1 / 7

Risk Stratification In Patients With Chronic Myocardial Ischemia

Risk Stratification In Patients With Chronic Myocardial Ischemia. Available methods for risk stratification in CAD patients. Clinical parameters ECG Chest x-ray Noninvasive testing Resting LV function Exercise test Stress imaging Coronary angiography. Gibbons RJ et al. www.acc.org.

melvinv
Download Presentation

Risk Stratification In Patients With Chronic Myocardial Ischemia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Risk Stratification In Patients With Chronic Myocardial Ischemia

  2. Available methods for risk stratification in CAD patients • Clinical parameters • ECG • Chest x-ray • Noninvasive testing • Resting LV function • Exercise test • Stress imaging • Coronary angiography Gibbons RJ et al. www.acc.org.

  3. High-risk criteria >3% annual mortality rate • Severe resting LV dysfunction (LVEF <35%) • High-risk treadmill score (≤-11) • Severe exercise LV dysfunction (LVEF <35%) • Stress-induced large perfusion defect (esp anterior) • Multiple, moderate-sized perfusion defects • Large, fixed perfusion defect with LV dilation or increased lung uptake (thallium-201) • Stress-induced moderate perfusion defect with LV dilation or increased lung uptake (thallium-201) • Echocardiographic wall motion abnormality (>2 segments) at low dobutamine dose (≤10 mg/kg per min) or low HR (<102 bpm) • Stress echocardiographic evidence of extensive ischemia Gibbons RJ et al. www.acc.org.

  4. Intermediate-risk criteria 1%-3% annual mortality rate • Mild/moderate resting LV dysfunction (LVEF 35%-49%) • Intermediate-risk treadmill score (-11 < score < 5) • Stress-induced moderate perfusion defect without LV dilation or increased lung intake (thallium-201) • Limited stress echocardiographic ischemia with a wall motion abnormality only at higher doses of dobutamine involving ≤2 segments Gibbons RJ et al. www.acc.org.

  5. Low-risk criteria <1% annual mortality rate • Low-risk treadmill score (≥5) • Normal or small myocardial perfusion defect at rest or with stress • Normal stress echocardiographic wall motion or no change of limited resting wall motion abnormalities during stress Gibbons RJ et al. www.acc.org.

  6. Comparison of 3 different risk scores N = 460 consecutive patients with NSTE-ACS TIMI risk score PURSUIT risk score GRACE risk score 30 30 30 25 25 25 20 20 20 Deathor MI(%) 15 15 15 10 10 10 5 5 5 0 0 0 <96 96-112 113-133 >133 0-2 3-4 5-7 <10 10-12 13-14 >14 Death/MI: 30 days 1 year de Araújo Gonçalves P et al. Eur Heart J. 2005;26:865-72.

  7. Summary • Chronic IHD continues to impose a high socioeconomic burden • Mechanistic understanding has undergone a paradigm shift • Traditional focus: Determinants of myocardial O2 supply/demand • Contemporary focus: Changes in Na+ and Ca2+ currents during ischemia • Contemporary management: • Aggressive treatment of multiple risk factors • Multifactorial treatment of symptoms • Renewed interest in the role of optimal medical therapy vs PCI

More Related