Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Acc 04 vuln pt

70 views

Published on

SHAPE Society

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Acc 04 vuln pt

  1. 1. APPROACH TO IDENTIFYING AND MANAGING CORONARY RISK Eugene Braunwald, M.D. March 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 ↓

×