Benefit of revascularization in terms of survival is...Hachamovitch R et al. Circulation...

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

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

…undergoing PCI, less than half were receiving OMT ….

STARTSTable Coronary Artery

Diseases RegisTry

Ischemia

Oxygen Demand

Systolic Pressure Volume

ContractilityHeart Rate

LV Wall Tension

OxygenSupply

CoronaryBlood Flow

Coronary Artery Disease

Vasospasm

Thrombus

Duration of Diastole

Adapted from Kern MJ. In: Braunwald’s Heart Disease. 7th ed. 2005

Myocardial Ischemia: Unbalanced Oxygen Supply and Demand

β-blockers

DHP CCBs

Non-DHP CCBs

Long-acting nitrates

Drug classCoronaryblood flow

Arterialpressure

Venousreturn

Myocardialcontractility

Heartrate

CCB = calcium channel blocker, DHP = dihydropyridine *Except amlodipine

O2 DemandO2 Supply

/

*

Classic Antianginal Drugs

CCB = calcium channel blocker, DHP = dihydropyridine *Except amlodipine

Boden WE et al. Clin Cardiol. 2001;24:73-9 Gibbons RJ et al. ACC/AHA 2002 Chronic Angina Guidelines

Kerins DM et al. The Pharmacological Basis of Therapeutics. 10th ed

Algoritmo per l’ottimale gestione del trattamento sintomatico del paziente con

cardiopatia ischemica cronica stabile

Sintomi non controllati

Ivabradina *

Ranolazina

Associazione con: 

Terapia di prima linea:

β –bloccante

Ca – antagonisti Nitrati LA 

Trimetazidina

Da valutare: 

Ca – antagonisti Nitrati LA 

Trimetazidina

Da valutare: 

Controindicazioni o   intolleranza

Ranolazina

Ivabradina *

* In pz in RS, FC ≥70 bpm, FEVS≤40%