2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease by Stephan D. Fihn, Julius.

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Presentation transcript:

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease by Stephan D. Fihn, Julius M. Gardin, Jonathan Abrams, Kathleen Berra, James C. Blankenship, Apostolos P. Dallas, Pamela S. Douglas, JoAnne M. Foody, Thomas C. Gerber, Alan L. Hinderliter, Spencer B. King, Paul D. Kligfield, Harlan M. Krumholz, Raymond Y.K. Kwong, Michael J. Lim, Jane A. Linderbaum, Michael J. Mack, Mark A. Munger, Richard L. Prager, Joseph F. Sabik, Leslee J. Shaw, Joanna D. Sikkema, Craig R. Smith, Sidney C. Smith, John A. Spertus, and Sankey V. Williams Circulation Volume 126(25):e354-e471 December 18, 2012 Copyright © American Heart Association, Inc. All rights reserved.

Applying Classification of Recommendations and Level of Evidence. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Spectrum of IHD. Guidelines relevant to the spectrum of IHD are in parentheses. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Diagnosis of patients with suspected ischemic heart disease.* *Colors correspond to the class of recommendations in the ACCF/AHA Table 1. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Algorithm for risk assessment of patients with SIHD.* *Colors correspond to the class of recommendations in the ACCF/AHA Table 1. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Algorithm for guideline-directed medical therapy for patients with SIHD.* *Colors correspond to the class of recommendations in the ACCF/AHA Table 1. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Algorithm for revascularization to improve survival of patients with SIHD.* *Colors correspond to the class of recommendations in the ACCF/AHA Table 1. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Algorithm for revascularization to improve symptoms of patients with SIHD.* *Colors correspond to the class of recommendations in the ACCF/AHA Table 1. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

The Ischemic Cascade. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Nomogram to predict risk of death based on clinical data and results of exercise testing. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Euro heart score sheet to calculate risk score for patients presenting with stable angina (derived from 3779 patients with newly diagnosed SIHD). *≥1 of previous cerebrovascular event; hepatic disease defined as chronic hepatitis or cirrhosis, or other hepatic disease causing elevation of transaminases ≥3 times upper limit of normal; PVD defined as claudication either at rest or on exertion, amputation for arterial vascular insufficiency, vascular surgery (reconstruction or bypass) or angioplasty to the extremities, documented aortic aneurysm, or noninvasive evidence of impaired arterial flow; chronic renal failure defined as chronic dialysis or renal transplantation or serum creatinine >200 mmol/L; chronic respiratory disease defined as a diagnosis previously made by physician or patient receiving bronchodilators or FEV1 50% predicted in previous studies; chronic inflammatory conditions defined as a diagnosis of rheumatoid arthritis, systemic lupus erythematosus or other connective tissue disease, polymyalgia rheumatica, and so on; malignancy defined as a diagnosis of malignancy within a year of active malignancy. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Risk of death or MI over 1 year after diagnosis of SIHD according to Euro heart score. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Nomogram showing the probability of severe (3-vessel or left main) coronary disease based on a 5-point score. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Nomogram for prediction of 5-year survival from clinical, physical examination, and cardiac catheterization findings. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

One-year mortality rates in randomized trials of patients with diabetes and multivessel CAD, comparing PCI (experimental) with CABG (control). Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Incidence of cardiac death or nonfatal MI during follow-up after a normal stress MPI. Adapted with permission from Hachamovitch et al.327 MI indicates myocardial infarction; MPI, myocardial perfusion imaging. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Cumulative incidence of MACE in patients with 3-vessel CAD based on SYNTAX score at 3-year follow-up in the SYNTAX trial treated with either CABG (blue) or PCI (gold). Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.

Nomogram for Estimating 2-Year CAD Event-Free Survival (ie, Freedom From CAD Death or Nonfatal MI) by Using Percent Ischemic Myocardium in Intermediate-Likelihood Patients by Post- Stress LV. Stephan D. Fihn et al. Circulation. 2012;126:e354-e471 Copyright © American Heart Association, Inc. All rights reserved.