Chronic stable angina secondary prevention

Revision as of 20:21, 22 November 2011 by Vanbot (talk | contribs) (Robot: Changing Category:Up to date cardiology to Category:Up-To-Date cardiology)
Jump to navigation Jump to search

Chronic stable angina Microchapters

Acute Coronary Syndrome Main Page

Home

Patient Information

Overview

Historical Perspective

Classification

Classic
Chronic Stable Angina
Atypical
Walk through Angina
Mixed Angina
Nocturnal Angina
Postprandial Angina
Cardiac Syndrome X
Vasospastic Angina

Differentiating Chronic Stable Angina from Acute Coronary Syndromes

Pathophysiology

Epidemiology and Demographics

Risk Stratification

Pretest Probability of CAD in a Patient with Angina

Prognosis

Diagnosis

History and Symptoms

Physical Examination

Test Selection Guideline for the Individual Basis

Laboratory Findings

Electrocardiogram

Exercise ECG

Chest X Ray

Myocardial Perfusion Scintigraphy with Pharmacologic Stress

Myocardial Perfusion Scintigraphy with Thallium

Echocardiography

Exercise Echocardiography

Computed coronary tomography angiography(CCTA)

Positron Emission Tomography

Ambulatory ST Segment Monitoring

Electron Beam Tomography

Cardiac Magnetic Resonance Imaging

Coronary Angiography

Treatment

Medical Therapy

Revascularization

PCI
CABG
Hybrid Coronary Revascularization

Alternative Therapies for Refractory Angina

Transmyocardial Revascularization (TMR)
Spinal Cord Stimulation (SCS)
Enhanced External Counter Pulsation (EECP)
ACC/AHA Guidelines for Alternative Therapies in patients with Refractory Angina

Discharge Care

Patient Follow-Up
Rehabilitation

Secondary Prevention

Guidelines for Asymptomatic Patients

Noninvasive Testing in Asymptomatic Patients
Risk Stratification by Coronary Angiography
Pharmacotherapy to Prevent MI and Death in Asymptomatic Patients

Landmark Trials

Case Studies

Case #1

Chronic stable angina secondary prevention On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Chronic stable angina secondary prevention

CDC onChronic stable angina secondary prevention

Chronic stable angina secondary prevention in the news

Blogs on Chronic stable angina secondary prevention

to Hospitals Treating Chronic stable angina secondary prevention

Risk calculators and risk factors for Chronic stable angina secondary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Phone:617-632-7753; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

Overview

In patients with chronic stable angina, initiation of intensive risk factor modification remains an urgent and essential part of secondary prevention strategy, as they directly influence the prognosis. Based on the 27th Bethesda Conference, risk factor modification is divided into four categories according to both the strength of evidence for causation and the evidence that risk factor modification established significant reduction in the occurrence of future coronary events.[1]

Proposed Risk Factor Categories based on the 27th Bethesda Conference[1]

Category I: Risk factors for which interventions have proved to reduce the incidence of coronary artery disease events such as cigarette smoking, LDL cholesterol, dietary modification, hypertension and thrombogenic factors.

Category II: Risk factors for which interventions are likely, based on our current pathophysiologic understanding and on epidemiologic and clinical trial evidence, to reduce the incidence of coronary artery disease events such as diabetes, physical inactivity, HDL cholesterol, obesity and postmenopausal status.

Category III: Risk factors clearly associated with an increase in coronary artery disease risk and which, if modified, might lower the incidence of coronary artery disease events such as psychosocial factors, triglycerides, Lp(a), homocysteine, oxidative stress and alcohol consumption.

Category IV: Risk factors associated with increased risk but which cannot be modified or whose modification would be unlikely to change the incidence of coronary artery disease events such as age, gender, family history and many others.

European Systematic Coronary Risk Evaluation (SCORE) system [2]

  • The SCORE project, assembled a pool of datasets from 12 European cohort studies, representing 2.7 million person years of follow-up to predict any kind of fatal cardiovascular event over a ten-year period.
  • This system includes both non-modifiable and modifiable coronary risk factors such as:
to estimate a person’s total ten-year risk of cardiovascular death.
  • The threshold for being at high-risk according to the SCORE system is defined as greater than or equal to 5% since it estimates the fatal events and not the composite primary end-point. This system is shown to be most helpful in the decision-making process to intensify secondary prevention strategies. Hence, the SCORE risk estimation system offers direct estimation of total fatal cardiovascular risk in a format suited to the constraints of clinical practice.

Individual Topics for Secondary Prevention

You can read in greater detail about each of the risk factor modification topic below by clicking on the link for that topic.

Vote on and Suggest Revisions to the Current Guidelines

Guidelines Resources

References

  1. 1.0 1.1 Pasternak RC, Grundy SM, Levy D, Thompson PD (1996) 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 3. Spectrum of risk factors for coronary heart disease. J Am Coll Cardiol 27 (5):978-90. PMID: 8609364
  2. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G et al. (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 24 (11):987-1003. PMID: 12788299
  3. Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). %5bhttp://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf%5d "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology" Check |url= value (help). Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.
  4. Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. [1] PMID: 10351980
  5. Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58.[2] PMID: 12515758
  6. Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[3] PMID: 17998462

Template:WikiDoc Sources