Evaluation of Global Residual Cardiovascular Risk in Secondary Prevention - PDF

Evaluation of global residual cardiovascular risk in secondary prevention Pr Gilles LEMESLE USIC et Centre Hémodynamique, CHRU de Lille Pr Gilles LEMESLE Institut Pasteur de Lille, UMR 1011 USICFaculté et Centre Hémodynamique...

Evaluation of global residual cardiovascular risk in secondary prevention Pr Gilles LEMESLE USIC et Centre Hémodynamique, CHRU de Lille Pr Gilles LEMESLE Institut Pasteur de Lille, UMR 1011 USICFaculté et Centre Hémodynamique, de Médecine CHRU de l’Université de Lille de Lille Institut Pasteur de Lille, UMR 1011 Faculté de Médecine de l’Université de Lille  Disclosures Honoraria and fees: Amgen, Astra Zeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Lilly, MSD, Novartis, Pfizer, Sanofi Aventis, Servier, The medicine company Why should we evaluate this risk ? What is our goal ? To organize a closer follow-up of the higher risk patients To optimize a better care and more aggressive treatments especially when focusing on antithrombotics and LDL-lowering drugs but not only...  To evaluate the risk, it is... ① To evaluate the risk of MI or the need for new revascularization – Related to complications of previous revascularization => stent thrombosis – Related to the underlying disease => atherosclerosis progression and new plaque rupture ② To evaluate the risk of complications related to atherosclerosis progression in other arterial territories ③ To evaluate the risk of evolution towards heart failure +++ The concept of stable CAD and residual risk Risk Stable = linear curve But the slope may still be high Virtual curve of the absence of risk Time  What is your goal ? The stent, the atherosclerotic disease or both ? gi st ry R Re O NO COR Annual risk at 0.8% per year 1/5 of events Lemesle et al. JACC 2017;69(17):2149-2156 What are the factors associated with disease progression ?  str y The residual ischemic risk gi e Risk of the composite CV death, MI, Stroke R I FY A R C L STROKE ++++ Vidal-Petiot V, et al. Lancet.  The residual ischemic risk Risk of MI ist ry R eg N OR CO RO Lemesle et al. JACC 2017;69(17):2149-2156  The residual ischemic risk Risk of the composite CV death, MI, Stroke t ry gis e History of non-coronary vascular intervention R R O N RO CO Delsart et al. Eur J Prevent. Cardiol. 2015:22;864-71  The residual ischemic risk Risk of the composite CV death, MI, Stroke istry R eg EACH R Annual risk at 4% per year Abtan et al. Clinical Cardiology 2016;39(11):670–677  Multivessel CAD and impact on prognosis gistry Re EACH R CAD, coronary artery disease; HR, hazard ratio; MI, myocardial infarction Maddox TM, et al. JAMA 2014;312:1754–1763 Evaluation of coronary anatomy The SYNTAX score Evaluation of coronary anatomy The calcium score on CT Uebleis C et al. Radiology 2009;252:682-690  The CLARIFY Risk Model for CV death and MI y str gi R e I FY A R C L 12 variables associated with the risk of CV death and MI ESC 2018 - D’après Ford I et al., LB Registry 2980  Incidence cumulée du critère combiné mortalité cardiovasculaire et infarctus du myocarde, par quintiles de distribution du score de risque dans la population CLARIFY (n = 15,770) 25 1er quintile 2e quintile 3e quintile 20 4e quintile Pourcentage de patients 5e quintile avec évènement 15 10 5 0 0 1 2 3 4 5 Années de suivi ESC 2018 - D’après Ford I et al., LB Registry 2980 Le score TRS 2°P  To evaluate coronary anatomy Plaque vulnerability and endovascular imaging Stone et al. NEJM 2011;364:226-35  Evaluer le risque de thrombose de stent Quels sont les facteurs de risque identifiés dans la littérature : Approche multifactorielle ST Lemesle et al. ACVD 2008;101:769-777  Evaluer le risque de thrombose de stent Les plus fréquents Les plus puissants D'Ascenzo et al. IJC 2013 Jul 31;167(2):575-84  Conclusion The perfect control of cardiovascular risk factors The concept of diffuse and aggressive atherosclerosis : multivessel CAD and/or peripheral disease – More aggressive antithrombotic and LDL- lowering strategies