慢性稳定性心绞痛的治疗（英文）.ppt

GUIDELINES FOR THE MANAGEMENT OF CHRONIC STABLE ANGINA American College of Cardiology, Puerto Rico Chapter, February 6, 2007 The Goals of Therapy in CAD To improve quality of life (symptoms) To reduce mortality To reduce morbidity To reduce progression of disease and induce regression. MEDICAL THERAPY ANTIPLATELETS BETA BLOCKERS NITRATES CALCIUM ANTAGONIST ACEI STATINS NEW THERAPIES ANTIPLATELET AGENTS ASA Physicians’ Health Study Swedish Angina Pectoris Trial TICLOPIDINE CLOPIDOGREL CAPRI CURE Receptor GP IIb-IIIa: The Final Common Pathway to Platelet Aggregation PHYSICIANS HEALTH STUDY The trials Data and Safety Monitoring Board stopped the aspirin arm of the PHS several years ahead of schedule because it was clear that aspirin had a significant effect on the risk of a first myocardial infarction. As reported in the July 20, 1989 New England Journal of Medicine,?aspirin reduced the risk of first myocardial infarction by 44% (P less than 0.00001). There were too few strokes or deaths upon which to base sound clinical judgment regarding aspirin and stroke or mortality Pharmacotherapy for Chronic Stable Angina (class I) 1. Aspirin in the absence of contraindications A? 2. Beta-blockers as initial therapy in the absence of contraindications in patients with prior myocardial infarction or without prior myocardial infarction A,B ?3. ACE inhibitor in all patients with CAD who also have diabetes and/or LV systolic dysfunction A? 4. LDL-lowering therapy in patients with documented or suspected CAD and LDL cholesterol 130 mg/dl, with a target LDL of 100 mg/dl A ?5. Sublingual nitroglycerin or nitroglycerin spray for the immediate relief of angina B? 6. Calcium antagonists ? or long-acting nitrates as initial therapy for reduction of symptoms when beta blockers are contraindicated B ?7. Calcium antagonists ? or long-acting nitrates in combination with beta blockers when initial treatment with beta blockers is not successful B? 8. Calcium antagonists ? and long-acting