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/Title (Le rle du score calcique coronaire dans la stratification du risque cardiovasculaire et la prise en charge du patient diabtique asymptomatique)
/Author (Macia Antoine)
/Creator (Word)
/ModDate (D:20230323173349+01'00')
/Subject ( C o n t e x t e : L e s c o r e c a l c i q u e c o r o n a i r e \( C A C \) e s t d e p l u s e n p l u s u t i l i s p o u r l a s t r a t i f i c a t i o n d u r i s q u e c a r d i o v a s c u l a i r e e t f o u r n i t u n e m e s u r e d e l a c h a r g e a t h r o s c l e r o t i q u e c o r o n a i r e , e n p a r t i c u l i e r c h e z l e s p a t i e n t s d i a b t i q u e s . M t h o d e s : D e j a n v i e r 2 0 1 4 d c e m b r e 2 0 2 0 , d e s p a t i e n t s d i a b t i q u e s a s y m p t o m a t i q u e s c o n s c u t i f s a y a n t s u b i u n e v a l u a t i o n d u C A C o n t t i n c l u s e t s u b d i v i s e s s e l o n l e C A C e n 4 s o u s - g r o u p e s : 0 , 1 - 9 9 , 1 0 0 - 3 9 9 e t "e 4 0 0 . N o u s a v o n s v a l u l e s e x a m e n s c o m p l m e n t a i r e s e t l e s c h a n g e m e n t s d a n s l e s t r a i t e m e n t s p r v e n t i f s \( a s p i r i n e , t r a i t e m e n t h y p o l i p i d m i a n t e t a g o n i s t e s d e s r c e p t e u r s d u g l u c a g o n - l i k e p e p t i d e 1 [ G L P - 1 ] \) p r e s c r i t s a p r s C A C . N o u s a v o n s g a l e m e n t v a l u l e s r s u l t a t s c a r d i o v a s c u l a i r e s . R s u l t a t s : U n t o t a l d e 3 7 1 p a t i e n t s o n t t i n c l u s e t s u b d i v i s e s c o m m e s u i t : C A C = 0 \( N = 9 0 , 2 4 , 3 % \) ; C A C 1 - 9 9 \( N = 1 1 1 , 2 9 , 9 % \) ; C A C 1 0 0 - 3 9 9 \( N = 7 0 , 1 8 , 9 % \) ; C A C "e 4 0 0 \( N = 1 0 0 , 2 6 , 9 % \) . L e s p a t i e n t s a y a n t u n C A C p l u s l e v t a i e n t p l u s g s , p l u s s o u v e n t d e s h o m m e s e t a v a i e n t u n e p r v a l e n c e p l u s l e v e d ' h y p e r t e n s i o n , d e d y s l i p i d m i e e t d e c o m p l i c a t i o n s d g n r a t i v e s d u d i a b t e . L e s p a t i e n t s p r s e n t a n t u n C A C p l u s l e v \( n o t a m m e n t C A C"e 4 0 0 \) o n t p l u s s o u v e n t s u b i d e s e x a m e n s c o m p l m e n t a i r e s . A p r s l e C A C , d e s c h a n g e m e n t s s i g n i f i c a t i f s o n t t o b s e r v s d a n s l a p r e s c r i p t i o n d ' a s p i r i n e e t d e t r a i t e m e n t h y p o l i p i d m i a n t u n i q u e m e n t e n p r s e n c e d ' u n C A C > 1 0 0 . A u c u n c h a n g e m e n t s i g n i f i c a t i f n ' a t o b s e r v d a n s l a p r e s c r i p t i o n d e G L P - 1 a v a n t e t a p r s C A C d a n s l e s 4 s o u s - g r o u p e s . A u c u n p a t i e n t a v e c C A C = 0 n ' a s u b i d ' i n f a r c t u s o u d e r e v a s c u l a r i s a t i o n n o n p l a n i f i e . U n e t e n d a n c e a t o b s e r v e e n t r e l e s p a t i e n t s a y a n t u n C A C "e 4 0 0 e t c e u x a y a n t u n C A C = 0 e n c e q u i c o n c e r n e l a s u r v i e s a n s I D M n i r e v a s c u l a r i s a t i o n n o n p l a n i f i e \( 9 2 , 2 % v s 1 0 0 % 3 a n s ; p = 0 , 0 7 7 \) . C o n c l u s i o n : L e C A C r e p r s e n t e u n o u t i l i n t r e s s a n t p o u r s t r a t i f i e r l e s p a t i e n t s d i a b t i q u e s a s y m p t o m a t i q u e s . C e u x d o n t l e C A C e s t "e 4 0 0 p o u r r a i e n t p r s e n t e r u n r i s q u e p l u s l e v e t m r i t e n t d e s i n v e s t i g a t i o n s p l u s p o u s s e s e t d e s s t r a t g i e s p r v e n t i v e s p l u s i n t e n s i v e s)
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Macia Antoine
Le rôle du score calcique coronaire dans la stratification du risque cardiovasculaire et la prise en charge du patient diabétique asymptomatique
Contexte : Le score calcique coronaire (CAC) est de plus en plus utilisé pour la stratification du risque cardiovasculaire et fournit une mesure de la charge athérosclerotique coronaire, en particulier chez les patients diabétiques. Méthodes : De janvier 2014 à décembre 2020, des patients diabétiques asymptomatiques consécutifs ayant subi une évaluation du CAC ont été inclus et subdivises selon le CAC en 4 sous-groupes : 0, 1-99, 100-399 et ≥400. Nous avons évalué les examens complémentaires et les changements dans les traitements préventifs (aspirine, traitement hypolipidémiant et agonistes des récepteurs du glucagon-like peptide 1 [GLP-1]) prescrits après CAC. Nous avons également évalué les résultats cardiovasculaires. Résultats : Un total de 371 patients ont été inclus et subdivises comme suit : CAC = 0 (N=90, 24,3%) ; CAC 1-99 (N=111, 29,9%) ; CAC 100-399 (N=70, 18,9%) ; CAC ≥400 (N=100, 26,9%). Les patients ayant un CAC plus élevé étaient plus âgés, plus souvent des hommes et avaient une prévalence plus élevée d'hypertension, de dyslipidémie et de complications dégénératives du diabète. Les patients présentant un CAC plus élevé (notamment CAC≥400) ont plus souvent subi des examens complémentaires. Après le CAC, des changements significatifs ont été observés dans la prescription d'aspirine et de traitement hypolipidémiant uniquement en présence d'un CAC>100. Aucun changement significatif n'a été observé dans la prescription de GLP-1 avant et après CAC dans les 4 sous-groupes. Aucun patient avec CAC=0 n'a subi d'infarctus ou de revascularisation non planifiée. Une tendance a été observée entre les patients ayant un CAC ≥400 et ceux ayant un CAC=0 en ce qui concerne la survie sans IDM ni revascularisation non planifiée (92,2 % vs 100 % à 3 ans ; p=0,077). Conclusion : Le CAC représente un outil intéressant pour stratifier les patients diabétiques asymptomatiques. Ceux dont le CAC est ≥400 pourraient présenter un risque plus élevé et méritent des investigations plus poussées et des stratégies préventives plus intensives
2023-03-19T10:00:20Z
Word
2023-03-23T17:33:49+01:00
2023-03-23T09:08:20+01:00
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