The POLI- VASCULAR PATIENT Dr. Carlos A. Ingino MTSAC DIRECTOR de - PowerPoint PPT Presentation

“ The POLI- VASCULAR PATIENT” Dr. Carlos A. Ingino MTSAC DIRECTOR de la CARRERA de CARDIOLOGÍA, USAL JEFE de CARDIOLOGÍA, CLÍNICA LA SAGRADA FAMILIA JEFE de CARDIOLOGÍA, ENERI INSTITUTO MÉDICO

REACH registry • International Prevalence of Cardiovascular Risk Factors in Outpatients With Atherothrombosis Bhatt DL, et al. JAMA. 2006;295(2):180-189.

REACH registry • EVENTS RATE IN PTS WITH ATE • 68200 pt, 44 countries, • ˃45yo (mean age 69yo), 64% male • Stable Vascular Disease (81,7%) • or ≥3 Risk Factors (18,3%) • FU 1 year: CV death-MI-stroke Bhatt DL, et al. JAMA. 2006;295(2):180-189.

Prevalence and distribution of single-bed and polyvascular disease in “REduction of Atherothrombosis for Continued Health, REACH registry” Polivascular Disease 44,6% 16,6% Coronary Heart Disease 8,4% Cerebro-Vascular Disease 1,6% 4,7% 1,7% 4,7% 18,3% Peripheral Arterial Pts with RF with Disease no Vasc Dis Bhatt DL, et al. JAMA. 2006;295(2):180-189.

Prevalence and distribution of single-bed and polyvascular disease in “REduction of Atherothrombosis for Continued Health, REACH registry” Cerebro- Vascular Coronary Heart Disease 16,6% Disease 8,4% Peripheral Arterial Disease 1,6% 1,7% Polivascular Disease 41.3% 18,3% 28.3% Pts with RF with no Vasc Dis CVD + CHD - PVD

Prevalence and distribution of single-bed and polyvascular disease in “REduction of Atherothrombosis for Continued Health, REACH registry” Poli-Vascular Disease 1,6% Coronary Cerebro-Vascular 4,7% 1,7% Heart Disease Disease 61% 4,7% PAD + CHD - CVD Peripheral 12,7% Arterial Disease 18,3% Pts with RF with no Vasc Dis Bhatt DL, et al. JAMA. 2006;295(2):180-189.

Eventos en Aterotrombosis REACH registry Vasc Dis 4.5-6.5%/a ≥ 3 RF 2.15%/a The Vascular Disease is almost three times the incidence events rate/year vs. múltiples RF Steg G, et al. JAMA. 2007;297:1197-1206

Eventos en Aterotrombosis REACH registry CHD (59%) 4.5%/a CVD (28%) 6.5%/a PAD (12%) 5.4%/a A grater number of affected vascular territories, higher rate of vascular events Steg G, et al. JAMA. 2007;297:1197-1206

REACH Registry CV events in Polivascular Disease • 19179 polyvascular diseases patients • To evaluate events rate at 2 years of FU compared with single arterial bed disease • 1.63 [95% CI, 1.45-1.83], p < 0.0001). Suarez C, et al. REACH Registry. Vasc Med. 2010 Aug;15(4):259-65.

CRUSADE registry

Enfermedad Polivascular e IAM • CRUSADE registry: non-ST-segment elevation ACS – 95 749 pts, enroled from 2003 to 2006 at 486 sites in USA • Previous Arterial disease: None: 49% ; 1, 38% ; 2, 11% ; y 3, 1,6% Bhatt DL, et al. Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes. Eur Heart J. 2009;30:1195-1202

Enfermedad Polivascular e IAM

The PESA (Progression of Early Subclinical Atherosclerosis) Study • 4184 asymptomatic participants aged 40-54 years • To evaluate extent of atherosclerosis in the carotid , abdominal aortic and ilio-femoral territories by 2D/3D ultrasound and coronary artery calcification by CT Fernández-Friera L,, et al. PESA study. Circulation. 2015 Jun 16;131(24):2104-13

The PESA (Progression of Early Subclinical Atherosclerosis) Study • Subclinical atherosclerosis was present in 63% of participants (71% of men; 48% of women). • Plaques were most common in the ilio-femorals (44%) , followed by carotids (31%) and aorta (25%) , while CAC was present in 18% . • Intermediate and generalized atherosclerosis was identified in 41% Fernández-Friera L,, et al. PESA study. Circulation. 2015 Jun 16;131(24):2104-13

The PESA (Progression of Early Subclinical Atherosclerosis) Study Fernández-Friera L,, et al. PESA study. Circulation. 2015 Jun 16;131(24):2104-13

The PESA (Progression of Early Subclinical Atherosclerosis) Study Fernández-Friera L,, et al. PESA study. Circulation. 2015 Jun 16;131(24):2104-13

Eco-Doppler Arterial

Score de Calcio Coronario

ANKLE-BRACHIAL INDEX • ROTTERDAM Study ˃0.90 → 99,4% sin claudicación ≤0.90 → 6,3% con claudicación Claudicación intermitente • POBRE SENSIBILIDAD • ALTA ESPECIFICIDAD Meijer WT, et al. Peripheral arterial disease in the elderly: the Rotterdam Study. Arterioscler Thromb Vasc Biol. 1998;18:185 – 192

Monte INGINO Gubbio, Italia