Klinische Studien zur antithrombotischen Therapie kardiovaskulärer Erkrankungen

2020 ◽  
Vol 49 (03) ◽  
pp. 57-61
Author(s):  
Christoph B. Olivier ◽  
Christoph Bode ◽  
Daniel Dürschmied
Keyword(s):  
Vitamin K ◽  
European Society ◽  
Klinische Studien ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Vitamin K Antagonist ◽  
Orale Antikoagulation ◽  
P2y12 Inhibitor ◽  
European Society Of Cardiology

ZUSAMMENFASSUNGDieser Artikel soll einen Überblick über klinische Studien des Jahres 2019 zur antithrombotischen Therapie kardiovaskulärer Erkrankungen geben. Im Jahr 2019 wurden auf den jährlichen Hauptkongressen der 3 international führenden kardiovaskulären Gesellschaften (American College of Cardiology, European Society of Cardiology und American Heart Association) 15 Studien zur antithrombotischen Therapie kardiovaskulärer Erkrankungen vorgestellt und in einer der führenden Fachzeitschriften veröffentlicht. Der Trend geht zu einer personalisierten antithrombotischen Therapie. Während eine verkürzte Dauer der Thrombozytenaggregationshemmung nach perkutaner Koronarintervention eher sicher erscheint, profitieren Patienten mit hohem individuellem ischämischen Risiko möglicherweise von einer verlängerten intensivierten antithrombotischen Therapie. Die Standardtherapie für Patienten mit Vorhofflimmern nach perkutaner Koronarintervention besteht aus einem Nicht-Vitamin-K-Antagonist oralen Antikoagulanz und einem P2Y12-Inhibitor. Nach 12 Monaten ohne neues Ereignis reicht bei den meisten dieser Patienten eine orale Antikoagulation ohne zusätzliche Thrombozytenaggregationshemmung aus. Nach Katheter-gestütztem Aortenklappenersatz kann für Patienten ohne Indikation für eine orale Antikoagulation eine Therapie mit 10 mg Rivaroxaban nicht empfohlen werden.

Stellenwert von MINOCA beim akuten Koronarsyndrom ohne ST-Streckenhebung

2021 ◽  
Vol 10 (02) ◽  
pp. 138-142
Author(s):  
Janine Pöss ◽  
Holger Thiele
Keyword(s):  
Myocardial Infarction ◽  
Coronary Arteries ◽  
European Society ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Spezifische Therapie ◽  
Scientific Statement ◽  
European Society Of Cardiology

ZusammenfassungBei 5–6% aller Patienten mit akutem Myokardinfarkt, die einer Koronarangiografie unterzogen werden, liegt ein Myokardinfarkt mit nicht obstruktiven Koronarien (myocardial infarction with non-obstructive coronary arteries; MINOCA) vor. Eine angemessene Diagnostik ist erforderlich, um die zugrunde liegende Ursache zu identifizieren und eine spezifische Therapie einzuleiten. Im Jahr 2019 hat die American Heart Association (AHA) in einem Scientific Statement eine überarbeitete Definition für den Begriff MINOCA vorgestellt und diese in ein klinisch sinnvolles Gerüst mit diagnostischen und therapeutischen Algorithmen zum Management von Patienten mit MINOCA eingebettet . Die im August 2020 aktualisierte Leitlinie der European Society of Cardiology (ESC) zum akuten Koronarsyndrom ohne persistierende ST-Strecken-Hebungen (NSTE-ACS) widmet dem Thema MINOCA ein eigenes, neues Kapitel . Folgender Beitrag fasst die wesentlichen Aspekte zusammen und gibt einen Überblick über dieses Krankheitsbild.

scholarly journals Recommendations and Associated Levels of Evidence for Statin Use in Primary Prevention of Cardiovascular Disease: A Comparison at Population Level of the American Heart Association/American College of Cardiology/Multisociety, US Preventive Services Task Force, Department of Veterans Affairs/Department of Defense, Canadian Cardiovascular Society, and European Society of Cardiology/European Atherosclerosis Society Clinical Practice Guidelines

2021 ◽  
Vol 14 (9) ◽  
Author(s):  
Jelena Pavlović ◽  
Philip Greenland ◽  
Oscar H. Franco ◽  
Maryam Kavousi ◽  
M. Kamran Ikram ◽  
...  
Keyword(s):  
European Society ◽  
Department Of Defense ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Canadian Cardiovascular Society ◽  
European Atherosclerosis Society ◽  
European Society Of Cardiology

