Transcript

CARDIOPATIA ISCHEMICA CRONICA

Terapia anti-ischemica ottimale nel paziente con ischemia residua

Fabio Barlocco

Cardiologia interventistica

Legnano

Definizione operativa di cardiopatia ischemica cronica.

• Pazienti sintomatici con angina pectoris (o suoi equivalenti) stabile.

• Pazienti asintomatici, ma con evidenza clinico-strumentale di pregresso infarto

miocardico o sindrome coronarica acuta (da oltre 1 anno).

• Pazienti asintomatici ma portatori di patologia ostruttiva coronarica accertata (es.

pazienti già sottoposti a procedura coronarica percutanea o intervento di bypass

aortocoronarico o con riscontro coronarografico di stenosi significative o con

evidenza di ischemia ai test provocativi).

Thus prolonged therapy

with isosorbide dinitrate

is not evidence-based.

Organic nitrates are among the

oldest drugs, but they still remain a

widely used adjuvant in the

treatment of symptomatic coronary

artery disease. While their efficacy

in relieving angina pectoris

symptoms in acute settings and in

preventing angina before physical

or emotional stress is undisputed,

the chronic use of nitrates has

been associated with potentially

important side effects such as

tolerance and endothelial

dysfunction.

Classe IIb

CCBEffect of amlodipine, atenolol and their combination on myocardial ischemia

during treadmill exercise and ambulatory monitoring. Canadian

Amlodipine/Atenolol in Silent Ischemia Study (CASIS) Investigators.

CONCLUSIONS:

Ischemia during treadmill testing was more effectively suppressed by amlodipine,

whereas ischemia during ambulatory monitoring was more effectively suppressed by

atenolol. The combination was more effective than either single drug in both settings.

J Am Coll Cardiol.1995 Mar 1;25(3):619-25.

Favourable long term prognosis in stable angina pectoris: an extended follow

up of the angina prognosis study in Stockholm (APSIS) Verapamil

Heart 2006 Feb; 92(2): 177–182.

REDRAWN FROM LEVINE HJ. REST HEART RATE AND LIFE EXPECTANCY. J AM COLL CARDIOL 1997

Humans are outliers relative to other mammals when comparing lifespan to heartbeat.

Resting heart rate and all-cause mortality in the

Framingham Study.

Jeffrey S. Borer Eur Heart J Suppl 2008;10:F2-F6

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author

2008. For permissions please email: [email protected]

Resting heart rate and mortality in the general population:

epidemiological studies

Jeffrey S. Borer Eur Heart J Suppl 2008;10:F2-F6

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author

2008. For permissions please email: [email protected]

Meccanismi sfavorevoli della frequenza cardiaca elevata

Beta Bloccanti

Changes in heart rate at rest (A) and at peak exercise (B) in the

different treatment groups during double-blind dose-ranging.

Jeffrey S. Borer et al. Circulation. 2003;107:817-823

Ranolazina

Ranolazina inibisce

selettivamente la

corrente tardiva del

sodio nel miocardiocita

ischemico senza

alterare frequenza

cardiaca e pressione

arteriosa in maniera

significativa

Studio CARISAN

um

ero

pe

r se

ttim

ane

6

5

4

3

2

1

0

Basale A 12 sett.

Fase dello studio

Basale A 12 sett.

Attacchi di angina Consumo di nitroglicerina

p<0.006

p<0.001

p<0.02

p<0.001

Placebo Ranolazina 1000 mg bidRanolazina 750 mg bid

MERLIN – TIMI 36:

efficacia nei pazienti con angina cronica


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