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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]
SINUS NODE INHIBITION:
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
“Chi va piano, va sano e va lontano”
Tartaruga: 6 bpm 150 anni di vita
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