The POLI- VASCULAR PATIENT Dr. Carlos A. Ingino MTSAC DIRECTOR de - - PowerPoint PPT Presentation

“The POLI-VASCULAR PATIENT”

• Dr. Carlos A. Ingino MTSAC

DIRECTOR de la CARRERA de CARDIOLOGÍA, USAL JEFE de CARDIOLOGÍA, CLÍNICA LA SAGRADA FAMILIA JEFE de CARDIOLOGÍA, ENERI INSTITUTO MÉDICO

REACH registry

• International Prevalence of Cardiovascular Risk

Factors in Outpatients With Atherothrombosis

Bhatt DL, et al. JAMA. 2006;295(2):180-189.

REACH registry

• EVENTS RATE IN PTS WITH ATE
• 68200 pt, 44 countries,
• ˃45yo (mean age 69yo), 64% male
• Stable Vascular Disease (81,7%)
• or ≥3 Risk Factors (18,3%)
• FU 1 year: CV death-MI-stroke

Bhatt DL, et al. JAMA. 2006;295(2):180-189.

44,6%

16,6%

4,7%

Prevalence and distribution of single-bed and polyvascular disease in “REduction of Atherothrombosis for Continued Health, REACH registry” 1,6% 4,7% 1,7%

Coronary Heart Disease

Cerebro-Vascular Disease

Peripheral Arterial Disease

8,4%

18,3%

Pts with RF with no Vasc Dis

Bhatt DL, et al. JAMA. 2006;295(2):180-189.

Polivascular Disease

16,6%

1,6% 1,7%

8,4%

Cerebro- Vascular Disease

Prevalence and distribution of single-bed and polyvascular disease in “REduction of Atherothrombosis for Continued Health, REACH registry”

Polivascular Disease Coronary Heart Disease

CVD + CHD - PVD

41.3% 28.3%

Peripheral Arterial Disease

18,3%

Pts with RF with no Vasc Dis

4,7%

Prevalence and distribution of single-bed and polyvascular disease in “REduction of Atherothrombosis for Continued Health, REACH registry”

1,6%

4,7% 1,7%

Peripheral Arterial Disease

61%

PAD + CHD - CVD

12,7%

Bhatt DL, et al. JAMA. 2006;295(2):180-189.

Coronary Heart Disease Cerebro-Vascular Disease Poli-Vascular Disease

18,3%

Pts with RF with no Vasc Dis

Eventos en Aterotrombosis

REACH registry

Vasc Dis

4.5-6.5%/a ≥ 3 RF 2.15%/a

The Vascular Disease is almost

three times the incidence

events rate/year vs. múltiples RF

Steg G, et al. JAMA. 2007;297:1197-1206

Eventos en Aterotrombosis

REACH registry

CHD (59%) 4.5%/a CVD (28%) 6.5%/a PAD (12%) 5.4%/a

A grater number of affected vascular

territories, higher rate of vascular events

Steg G, et al. JAMA. 2007;297:1197-1206

REACH Registry CV events in Polivascular Disease

• 19179 polyvascular diseases patients
• To evaluate events rate at 2 years of FU compared with

single arterial bed disease

• 1.63 [95% CI, 1.45-1.83], p < 0.0001).

Suarez C, et al. REACH Registry. Vasc Med. 2010 Aug;15(4):259-65.

CRUSADE registry

Enfermedad Polivascular e IAM

• CRUSADE registry: non-ST-segment elevation ACS

– 95 749 pts, enroled from 2003 to 2006 at 486 sites in USA

• Previous Arterial disease: None: 49%; 1, 38%; 2, 11%; y 3, 1,6%

Bhatt DL, et al. Prior polyvascular disease: risk factor for adverse ischaemic

• utcomes in acute coronary syndromes. Eur Heart J. 2009;30:1195-1202

Enfermedad Polivascular e IAM

The PESA (Progression of Early Subclinical Atherosclerosis) Study

• 4184 asymptomatic participants aged 40-54 years
• To evaluate extent of atherosclerosis in the carotid,

abdominal aortic and ilio-femoral territories by 2D/3D ultrasound and coronary artery calcification by CT

Fernández-Friera L,, et al. PESA study. Circulation. 2015 Jun 16;131(24):2104-13

The PESA (Progression of Early Subclinical Atherosclerosis) Study

• Subclinical atherosclerosis was present in 63% of

participants (71% of men; 48% of women).

• Plaques were most common in the ilio-femorals (44%),

followed by carotids (31%) and aorta (25%), while CAC was present in 18%.

• Intermediate and generalized atherosclerosis was

identified in 41%

Fernández-Friera L,, et al. PESA study. Circulation. 2015 Jun 16;131(24):2104-13

The PESA (Progression of Early Subclinical Atherosclerosis) Study

Fernández-Friera L,, et al. PESA study. Circulation. 2015 Jun 16;131(24):2104-13

The PESA (Progression of Early Subclinical Atherosclerosis) Study

Fernández-Friera L,, et al. PESA study. Circulation. 2015 Jun 16;131(24):2104-13

Eco-Doppler Arterial

Score de Calcio Coronario

ANKLE-BRACHIAL INDEX

• ROTTERDAM Study

˃0.90 → 99,4%

sin claudicación

≤0.90 → 6,3%

con claudicación

Claudicación intermitente

• POBRE SENSIBILIDAD
• ALTA ESPECIFICIDAD

Meijer WT, et al. Peripheral arterial disease in the elderly: the Rotterdam Study. Arterioscler Thromb Vasc Biol. 1998;18:185–192

Monte INGINO Gubbio, Italia