-4- cesare greco - associazione regionale cardiologi ... · e come pianificare la prevenzione...
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La mortalità nei sei mesi dopo l’infarto è molto alta:Le linee guida ESC/EAS
e come pianificare la prevenzione secondaria dopo SCA
Cesare Greco
XVII° Congresso Regionale ARCARoma 22‐23 settembre 2017
Cardiopatia ischemica:
Kostis Circ Cardiovasc Qual Outcomes 2010
mortality Discharge – 1 year mortality 12.07‐13.9 % annual variation 0.15 (0.10 to 0.20)P<0.0001)
285.397 pts MIDAS New Jersey
Trends of 30 day and 31–365 day mortality after first AMI 1984-2008A Danish nationwide cohort study
Schmidt et al. BMJ 2012
234 331 patients
Trends of risk ratios between fatal readmission rates and index in-hospital mortality rates in AMI - Italy 2001-2011
Greco et al. Int J Cardiol 2015
1.110,822 patients admitted with AMI from 2001 to 2011 in all Italian hospitals sites
%
5
10
Dati SDO ISSre-ricoveri fatali94166 IMA dimessivivi 2011
Dati CLICONre-ricoveri fatali +mortalità extraH11.269 dimessi vivi SCA 2010-2011 5 ASL
5.28
10.6
Mor
talit
à ad
1 a
nno
Rischio residuoMortalità IMA inH, reH fatale e totale ad 1 anno
8.7
Dati SDO ISSMortalitàIn H 2011
Fonte: SDO regioni di ER, Lombardia, FVG SDO nazionali
SDO nazionali 2001-2012Proporzione di STEMI e NSTEMI
Index admission mortality, fatal readmission and total mortality rates at 30 days, 60 days and 1 year in patients with AMI whith and without
heart failure during index admission.
Greco et al. Int J Cardiol 2015
1.110,822 patients with AMI from 2001 to 2011 in all Italian hospitals sites
ALTA
MEDIA
BASSA MEDIA ALTA
Complessità / intensità clinica ( rischio di morte, rischio trombotico, rischio cardiovascolare, comorbidità)
Com
plessità
’/ intensità
assistenziale e preventiva
CR DEGENZIALE
AMBULATORI CARDIOLOGICI, COUNSELING, MMG
CR AMULATORIALE, AMBULATORI PREVENZIONE SECONDARIA INTENSIVA
NB Il rapporto è funzione anche del contesto organizzativo
Efficacy of a long‐term secondary prevention programme following inpatient cardiovascular rehabilitation on risk and health‐related quality of life in a low‐education cohort: a randomized controlled study
Mayer‐Berger Eur J Prev Cardiol 2012
600 CAD patients 3 weeks of CR with 3 years follow up .Intervention : one additional day of CR at 6 months and telephone reminders
Mayer‐Berger Eur J Prev Cardiol 2012
Efficacy of a long‐term secondary prevention programme following inpatient cardiovascular rehabilitation on risk and health‐related quality of life in a low‐education cohort: a randomized controlled study
PROCAM (PRospective CArdiovascular Muster) risk score
intervention group
Changes in PROCAM score percentage of patients for different risk categoriesFollow up of 36 month
control group
Risk of repeat cardiovascular events (MI/stroke/death) with progressive behavioral change.
Chow C K et al. Circulation. 2010 Copyright © American Heart Association, Inc. All rights reserved.
Age Adjusted Mortality Rates in Subject with Cardiovascular Disease categorised by level of fitness
0
0,5
1
1,5
2
2,5
3
3,5
4
4,5
5
1 2 3 4 5
LEAST FIT
MOST FIT
(3.3‐5.2)
(2.4‐3.7)
(1.7‐2.8)
(1.4‐2.2)
1.0
-4.9
MET
5.0
–6.
4M
ET
6.5
–8.
2M
ET
8.3
–10
.6M
ET
10.
7M
ET
Myers J N Engl J Med. 2002
• BetaBlockers if MI/LV dysfunction/HF• Consider low dose rivaroxabanIf mild or severe LV dysfunction/HF
Re-evaluate after RIVER-PCI
And DAPTEzetimibe/CPSK9
If mr LVD
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