Beruflich Dokumente
Kultur Dokumente
Overview
Drug eluting stents: the controversy continues Bioabsorable stents: the next frontier Prevention of IE: New US guidelines Extreme exercise may not be good for the heart EUROASPIRE data and need for lifestlye changes No place for supplements as secondary prevention in CVD Limited use of oral anticoagulation in Atrial Fibrillation Stem cells: a paracrine effect in heart failure Highlights of new European guidelines on the prevention of cardiovascular disease and management of hypertension
GRACE
Observational registry of ACS Data on 6600 pts in 94 hospitals in 14 countries Compares outcomes DES with BMS Subset analysis looked at outcomes of STEMI pts Significant difference in survival between 6 months and 2 years: 8.6% with DES and 1.6% with BMS had died No evidence of increased mortality in NSTEMI Limitations:
No info on the type of DES or BMS use Characteristics of lesions: length, calcification or bifurcation
Progress study
61 patients followed for 12 months 9 followed for 28 months Fitted with AMS(Absorbable Metallic Stent) Mg2+ in alloy Findings: Complete degredation of stents Durability of results Restoration of vasoreactivity function of stented segment of the vessel
Are future of stenting Better data needed before use in routine practice
2) Prophylaxis recommended for all dental procedures involving manipulation of gingival tissue or periapical region of teeth or perforation of oral mucosa 3) Not recommended based on increased lifetime risk of acquiring IE 4) Not needed in GU of GI tract procedures
EUROASPIRE data
Results from 3rd EUROASPIRE study 8547 coronary patients in 8 countries Interviewed + examined early 90s, 2000, 2006/7 Obesity: rates from 25% to 38% Central obesity: rates 42% to 54% Smoking: Prevalence not changed Increased in younger pts (<50 years) and women
Diabetes: prevalence from 17%-28% Hypertension: no. of pts reaching target BP from 41% to 39% Large in prescriptions of antihypertensives Lipids: management much improved Need for preventive cardiology programmes Professional intervention by MDT for lifestyle change <1/3 of pts have access to structured preventive and rehabilitative programmes
Results: 30 day mortality 6.5% Compares to 20% with STS 13.8% mortality during 1st year 4.7% needed conversion to open heart surgery Success rate >90% At one year reoperation rate 1.6% Actual survival 74.4%
77 diagnosed on admission
On discharge 15% with known Afib were undertreated according to the guidelines Estimated that 25 of 89 cases could have been prevented but 5 more cases of intracranial haemorrhage To improve the situation CHADS2 score needs to be calculated
Most research done in MI Complications with stem cells in HF: established scars and diminished homing capabilities Promising results in recent studies (TOPCARE-CHF)
BOOST II trial Multicentre study with 200 pts BOOST I: positive effects in MI Aim: to assess effects on cardiac function To investigate whether the beneficial effects of stem cells are produced by paracrine mechanisms rather than proliferating cells that generate a new myocardium Future?? Need to improve cell delivery, isolation and storage Current study: penetrating the heart with US guided low energy shock waves cytokine levels homing capacity
Close relatives of subjects with premature atherosclerotic CVD or those at high risk
Primary prevention
No smoking Healthy food choices Activity: 30mins mod exercise/day BMI<25 kg/m2 Total cholesterol <5mmol/l LDL cholesterol <3mmol/l Blood glucose <6mmol/l
3) To achieve more rigorous risk factor control in high risk pts (established CVD or diabetes)
BP <130/80mmHg Total cholesterol <4.5mmol/l with option of 4mmol/l if feasible LDL cholesterol <2.5mm/l with option of <2mmol/l if feasible Fasting blood glucose <6mmol/l and HbA1c < 6.5%
Management of Lipids
For CVD, DM and lipid levels
Dietary and exercise advice and attention to all risk factors Some recommend statins for all CVD and DM pts regardless of baseline levels
QuickTime and a TIFF (Uncompressed) decompressor are needed to see this picture.
Angina pectoris
Heart failure
BB, CA
Diuretics, BB, ACEI, ARB, antialdosterone agents ARB, ACE BB, non-dihydropiridine CA ACEI, ARB, loop diuretics CA
Condition
ISH (elderly) Metabolic syndrome Diabetes Mellitus Pregnancy Blacks Diuretics, CA ACEI, ARB, CA ACEI, ARB CA, methyldopa, BB Diuretics, CA