Apart from that, meta-analyses of SIHD strategy trials do not support a difference in prognosis between routine revascularization and GDOMT only [142-144].
It may be that revascularization in SIHD may not be beneficial because not all anatomically obstructive coronary stenoses produce ischaemia, or because not all high-grade coronary stenoses result in cardiac death and/or MI, or conversely, because most cases of cardiac death and/or MI arise from angiographically mild coronary lesions, which are not revascularized .
A potential explanation for failure of revascularization to reduce the incidence of death or MI in prior SIHD strategy trials is that lower risk patients were permitted into these trials, diluting the power to show a benefit from revascularization.
(FFR) to achieve complete ischaemic (rather than anatomic) revascularization; and (5) being adequately powered to demonstrate whether routine revascularization reduces cardiovascular death or nonfatal MI in patients with SIHD and at least moderate ischaemia .
Como forma de delimitacao do escopo da pesquisa, foram selecionados os sistemas SIM e SIHD utilizados nos estados do Parana e do Rio Grande do Sul.
Assim, a partir da categorizacao dos SIS para efetuar a escolha e com base nos fatores motivadores citados, os sistemas SIM e SIHD foram escolhidos para este estudo.
A Unidade de Analise deste estudo foram os Sistemas de Informacao em Saude (SIM e SIHD) ofertados pelo DATASUS, caracterizados como sistemas de apoio a gestao e ao planejamento governo a governo.
In the clinical practice guideline for evaluating patients with known or suspected SIHD, there are 28 recommendations that address initial cardiac testing to establish the diagnosis; cardiac stress testing in diagnosed patients to assess their risk of myocardial infarction or death; and coronary angiography for risk assessment (Ann.
Cardiac stress testing "is indicated in most symptomatic patients suspected of having SIHD to establish the diagnosis, and it is indicated in most patients with both suspected and established SIHD to identify [those] at very high risk for death or MI who might have lesions where anatomic intervention could be beneficial," stated the evaluation guideline's executive summary.
This clinical practice guideline includes detailed algorithms for diagnosing patients who are suspected of having SIHD, and for assessing risk in those who are known to have SIHD, which may be particularly helpful for clinicians in primary care practice.
Two patients with the same pretest probability of SIHD may prefer different approaches because of variations in personal beliefs, economic considerations, or stage of life," said Dr.
The second guideline, for management of SIHD, includes 48 specific recommendations that address patient education, management of known risk factors (dyslipidemia, hypertension, diabetes, low levels of physical activity, over-weight/obesity, and smoking), medical therapy to prevent MI and death, medical therapy to relieve symptoms, revascularization to improve symptoms, revascularization to improve survival, and patient follow-up (Ann.