Chronic stable angina risk stratification: Difference between revisions
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*History of [[smoking]] and [[diabetes]] | *History of [[smoking]] and [[diabetes]] | ||
*Presence of other [[peripheral vascular diseases]] | *Presence of other [[peripheral vascular diseases]] | ||
For a full discussion on individual risk stratifying topics, visit the microchapters below: | |||
:'''[[Chronic stable angina risk stratification electrocardiogram/chest x-ray|Electrocardiogram/chest X-ray]] | [[Chronic stable angina risk stratification rest left ventricular function|Assessment of resting LV function]] | [[Chronic stable angina risk stratification coronary angiography|Coronary angiography and left ventriculography]]''' | |||
:Exercise testing for Risk Stratification and Prognosis: | |||
:'''[[Chronic stable angina risk assessment in patients with an intermediate or high probability of coronary artery disease|Exercise treadmill test]] | [[Chronic stable angina risk stratification cardiac stress imaging in patients who are able to exercise|In patients who are able to exercise]] | [[Chronic stable angina risk stratification cardiac stress imaging in patients who are unable to exercise|In patients who are unable to exercise]]''' | |||
===Risk Stratification Categories and Appropriate Management=== | ===Risk Stratification Categories and Appropriate Management=== | ||
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*If the patient is unable to exercise then a [[Chronic stable angina risk stratification cardiac stress imaging in patients who are unable to exercise|pharmacological stress test]] is used to stratify the risk underlying the [[atherosclerosis|atherosclerotic state]]. | *If the patient is unable to exercise then a [[Chronic stable angina risk stratification cardiac stress imaging in patients who are unable to exercise|pharmacological stress test]] is used to stratify the risk underlying the [[atherosclerosis|atherosclerotic state]]. | ||
*For patients with [[ Canadian Cardiovascular Society#C.C.S. Class III|CCS class III or IV]] [[angina]], patients with poor [[LVEF]] or non responsive to medical therapy there may be some benefit to performing [[Chronic stable angina risk stratification coronary angiography|coronary angiography]]. | *For patients with [[ Canadian Cardiovascular Society#C.C.S. Class III|CCS class III or IV]] [[angina]], patients with poor [[LVEF]] or non responsive to medical therapy there may be some benefit to performing [[Chronic stable angina risk stratification coronary angiography|coronary angiography]]. | ||
===Guidelines for Risk Stratification of Chronic Stable Angina in Asymptomatic Patients=== | ===Guidelines for Risk Stratification of Chronic Stable Angina in Asymptomatic Patients=== | ||
Revision as of 16:30, 29 January 2013
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Chronic stable angina Microchapters | ||
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Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Diagnosis | ||
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Alternative Therapies for Refractory Angina | ||
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Discharge Care | ||
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Guidelines for Asymptomatic Patients | ||
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Case Studies | ||
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Chronic stable angina risk stratification On the Web | ||
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to Hospitals Treating Chronic stable angina risk stratification | ||
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Risk calculators and risk factors for Chronic stable angina risk stratification | ||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Smita Kohli, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
The average mortality in patients with stable angina ranges from 1-3%. However, the prognosis varies widely depending on various factors such as: the duration and severity of symptoms, resting ECG abnormalities, abnormal left ventricular function and associated comorbidities.[1]
Risk Stratification
Risk Stratification Based on Different Factors
Anatomic Factors
- Left ventricular function, indicated as the strongest predictor of long term survival
- Extent of atherosclerosis in the coronary arteries (single vessel disease vs multivessel disease)
- Evidence of a recent coronary plaque rupture (acute coronary syndrome)
- Overall health and presence of other co-morbidities
Clinical Factors
An initial scoring system was proposed by the Framingham Heart Study group to predict 10 year risk for patients with CAD based upon:
- Patient's age and sex
- Total cholesterol
- Presence of hypertension
- History of smoking and diabetes
- Presence of other peripheral vascular diseases
For a full discussion on individual risk stratifying topics, visit the microchapters below:
- Electrocardiogram/chest X-ray | Assessment of resting LV function | Coronary angiography and left ventriculography
- Exercise testing for Risk Stratification and Prognosis:
- Exercise treadmill test | In patients who are able to exercise | In patients who are unable to exercise
Risk Stratification Categories and Appropriate Management
- Patients at low risk have an annual mortality rate of less than 1% and can be managed medically.
- Patients at intermediate risk have an annual mortality rate of 1%–3% and may require additional imaging studies such as exercise imaging for further risk assessment.
- Patients at high risk have an annual mortality rate of more than 3% and require coronary angiography.
Risk Stratification of Chronic Stable Angina in Symptomatic Patients
The next step after establishing the clinical probability of angina is to assess the risk of underlying coronary artery disease based on initial rest ECG and the patients ability to exercise.
- If the rest ECG is abnormal, the next step is to conduct a stress imaging test.
- If the patient is unable to exercise then a pharmacological stress test is used to stratify the risk underlying the atherosclerotic state.
- For patients with CCS class III or IV angina, patients with poor LVEF or non responsive to medical therapy there may be some benefit to performing coronary angiography.
Guidelines for Risk Stratification of Chronic Stable Angina in Asymptomatic Patients
Risk Stratification by Noninvasive Testing | Coronary Angiography in Asymptomatic Patients
References
- ↑ Daly CA, De Stavola B, Sendon JL, Tavazzi L, Boersma E, Clemens F et al. (2006) Predicting prognosis in stable angina--results from the Euro heart survey of stable angina: prospective observational study. BMJ 332 (7536):262-7. DOI:10.1136/bmj.38695.605440.AE PMID: 16415069