Professional Documents
Culture Documents
COM
GII THIU
GII THIU CAC TAI NGHIN CU KHOA HOC TAI HI NGHI NI KHOA TOAN QUC TAI THANH PH H CHI MINH THANG 7/ 2011
DEMA-CVN.COM
PGS.TS. NGUYN QUANG TUN, FACC DEMA-CVN.COM VIN TIM MACH VIT NAM
Mc tiu ca iu tr trong TN
1.
2.
DEMA-CVN.COM
CANTHIP
NI KHOA
DEMA-CVN.COM
Ch nh chp MV
Nhm A: C ch nh chp MV Bnh nhn c mc au ngc r (CCS III IV) v khng khng ch c vi iu tr ni khoa ti u. Bnh nhn c nguy c cao theo phn tng nguy c trn cc thm d khng chy mu. Bnh nhn c au tht ngc m sng st sau cp cu ngng tun hon hoc c bit c ri lon nhp trm trng Bnh nhn au tht ngc c km theo du hiu ca suy tim Bnh nhn ang chun b cho phu thut mch mu ln Bnh nhn au tht ngc m ngh nghip hoc li sng c nhng nguy c bt thng (phi cng, din vin xic)
DEMA-CVN.COM
NGC N INH
DEMA-CVN.COM
DEMA-CVN.COM
1. 2. 3.
4.
ESC Guidelines on the management of stable angina pectoris. Eur. Heart J 2006 ; 27 : 1341-1381 DEMA-CVN.COM
Cn bng s n nh mng x va
lipid, oxy ho Lipid Nhim trng? Tnh nhy cm di truyn Thuc gim lipid mu Chng oxy ha? Tn thng c hc
Qu trnh vim
Sa cha
Mng x va khng n nh
Mng x va n nh
LIN QUAN GIA LDL-C VA BIN CHNG TIM MACH: CANG THP CANG TT?
30 4S - Pl 25
20
4S - Rx
LIPID - Pl 15 LIPID - Rx CARE - Rx HPS - Rx TNT Atv10 PROVE-IT - Pra TNT Atv80 PROVE-IT Atv AFCAPS - Rx ASCOT - Pl ASCOT - Rx 0 40 (1.0) 60 (1.6) 80 (2.1) 100 (2.6) 120 (3.1) 140 (3.6) 160 (4.1) 180 (4.7) 200 (5.2) CARE - Pl
HPS - Pl
10
AFCAPS - Pl
6
WOSCOPS - Rx
DEMA-CVN.COM Rosenson RS. Exp Opin Emerg Drugs 2004;9(2):269-279, LaRosa JC et al. N Engl J Med 2005;352:1425-1435.
LIN QUAN GIA TIN TRIN CA XVM TRN IVUS VA CAC BIN CHNG QUA 18 THNG THEO DI
60 50
Observational study of plaques in left main coronary arteries of patients with established atherosclerosis. DEMA-CVN.COM PCI=percutaneous catheter intervention. Adapted with permission from von Birgelen C, et al. Circulation. 2004;110:1579-1585.
1.3 1.2
Odds ratio
Q1 Lowest Q2 Q3 Q4 Highest
Cng sm cng tt
1.1 1.0 0.9 0.8 -4 2 4 Annual Change Percent Atheroma Volume DEMA-CVN.COM Nicholls SJ et al J Am Coll Cardil 2010;55:2399-407 -2 0
Athero Athero regression progression More MACE Fewer MACE
The patients were enrolled if a change of 6 months in the site of the proximal reference from an ACS culprit lesion could be precisely measured by IVUS. The exclusion criteria were death and cardiovascular events before follow-up IVUS and repeat revascularization therapy at follow-up IVUS.
2 risk factors
(10-yr risk <10%)
190 -
160
mg/dL
160 -
goal
goal
130
mg/dL
130
mg/dL
goal
100
mg/dL
or optional
100
mg/dL*
100 or optional
70 mg/dL*
70 *Therapeutic option
DEMA-CVN.COM 70 mg/dL =1.8 mmol/L; 100 mg/dL = 2.6 mmol/L; 130 mg/dL = 3.4 mmol/L; 160 mg/dL = 4.1 mmol/L Grundy SM et al. Circulation 2004;110:227-239.
