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Finding and treating high-risk coronary patients

ESC Congress 2010

Clinical seminar: Finding and treating high-risk coronary patients
(chaipersons: Kristensen, Steen Dalby; Weis, Michael)

Chronic Ischaemic Heart Disease (IHD)

Professor A. Maseri, Florence, Italy has for decades been a leading researcher within the area of diagnosis and treatment of coronary ischaemia. He gave an excellent presentation on ‘What to do with the victims of non-invasive coronary angiography?’. The number of patients with chest pain and a normal CT-angiography is increasing rapidly, and research programmes on how to manage these patients are highly needed. Some of these patients should undergo further investigations to test their endothelial function. Coronary spasm is often a primary player in these patients. They will benefit from treatment with vasodilators and preventive measures that improve endothelial function.
The rapid development in CT technology is a challenge for the organization at the regional level. It was suggested to create imaging networks with centres of excellence surrounded by smaller diagnostic centres. Access to the newest high-resolution CT-technology is mandatory for optimal diagnosis.

In the next presentation Professor R. Bugiardini, Bologna, Italy emphasized that the prevalence of non-obstructive coronary artery disease is unknown but probably very high. More research on the importance of diagnosis and treatment of this condition is needed. Women with symptomatic non-obstructive coronary artery disease have a poorer prognosis than men. Proper diagnostic evaluation with measurement of the coronary flow reserve seems justified as these patients may benefit from optimal medical therapy.

Patients with stable coronary artery disease and proven myocardial ischaemia benefit from revascularization with PCI or CABG. Professor E. Barbato, Aalst, Belgium gave an excellent presentation on our diagnostic armamentarium for documentation of myocardial ischaemia. Stress test with myocardial scintigraphic demonstration of myocardial ischaemia is still used but recently, invasive evaluation of fractional flow reserve with pressure wire during adenosine infusion has been introduced, and this test is now the standard technique in many hospitals. A flow ratio above 0.80 indicates a non-obstructive lesion and there is no evidence at present to indicate that patients with such lesions will benefit from invasive therapy.

Professor T. R. Pedersen, Oslo, Norway, the primary investigator of the landmark 4S-trial, gave a very exciting talk entitled ‘Should we prescribe aspirin and statins to all subjects over 65?’ Aspirin should not be used routinely is these patients as the documentation for a beneficial benefit-risk ratio is lacking. Pedersen recommended the use of statins in subjects above 65 years of age, based on the large randomized statin trials that have been published. He also stated that the use of the polypill is an interesting concept that should be further explored.




Finding and treating high-risk coronary patients

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.