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DALLE NUOVE LINEE GUIDA:

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Presentazione sul tema: "DALLE NUOVE LINEE GUIDA:"— Transcript della presentazione:

1 DALLE NUOVE LINEE GUIDA:
LE TRE DIAPOSITIVE PIÙ IMPORTANTI ED INNOVATIVE SU Cardiopatia ischemica cronica PL. Temporelli Fondazione Salvatore Maugeri, IRCCS, Divisione di Cardiologia Riabilitativa, Veruno

2 “Cardiopatia Ischemica Cronica”
Popolazione generale Ischemia Angina Pregresso IMA, pregressa PTCA, pregresso CABG Coronaropatia

3 Prevalenza dell’angina stabile
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 Da 11% a 20%* Da 10% a 15%* angina stabile Ital Heart J 2004; 5 (Suppl 3): 49S-92S Eur Heart J 2006; 27: Osservatorio Epidemiologico Cardiovascolare Italiano Prevalenza dall’angina stabile: 30.000/mllione di ab. * Popolazione di età compresa tra i 65 e 74 anni Coronaropatici 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: Circa 10 milioni di adulti europei soffrono di angina

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7 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.

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9 Stress testing in patients with stable angina who require noninvasive testing
Fihn SD et al. JACC 2012;60:e44-e164

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11 Relationship between cardiac mortality
and extent of ischemia

12 Benefit of revascularization in terms of survival is proportional to the amount of ischaemia
Hachamovitch R et al. Circulation 2003;107:2900–7 patients

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14 JAMA Intern Med. August 25, 2014

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19 …undergoing PCI, less than half were receiving OMT ….
Borden W, JAMA 2011 …undergoing PCI, less than half were receiving OMT ….

20 Qual’è la terapia ottimale nell’angina stabile secondo
le Linee Guida?

21 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

22 Percentage of the Decrease in Deaths from CHD Attributed to Treatments and Risk-Factor Changes
The Centers for Disease Control 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.

23 Medical management of patients with stable coronary artery disease.
ESC Guidelines. Eur Heart J 2013; 34:

24 Medical management of patients with stable coronary artery disease.
ESC Guidelines. Eur Heart J 2013; 34:

25 β-bloccanti nella angina stabile: confronto L.G. ESC 2006 vs 2013
Fig. 4, Pag. 35 Raccomandazioni dei BB (2006) Raccomandazioni dei BB (2013) Sintomi Prognosi Sintomi Prognosi 1 A 1 A angina e post-IM 1 A 1 B angina senza IM

26 Medical management of patients with stable coronary artery disease.
ESC Guidelines. Eur Heart J 2013; 34:

27 Medical management of patient with stable CAD
Eur Heart J , August 30, 2013 Medical management of patient with stable CAD

28 Fox K, September 2014

29 Medical management of patient with stable CAD
Eur Heart J , August 30, 2013 Medical management of patient with stable CAD

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32 Rassaf, Eur Heart J 2013

33 Medical management of patient with stable CAD
Eur Heart J , August 30, 2013 Medical management of patient with stable CAD

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35 Mega J, Circulation 2010

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39 LA TERAPIA FARMACOLOGICA NELLA CARDIOPATIA ISCHEMICA CRONICA
I βbloccanti sono indicati per migliorare la prognosi SI dopo IM e nello SC Le statine sono indicate per migliorare la prognosi Sicuramente SI I Nitrati long acting sono sempre indicati nel lungo termine Probabilmente NO Ranolazina è efficace in seconda linea e talora indicata come prima scelta Sembra proprio SI


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