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Braunwald

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SHAPE Society

Publicada em: Saúde e medicina
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Braunwald

  1. 1. APPROACH TO IDENTIFYING ANDAPPROACH TO IDENTIFYING AND MANAGING CORONARY RISKMANAGING CORONARY RISK Eugene Braunwald, M.D.Eugene Braunwald, M.D. March 6, 2004March 6, 2004
  2. 2. • Prevention of acute events must be the primary goal. Treatment should be regarded as “locking the barn door after the horse is stolen”
  3. 3. • One third of cases of sudden death and acute MI occur in previously asymptomatic persons - - previously regarded as “acts of God” • Most of these are now known to have pre- clinical disease, classical or novel risk factors • Need to identify high risk asymptomatic persons prospectively to provide intensive prevention
  4. 4. • All patients with clinically apparent atherosclerotic disease require intensive global risk factor reduction • Some have unstable placques (“accidents about to happen”) and these must be identified
  5. 5. <0.5%/yr 0.5-2%/yr 2-15%/yr >15%/yr Very High Risk High Risk Intermediate Risk Low Risk
  6. 6. Low riskLow risk Lifestyle &Lifestyle & 0.5%/yr0.5%/yr Follow-upFollow-up (40%)(40%) Framingham Risk ScoreFramingham Risk Score IntermediateIntermediate AdditionalAdditional CRP, Cholest., GlucoseCRP, Cholest., Glucose 0.5-2%/yr0.5-2%/yr TestingTesting (50%)(50%) High riskHigh risk IntensiveIntensive > 2%/yr> 2%/yr global riskglobal risk ↓ (10%)(10%)
  7. 7. Low riskLow risk Risk factorRisk factor ABIABI EBCTEBCT IMTIMT High riskHigh risk Intensive global + non-invasiveIntensive global + non-invasive riskrisk detection ofdetection of unstableunstable placque(s)placque(s)
  8. 8. Non-invasiveNon-invasive Detection +Detection + novel anti-novel anti- ++ inflammatoriesinflammatories 25%/yr25%/yr anti-thrombotic Rx;anti-thrombotic Rx; Very high risk Invasive detectionVery high risk Invasive detection CABG, multiCABG, multi 15%/yr15%/yr of unstableof unstable DESDES 2%2% placquesplacques -- 10%/yr10%/yr continue intensivecontinue intensive risk factorrisk factor ↓

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