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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%