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
“Cardiopatia Ischemica Cronica”
Popolazione
generale
Ischemia
Pregresso IMA,
Angina
pregressa PTCA,
pregresso CABG
Coronaropatia
Prevalenza dell’angina stabile
* Popolazione di età compresa tra i 65 e 74 ann
9.1 milioni di adulti americani
soffrono di angina
Rosamond W, et al. Heart Disease and Stroke Statistics – 2008 Update.
Circulation. 2008;117:e25-e146.
5.000.000
Coronaropatici
Da 11% a 20%*
1.500.000
angina stabile
Osservatorio Epidemiologico
Circa 10 milioni di adulti europei
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.
Cardiovascolare Italiano
Da 10% a 15%*
Prevalenza dall’angina stabile:
30.000/mllione di ab.
Ital Heart J 2004; 5 (Suppl 3): 49S-92S
Eur Heart J 2006; 27: 1341-81
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
Benefit of revascularization in terms of survival is
proportional to the amount of ischaemia
Hachamovitch R et al. Circulation 2003;107:2900–7
10 627 patients
JAMA Intern Med. August 25, 2014
3°
Borden W, JAMA 2011
…undergoing PCI, less than half
were receiving OMT ….
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
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.
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
β-bloccanti nella angina stabile:
confronto L.G. ESC 2006 vs 2013
Fig. 4, Pag.
35
Raccomandazioni dei BB
(2006)
Sintomi
1A
Prognosi
1 A angina e post-IM
1 B angina senza IM
Raccomandazioni dei BB
(2013)
Sintomi
1A
Prognosi
Medical management of patients with stable coronary artery disease.
ESC Guidelines. Eur Heart J 2013; 34: 2949-3003
Eur Heart J , August 30, 2013
Medical management of patient with stable CAD
Fox K, September 2014
Eur Heart J , August 30, 2013
Medical management of patient with stable CAD
Rassaf, Eur Heart J 2013
Eur Heart J , August 30, 2013
Medical management of patient with stable CAD
Mega J, Circulation 2010
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