• from: stable ischemic heart disease 󰒖

Optimal-medical-therapy-stable ischemic heart disease

• ASA 75–162 mg/d;
  • can substitute clopi if ASA-intolerant.
  • ~12 mos after PCI,
  • clopi monoRx ↓ risk of ischemic and bleeding events by ~30% c/w ASA monoRx (Lancet 2021;397:2487).
• βB for 3 years post-MI or if ↓ EF;
  • can consider in all Pts w/ SIHD
• ACEI (or ARB if intolerant of ACEI) if
  • HTN,
  • DM,
  • CKD,
  • ↓ EF (Lancet 2006;368:581)
• Dual antiplatelet therapy (ASA + P2Y12 inhibitor):
  • ↓ CV events by ~10% in Pts with known IHD w/o MI but w/ DM,
  • but ↑ bleeding (THEMIS, NEJM 2019; 381:1309)
• Rivaroxaban 2.5 mg bid + ASA 100 mg/d:
  • 24% ↓ CV events and 18% ↓ death vs. ASA alone,
  • but ↑ major bleeding in stable ASCVD (COMPASS, NEJM 2017;377:1319)
• Colchicine (0.5 mg/d)
  • ↓ CV events by 31%,
  • but ? ↑ non-CV death (NEJM 2020;383:1838)
• Medical therapies for symptomatic relief (Circ 2014;130:1749)
  • Beta-blockers 1st-line therapy; CCB (except short-acting dihydropyridines)
  • Long-acting nitrates
  • Ranolazine (↓ late inward Na+ current to ↓ myocardial demand): 2nd-line anti-anginal