Chronic stable angina risk stratification
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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
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.
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
Guidelines for Risk Stratification of Chronic Stable Angina in Asymptomatic Patients
Risk Stratification by Noninvasive Testing | Coronary Angiography in Asymptomatic Patients
Vote on and Suggest Revisions to the Current Guidelines
Guidelines Resources
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [2]
- Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [3]
- The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [4]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [5]
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
- ↑ Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. PMID: 10351980
- ↑ Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology". Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.
- ↑ Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58. PMID: 12515758
- ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72. DOI:10.1161/CIRCULATIONAHA.107.187930 PMID: 17998462