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