Was ist neu in der Kardiologie 2019? - Stephan Baldus Klinik III für Innere Medizin
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Was ist neu in der Kardiologie 2019? Stephan Baldus Klinik III für Innere Medizin 12.01.2019
of this. By contrast, STEMI usually presents with
www.bmj.com/ on 19 December 2018 by guest. Protected by copyright.
would expect this to result in lower rates of myocardial more pronounced symptoms and is usually treated
infarction before Christmas than afterwards. However, with minimal delay. Previous studies have shown a
the absence of any decline preceding or following
Risikotage liegen hinter uns...
Christmas indicates that these behavioural aspects
higher risk of myocardial infarction in the working
population.29 By contrast, we found the pattern to be
are not the main contributing factors to the Christmas similar in both retired (≥75 years) and younger patients
peak in myocardial infarction. (
of this. By contrast, STEMI usually presents with
www.bmj.com/ on 19 December 2018 by guest. Protected by copyright.
would expect this to result in lower rates of myocardial more pronounced symptoms and is usually treated
infarction before Christmas than afterwards. However, with minimal delay. Previous studies have shown a
the absence of any decline preceding or following
Risikotage liegen hinter uns...
Christmas indicates that these behavioural aspects
higher risk of myocardial infarction in the working
population.29 By contrast, we found the pattern to be
are not the main contributing factors to the Christmas similar in both retired (≥75 years) and younger patients
peak in myocardial infarction. (
Mentaler Stress - Myokardischämie
Hämodynamik Myocardial ischemia
Women Men
Herzfrequenz + 25/min Conventional stress
(n=300)
Myocardial ischemia 31% 16%
Blutdruck
Mental stress
systolisch + 41mmHg
(n=306)
diastolisch + 28mmHg
Myocardial ischemia 22% 11%
Vaccarino
Sex and Age Specific Inflammatory ResponsesSullivan et alet al. Circulation 2018
4 12.01.2019
Sullivan et al. JAHA 2018
Was erwarten wir dieses Jahr?
ESC Leitlinien 2019
• Chronisches Koronarsyndrom
• Diabetes und KHK
• Dyslipidämie
• Lungenembolie
5 12.01.2019
Primärprävention venöser Thrombembolien bei Krebspatienten
durch NOACs
N=574, ambulant
mind. 3 Monate Chemotherapie
gynäkologisch/Lymphom/BC
1:1
Placebo Apixaban
2x2.5mg/d
Carrier, NEJM 2018
6 12.01.2019Primärprävention venöser Thrombembolien bei Krebspatienten
durch Faktor Xa Inhibition
Khorana Risiko Score
Patientencharakteristika Risiko Score
N=574, ambulant
mind. 3 Monate Chemotherapie Tumor-Entität
gynäkologisch/Lymphom/BC Magen/Pankreas 2
1:1 Lunge, Lymphom, gynäkolog. 1
Prä-Chemo Thrombozytenzahl > 1
350 MRD/l
Placebo Apixaban Hb < 10g/dl 1
2x2.5mg/d Prä-Chemo Leukozytenzahl > 11 1
MRD/l
BMI < 35kg/m2 1
Niedriges Risiko: 0
Intermediäres Risiko: 1-2
7 12.01.2019
Carrier, NEJM 2018
Hohes Risiko: >3NOAC zur Verhinderung von Thrombembolien bei Krebspatienten
Apixaban to Prevent Venous Thromboembolism
N=574, ambulant .001
0
istent with rates reported in previous
mind. 3 Monate Chemotherapie p<
ving patients with cancer with a Kho- 100
.2%
f 2 orgynäkologisch/Lymphom/BC
higher.7 Our analysis of out- 10
vs
Patients Alive without Venous
g the treatment period1:1
100
showed a more 80
.2
:4
Thromboembolism (%)
nefit (hazard ratio, 0.14; 95% CI,
te
95
a Apixaban
than previous studies that assessed 60
90
M on
hromboprophylaxis.20,21 The reasons 6 Placebo
epancy are unclear, but the use of a 85
n /
nt andPlacebo Apixaban
40
lie
a twice-daily dosing regimen bo
80
2x2.5mg/d m
for some of the difference. 20
be 0
of major bleeding was significantly m
hr0o
0 30 60 90 120 150 180
apixaban than with placebo in the T
ention-to-treat analysis (3.5% and ö se 0 30 60 90 120 150 180
n
ctively; hazard ratio, 2.00; 95% CI, Ve Days
number needed to harm, 59), but No. at Risk
Major bleeding:
Apixaban 288 1.1% vs
276 2652.1%256p=0.046
249 244 229
not significantly higher with apixa- Placebo 275 268 259 244 237 228 215
h placebo in the analysis of outcomes Carrier, NEJM 2018
eatment period (2.1% and 1.1%, re- Figure 2. Kaplan–Meier Cumulative Event Rates of Venous Thromboembolism.
azard ratio, 1.89; 95% CI, 0.39 to The inset shows the same data on an enlarged y axis.
8 12.01.2019
needed to harm, 100). The between-Rekurrenz von Thrombembolien nach Absetzen einer
Antikoagulation
Symptomatische rezidivierende VTE
EINSTEIN Investigators, N Engl J Med 2010
9 12.01.2019Arterielle thrombembolische Ereignisse vor der Diagnose Krebs
N=748.000 pts.
>67 Jahre
Krebs-Erstdiagnose
2005-2013
10 12.01.2019 Navi et al. Blood 2019, in pressArterielle thrombembolische Ereignisse vor der Diagnose Krebs
N=748.000 pts.
From www.bloodjournal.org by guest on January 3, 2019. For personal use only.
>67 Jahre
Krebs-Erstdiagnose
+ 70%
2005-2013
Relative Odds of
Stroke /AMI
11 12.01.2019 Navi et al. Blood 2019, in press12
h r!
e s Ja
e u
s N
e
su nd
e
e in g
e n
Ihn
12 12.01.2019You can also read
