Risultati per: Gestione dei pazienti con angina stabile

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Circulation, Volume 150, Issue Suppl_1, Page A4143127-A4143127, November 12, 2024. Background:Cross-sectional Seattle Angina Questionnaire (SAQ) scores not only measure patients’ symptoms, function and quality of life, but are also associated with prognosis in chronic coronary disease (CCD). Yet, the prognostic significance of serial SAQ scores in the modern era is unknown, particularly after revascularization.Hypothesis:Serial collection of SAQ scores can provide updatable estimates of clinical risk in patients with CCD.Aims:To describe the association of serial SAQ Summary Scores (SAQ-SS) with the primary endpoint of the ISCHEMIA trial (CV death, MI, or hospitalization for heart failure, unstable angina, or resuscitated cardiac arrest), stratified by medical management and recent revascularization.Methods:Analyses were framed from the perspective of a clinician reviewing the SAQ-SS in clinic and seeking to understand whether the prior score, the current score, or the change was most prognostic of subsequent clinical events. Cox models were created using the 3-month, 6-month, and change between the 3- and 6-month SAQ-SS scores, individually, as well as those scores in combination to find the most prognostic permutation. Each model was adjusted for 17 potentially confounding covariates. We performed separate analyses for the conservative and invasive management cohorts. In the conservative group, we excluded those who underwent revascularization prior to their 6-month assessment. In the invasive group, we included only patients who were revascularized within the first three months. In both groups, we excluded patients with events prior to 6 months.Results:In both the conservatively managed (n=1965) and recent revascularization (n=1447) cohorts, unadjusted analyses estimated a 6-9% lower risk of clinical events over a median of 3.2 years for each 5-point increase in SAQ-SS score. The current SAQ-SS score was most strongly associated with clinical events, even after including the prior SAQ-SS score and all other covariates (Table).Conclusions:Routine clinical use of the SAQ provides an updatable measure of risk in patients with CCD—managed either medically or with revascularization—with the current SAQ-SS score demonstrating the strongest association with clinical events.

Circulation, Volume 150, Issue Suppl_1, Page A4142676-A4142676, November 12, 2024. Background:Interview techniques for angina pectoris in patients with chest pain have demonstrated a low positive probability of 35.7% (PROMISE study) when using the Diamond-Forrester approach, which evaluates pre-test probability (PTP) based on classic chest symptoms, age, and gender. Therefore, it is beneficial to use artificial intelligence (AI) to create a more precise medical interview system by combining patient clinical data. Our objective is to create such a system.Methods:A medical interview is taken from patients presenting with chest pain as a chief complaint. Then, coronary artery examinations (CAG, contrast-enhanced CT, stress tests) will be conducted to definitively diagnose angina. The results of these definitive diagnoses will be combined with the patients’ baseline data to develop an AI algorithm. The input attributes used for the interview are listed in Table 1. A multilayer perceptron (MLP) was applied to predict patients diagnosed with angina pectoris, and these models were validated using 10-fold cross-validation.Results:There were a total of 315 patients, of whom 135 were diagnosed with angina pectoris. Additionally, patient information including atherosclerosis risk factors such as diabetes (102 cases), dyslipidemia (216 cases), hypertension (225 cases), and smoking status (never: 141 cases, past: 124 cases, current: 23 cases) were added as attributes and analyzed. Using only medical interviews and setting the threshold at 80% (where the AI determined the probability of angina to be 80% or higher), the prediction accuracy was 62.6%, with a sensitivity of 30.8% and a specificity of 87.7%. The precision was 66.6%. Additionally, when the four atherosclerosis risk factors were included, the prediction accuracy increased to 69.9%. Notably, the precision reached 79.9%. (Figure1)Conclusion:Our AI system based on interview data demonstrated high accuracy for diagnosis of angina while it was improved by adding the attribute of the four atherosclerosis risk factors. Further investigation is needed to complete a highly accurate AI-based application by increasing the number of samples.

Circulation, Volume 150, Issue Suppl_1, Page A4147752-A4147752, November 12, 2024. Background:Angina with no obstructive coronary arteries (ANOCA) is clinically challenging to diagnose and manage. The agreement between Doppler-derived coronary flow reserve (CFRDoppl) and PET-derived CFR (CFRPET) in patients with ANOCA remains unclear.Aims:To evaluate the correlation between Doppler- and PET-derived CFR in patients with ANOCA.Methods:We conducted a single-center, retrospective study of adult patients (age ≥18 years) with ANOCA who were referred for evaluation of possible microvascular ischemia with Doppler- and PET-derived CFR at the Mayo Clinic (Rochester, MN) between January 1, 2018, and May 1, 2024. Pearson correlation was used to quantify the association between Doppler- and PET-derived CFR. Agreement between Doppler- and PET-derived CFR was assessed by Bland-Altman analysis using a 2-way mixed effects model with measures of absolute agreement.Results:A total of 66 patients were initially identified, of which 40 were included in the final analysis (66.7% female, median age 58 years [Q1-Q3: 45-66 years]). Median time between PET- and Doppler-derived CFR was 8 days (Q1-Q3: 1-31 days). Median CFRDopplwas 2.75 (IQR: 2.23-3.28) and median CFRPETwas 2.50 (IQR: 2.10-3.10). Doppler-derived CFR displayed a wider range than PET-derived CFR (0.8-5.2 vs 1.2-4.0). A strong correlation was found between Doppler- and PET-derived CFR (r=0.81; p

Circulation, Volume 150, Issue Suppl_1, Page A4146729-A4146729, November 12, 2024. Background:Although residual angina after revascularization for chronic coronary disease (CCD) is common, it is unclear if the cause is incomplete revascularization of epicardial coronary disease or other ischemic mechanisms such as microvascular dysfunction or vasospastic angina.Methods:Among invasively managed ISCHEMIA trial participants with angina at baseline and anatomic complete revascularization (ACR) determined by core lab analysis, the frequency of and characteristics associated with residual angina and its association with health status, medication use at 6 months, and 5-year all-cause and cardiovascular (CV) mortality were assessed. The Seattle Angina Questionnaire Angina Frequency (SAQ AF) was used in a binary fashion to define residual angina as a score