chroniques : un nouveau label Pourquoi la maladie coronaire stable - - PowerPoint PPT Presentation
Les syndromes coronaires chroniques : un nouveau label Pourquoi la maladie coronaire stable n'existe plus ? Stphane Manzo-Silberman Service de Cardiologie, Hpital Lariboisire, Paris Universit Paris, UMRS 942 D CLARATION DE LIENS
Stéphane Manzo-Silberman Service de Cardiologie, Hôpital Lariboisière, Paris Université Paris, UMRS 942
DÉCLARATION DE LIENS D’INTÉRÊT AVEC LA PRÉSENTATION
Speaker’s name : Stéphane Manzo-Silberman
– Lifestyle modification – Pharmacological therapy – Invasive intervention
suspected CAD and ‘stable’ anginal symptoms, and/or dyspnoea CCV new onset of heart failure (HF) or left ventricular (LV) dysfunction and suspected CAD asymptomatic and symptomatic patients with stabilized symptoms <1 year after an ACS, or patients with recent revascularization asymptomatic and symptomatic patients >1 year after initial diagnosis or revascularization angina and suspected vasospastic or microvascular disease asymptomatic subjects in whom CAD is detected at screening
Suspected CAD and ‘stable’ anginal symptoms, and/or dyspnoea CCV
Suspected CAD and ‘stable’ anginal symptoms, and/or dyspnoea CCV
Suspected CAD and ‘stable’ anginal symptoms, and/or dyspnoea CCV
Suspected CAD and ‘stable’ anginal symptoms, and/or dyspnoea CCV
– as rest angina >20 min – crescendo angina, i.e. previous angina, which progressively increases in severity and intensity, and at a lower threshold, over a short period of time. – new-onset angina<2 months onset of moderate-to-severe angina (Canadian Cardiovascular Society grade II or III )
Suspected CAD and ‘stable’ anginal symptoms, and/or dyspnoea CCV
New onset of heart failure (HF) or left ventricular (LV) dysfunction and suspected CAD
– Pharmacological – Revascularization
asymptomatic and symptomatic patients with stabilized symptoms <1 year after an ACS, or patients with recent revascularization
Asymptomatic and symptomatic patients with stabilized symptoms <1 year after an ACS, or patients with recent revascularization
Asymptomatic and symptomatic patients >1 year after initial diagnosis or revascularization
biomarkers: every 1 or 2 years
Angina and suspected vasospastic or microvascular disease
– Stenoses with mild or moderate angiographic severity, or diffuse coronary narrowing, – Disorders affecting the microcirculatory domain – Dynamic stenoses of epicardial vessels caused by coronary spasm or intramyocardial bridges
Angina and suspected vasospastic or microvascular disease
Angina and suspected vasospastic or microvascular disease
– IMR ≥ 25 or CFR < 2.0
– Epicardial: Symptoms + ECG+ severe vasoconstriction – Microvascular spasm: Symptoms ± ECG+ 0 vasoconstriction
– 151 patients randomized: stratified medical treatment based on testing vs standard care – Testing: CFR, IMR, Acetylcholine testing1 year: significant difference in Angina scores
Asymptomatic subjects in whom CAD is detected at screening
Asymptomatic subjects in whom CAD is detected at screening: WOMEN
– Specific risks – Calcium score
situations in which an acute coronary artery thrombosis dominates the clinical presentation
microvascular dysfunction to epicardial obstruction
– Pretest probability – Risk stratification – Diagnosis approach – Risk for future events