Acute coronary syndrome role of ct and statin in prevention care

Acute Coronary Syndrome : Role of CT and STATIN in Prevention Care BS CK II.. 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain... 2021 AHA/ACC Guideline for the Eval

Acute Coronary Syndrome : Role of CT and STATIN in Prevention Care

BS CK II Nguyễn Xuân Trình

Department of Cardiology- MEDIC Medical CenterMEDIC

ECG: RBBB

CHỤP MSCT MẠCH VÀNH

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TỒN TẠI TĨNH MẠCH CHỦ TRÊN TRÁI MEDIC

DISCUSSION

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The Spectrum Of Clinical Presentations, ECG Findings, and hs Troponin In ACS

2023 ESC Guidelines for the management of acute coronary

syndromes

Unstable Angina:

- Myocardial ischaemia at rest or on minimal exertion

in the absence of acute cardiomyocyte injury/necrosis

- Specific clinical findings:

- Prolonged (>20 min) angina at rest;

- New onset of severe angina;

- Angina that is increasing in frequency, longer

in duration,

- or lower in threshold; or angina that occurs

after a recent episode of MI

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Admir Dedic and Murat Arslan (2023) CT for suspected acute coronary syndrome Oliver Gaemperli EACVI Handbook of Cardiovascular CT P167-173 Oxford University Press

Gulati et al 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain Circulation.2021;144:e368–e454

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Gulati et al 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain Circulation.2021;144:e368–e454

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2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/ SCMR Guideline for the Evaluation and Diagnosis of Chest Pain

No CAD= No Stenosis or Plaque

ACS Occurs In Previously Documented Mild Stenosis

>>> The relative risk of high-risk plaque (HRP) for short-term MACE within the ED # 30 times

Rydzinski Y et al Coronary CT Angiography for Acute Chest Pain in the ER J Am Osteopath Coll Radiol 2017; Vol 6, Issue 2

Source: Chang JACC 2018, 71: 2511-22; Puchner JACC 2014; 64: 684-692; Ferencik JAMA Cardiol 2018;3:144-152;

Williams Circulation 2020; 141:1452-1462

Rozemarijn Vliegenthart Future Trends in CT for Coronary Artery Disease: From Diagnosis to Prevention Radiology 2023; 307(3):e223285

• The greatest role of CACS and CTCA is in a primary prevention

Thomas D Heseltine, et al Latest Advances in Cardiac CT Eur Cardiol.2020 Feb; 15: e01

Michael J Gallagher (2023) https://www.vumedi.com/term/ct/

Evidence on CT Guided Preventive Care

Michael J Gallagher (2023) https://www.vumedi.com/term/ct/

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Atherosclerosis Guided Treatment

Event rate curves (death, nonfatal MI) during 30-day follow-up period for patients with

continued statin therapy, withdrawn statin therapy, and without statin therapy.

Christopher Heeschenet al Withdrawal of Statins Increases Event Rates in Patients With Acute Coronary Syndromes.Circulation Vol 105, Issue 12, 26 March 2002; Pages 1452

Statin discontinuation was associated with a 33% increased risk of admission for cardiovascular event in 75-year old primary prevention patients.

Cardiovascular events after statin discontinuation

Eur Heart J, Volume 40, Issue 43, 14 November 2019, Pages 3516–3525, https://doi.org/10.1093/eurheartj/ehz458

(Hội Tim Mạch Học Việt Nam)

Mục tiêu giảm LDL-Cholesterol theo Hội Tim Mạch Châu Âu ESC 2019

• Acute Coronary Syndrome : Include STEMI, NSTEMI, and unstable angina, one-third of total deaths in people older than 35

• Role of Coronary CTA: From Diagnosis to Prevention.

• High Sensitivity, Specificity and NPV

• Non Obstructive CAD ( < 50% Stenosis) and Obstructive CAD ( ≥ 50% Stenosis)

• High-risk plaque features and PCAT CT attenuation Risk Stratification of Patients With Acute Chest Pain  Prevention

• STATIN: Primary-Secondary prevention :

• Statin therapy was associated with a reduced event rate

• Statin discontinuation was associated with a increased risk of cardiovascular event (death, nonfatal MI)

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Thank You

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