T bin c (%)
T vong do tim mch, NMCT khng t vong hay cp cu ngng tun hon RRR: 20%, P=0,0003 Placebo
12 10 8 6
9,9%
8,0%
Perindopril
2
0 0 1 2 3 4 5
nm
6108 6110 5943 5957 5781 5812 5598 5653 4450 4515 71 64
RRR 20%
P=0,0003
RRR 28%
P=0,004
9.9% 8.0%
8.7%
6.3%
placebo
Perindopril
placebo
Perindopril
Gin mch
nh hng n Ti cu trc
Chng vim
Cung
Khu knh MV p lc ti mu Nng Hb Thi gian TTr
DEMA-CVN.COM
3 nhm b/n:
Vn ng tng TS tim 150/ph Nhm MV bnh thng: tng tit din MV (+ 31%) v tng lu lng MV (+ 137%) Nhm hp nh (< 30%): tit din MV gim (- 10%) v lu lng MV tng nh (+ 10%)
Nhm hp nng (> 70%): co MV nng (- 73% tit din) v gim nng lu lng (- 70%)
DEMA-CVN.COM
2.0 1.0
0.5
Phn tch gp hi cu t
12 nghin cu c i chng 0
-5 -10
DEMA-CVN.COM
HR (bpm)
-15
-20
In the treatment of stable angina, it is conventional to adjust the dose of betablockers to reduce heart rate at rest to 55 to
DEMA-CVN.COM
J AM Coll Cardiol. 2003;41:159-168
c t Lai Lt Ma 2009
DEMA-CVN.COM
Metoprolol Atenolol
Bisoprolol
37 50
50
75 (50-100) 50 (25-50)
5 (5-7.5)
200 100
10
Km dung np thuc qua theo di lu di: sau 1, 3, v 5 nm theo th t 78%, 64%, v 58% nhng ngi sng st tip tc iu tr -blockers
DEMA-CVN.COM
Gislason GH, et al. Eur Heart J. 2006;27:1153-1158.
10 Placebo
10
Placebo
5
42%
5
73% Ivabradine
Ivabradine
0 0 0.5 1 Years 1.5 2 0 0 0.5 1 Years
1.5
DEMA-CVN.COM
Fox K, et al. Eur Heart J. 2009 FASTTRACK.
Intolerant or contraindication
HR > 60 bpm
If inhibitor
Intolerant Symptoms not controlled after dose optimization
Add If inhibitor
Gio dc sc kho
Bin php rt hiu qu:
Thng b b qua
MMWR Morb Mortal Wkly Rep 1998;47:91-5 DEMA-CVN.COM
NGNG HT THUC LA
Bt u bng thay i li sng: kim sot trng lng c th, tng hot ng th lc, ung ru va phi, gim n mui, tng n rau qu ti v cc sn phm cha t cht bo.
Huyt p 140/90 mmHg (hay 130/80 vi bnh thn mn hay tiu ng) Nu dung np c, nn bt u bng thuc h p (chn bta, c ch men chuyn, thiazide) t c huyt p mc tiu.
NGHIN CU INVEST
Nghin cu a trung tm: 862 trung tm ti 14 nc.
i tng nghin cu: bao gm 22.576 bnh nhn THA v bnh MV. Mc tiu nghin cu: xc nh xem liu vic h huyt p thp c lm tng t l t vong v bin chng hay khng? (t vong, NMCT khng t vong)
NGHIN CU ACCORD
Nghin cu a trung tm: 77 trung tm ti Hoa k v Canada.
i tng nghin cu: bao gm 10.251 bnh nhn T tp 2 c nguy c cao b NMCT v t qu.
Mc tiu nghin cu: xc nh xem liu vic iu tr h ng mu tch cc hn c lm gim cc bin chng tim mch nh NMCT, t qu v t vong do tim mch cc bnh nhn T tp 2 c nguy c cao b bin chng tim mch hay khng?
NGHIN CU ACCORD
Phng php nghin cu: cc bnh nhn c chia ngu nhin thnh 2 nhm:
5.128 bnh nhn iu tr h ng mu tch cc hn cc khuyn co hin hnh (HbA1C < 6%).
5.123 bnh nhn iu tr theo quy chun (HbA1C: 7-7,9%).
Tp luyn th lc
Mc tiu: t nht 30 pht mi ngy 5 ngy mi tun
I IIa IIb III
Tp luyn vi cng trung bnh 30-60 pht mi ngy nh i b nhanh tt c cc ngy trong tun. Vi cc bnh nhn c nguy c cao nh hi chng vnh cp, ti to mch, suy tim th cn c s gim st ca nhn vin y t.
Nu vng bng > 90 cm nam gii, 80 cm n gii th bt u thay i li sng v xem xt vic iu tr hi chng chuyn ho nu c ch nh. Mc tiu ban u iu tr gim cn vo khong 10% so vi ban u, nu thnh cng th c th xem xt gim cn thm nu c ch nh.
495 (0.6)
888 (1.1) 457 (0.6) 466 (0.6) 398 (0.5) 943 (1.2) 2387 (3.1)
581 (0.9)
1026 (1.6) 535 (0.9) 538 (0.9) 427 (0.7) 1361 (2.2) 2910 (4.7)
<0.001
<0.001 0.001 0.002 0.018 <0.001 <0.001
0.81 (0.700.92)
0.84 (0.720.97) 0.52 (0.470.57) 0.65 (0.620.70)
Community cohort of 140,055 subjects in the 19981999 season of which 55.5 % were immunized. DEMA-CVN.COM Nichol et al. N Engl J Med 2003;348:1322-32.
DEMA-CVN.COM King III et al. PCI Focused update. JACC Vol 51, No 2, 2008.
KT LUN
1. iu tr ni khoa l c bn, chp MV bnh nhn c nguy c cao.
DEMA-CVN.COM