Background: Despite using identical evidence to support practice guidelines for lipid-lowering treatment in primary prevention of cardiovascular disease (CVD), it is unclear to what extent the 2018 American Heart Association/American College of Cardiology/Multisociety, 2016 US Preventive Services Task Force (USPSTF), 2020 Department of Veterans Affairs/Department of Defense, 2021 Canadian Cardiovascular Society, and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines differ in grading and assigning levels of evidence and classes of recommendations (LOE/class) at a population level. Methods: We included 7262 participants, aged 45 to 75 years, without history of CVD from the prospective population-based Rotterdam Study. Per guideline, proportions of the population recommended statin therapy by LOE/class, sensitivity and specificity for CVD events, and numbers needed to treat at 10 years were calculated. Results: Mean age was 61.1 (SD 6.9) years; 58.2% were women. American Heart Association/American College of Cardiology/Multisociety, USPSTF, Department of Veterans Affairs/Department of Defense, Canadian Cardiovascular Society, and European Society of Cardiology/European Atherosclerosis Society strongly recommended statin initiation in respective 59.4%, 40.2%, 45.2%, 73.7%, and 42.1% of the eligible population based on high-quality evidence. Sensitivity for CVD events for treatment recommendations supported with strong LOE/class was 86.3% for American Heart Association/American College of Cardiology/Multisociety (IA or IB), 69.4% for USPSTF (USPSTF-B), 74.5% for Department of Veterans Affairs/Department of Defense (strong for), 93.3% for Canadian Cardiovascular Society (strong), and 66.6% for European Society of Cardiology/European Atherosclerosis Society (IA). Specificity was highest for the USPSTF at 45.3% and lowest for European Society of Cardiology/European Atherosclerosis Society at 10.0%. Estimated numbers needed to treat at 10 years for those with the strongest LOE/class were ranging from 20 to 26 for moderate-intensity and 12 to 16 for high-intensity statins. Conclusions: Sensitivity, specificity, and numbers needed to treat at 10 years for assigned LOE/class varied greatly among 5 CVD prevention guidelines. The level of variability seems to be driven by differences in how the evidence is graded and translated into LOE/class underlying the treatment recommendations by different professional societies. Efforts towards harmonizing evidence grading systems for clinical guidelines in primary prevention of CVD may reduce ambiguity and reinforce updated evidence-based recommendations.

scholarly journals Prevalência de alto risco cardiovascular na população adulta brasileira segundo diferentes critérios: estudo comparativo

2021 ◽  
Vol 26 (4) ◽  
pp. 1221-1231
Author(s):  
Deborah Carvalho Malta ◽  
Pedro Cisalpino Pinheiro ◽  
Renato Teixeira Azeredo ◽  
Filipe Malta Santos ◽  
Antonio Luiz Pinho Ribeiro ◽  
...  
Keyword(s):  
European Society ◽  
Framingham Heart Study ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Heart Study ◽  
European Society Of Cardiology

Resumo O estudo visa comparar a proporção de indivíduos classificados como portadores de alto risco cardiovascular (RCV) na população adulta brasileira, segundo seis diferentes calculadoras de risco, visando analisar a concordância entre as medidas. Estudo transversal, no qual foram utilizados dados laboratoriais da Pesquisa Nacional de Saúde (PNS). As prevalências do RCV em 10 anos para a população entre 45 e 64 anos foram: Escore de risco global (ERG) da Sociedade Geral de Cardiologia (SBC):38,1%, “American College of Cardiology” e “American Heart Association” ACC/AHA, 44,1%, “Framingham Heart Study”/ERG 19,4%, SCORE da “European Society of Cardiology”, 14,6, Organização Mundial da Saúde/Sociedade Internacional de hipertensão (OMS/ISH) e Lim et al. As calculadoras de RCV apresentaram baixa concordância para identificar os indivíduos de alto risco e alta concordância dos de risco baixo/moderado, exceto pela ACC/AHA. O emprego de diferentes calculadoras resultou em diferentes populações elegíveis para iniciar a terapia farmacológica para prevenção cardiovascular, o que pode implicar em percepções de risco inadequadas, baixo custo efetividade desse tratamento e dificuldade de implementação de políticas públicas.

scholarly journals Levels of Evidence Supporting American College of Cardiology/American Heart Association and European Society of Cardiology Guidelines, 2008-2018

JAMA ◽  
2019 ◽  
Vol 321 (11) ◽  
pp. 1069 ◽  
Author(s):  
Alexander C. Fanaroff ◽  
Robert M. Califf ◽  
Stephan Windecker ◽  
Sidney C. Smith ◽  
Renato D. Lopes
Keyword(s):  
European Society ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
Levels Of Evidence ◽  
European Society Of Cardiology

scholarly journals New АСС/AHA and ESC/ESH arterial hypertension guidelines

2018 ◽  
Vol 17 (5) ◽  
pp. 99-119 ◽  
Author(s):  
E. V. Reznik ◽  
I. G. Nikitin
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
European Society ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
National Guidelines ◽  
Hypertension Guidelines ◽  
European Society Of Cardiology ◽  
Detection Evaluation

The American College of Cardiology and the American Heart Association updated the guideline for the prevention, detection, evaluation and management of high blood pressure in adults in 2017 The European Society of Cardiology and the European Society оf Hypertension updated guidelines for the management of arterial hypertension in 2018. This article reviews new positions of these documents, compares approaches to current issues of managing of the patients with arterial hypertension, pro and contra with previous versions of similar documents. It is necessary to update the National guidelines for management of patients with arterial hypertension, which should include the dignity of both European and American approaches.

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