symptomatic Patients
According to Age and Sex* (Combined Diamond/Forrester
and CASS Data)
*Each value represents the percent with significant CAD on catheterization.
Stress testing in patients with stable angina who require noninvasive testing
Fihn SD et al. JACC 2012;60:e44-e164
2°
Relationship between cardiac mortality and extent of ischemia
Hachamovitch R et al. Circulation 2003;107:2900–7
Benefit of revascularization in terms of survival is proportional to the amount of ischaemia
10 627 patients
JAMA Intern Med. August 25, 2014
3°
…undergoing PCI, less than half were receiving OMT ….
Borden W, JAMA 2011
Qual’è la terapia ottimale nell’angina stabile secondo
le Linee Guida?
Key points
Lifestyle changes are vital in the management of
stable angina, including smoking cessation,
healthy diet, weight loss and control of lipid levels
Associated conditions, such as hypertension and diabetes,
should be treated according to relevant guidance
Anti-anginal drugs should be titrated to the optimal
licensed dose to control symptoms
Revascularisation should be considered in selected
patients
Percentage of the Decrease in Deaths from CHD Attributed to Treatments and Risk-Factor Changes
Ford ES et al. N Engl J Med 2007; 356:2388
The use of revascularization
for chronic angina resulted in a
reduction of approximately
15,690 deaths in 2000, as
compared with deaths in 1980,
or approximately
5% of the total and only 1.3%
was attributable to PCI.
The Centers for Disease Control
Medical management of patients with stable coronary artery disease.
ESC Guidelines. Eur Heart J 2013; 34: 2949-3003
Medical management of patients with stable coronary artery disease.
ESC Guidelines. Eur Heart J 2013; 34: 2949-3003
Sintomi Prognosi
1 A
Raccomandazioni dei BB (2006)
1 A angina e post-IM
1 B angina senza IM
Sintomi Prognosi
1 A
Raccomandazioni dei BB (2013)
Fig. 4, Pag. 35
β-bloccanti nella angina stabile: confronto L.G. ESC 2006 vs 2013
Medical management of patients with stable coronary artery disease.
ESC Guidelines. Eur Heart J 2013; 34: 2949-3003
Medical management of patient with stable CAD
Eur Heart J , August 30, 2013
Fox K, September 2014
Medical management of patient with stable CAD
Eur Heart J , August 30, 2013
Rassaf, Eur Heart J 2013
Medical management of patient with stable CAD
Eur Heart J , August 30, 2013
Mega J, Circulation 2010
LA TERAPIA FARMACOLOGICA NELLA CARDIOPATIA ISCHEMICA CRONICA
I βbloccanti sono indicati per migliorare la prognosi
I Nitrati long acting sono sempre indicati nel lungo
termine
Ranolazina è efficace in seconda linea e talora indicata
come prima scelta
SI dopo IM e nello SC
Probabilmente NO
Sembra proprio SI
Le statine sono indicate per migliorare la prognosi Sicuramente SI