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PCI for STEMI

PCI for STEMI. Ari de la Hera, M.D. N Engl J Med 2006;355:2308-2320. ED physician activates the Cath Lab Single call to activate the Cath Lab Cath Lab operational within 20 minutes of activation Real time data feedback for case review

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PCI for STEMI

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  1. PCI for STEMI Ari de la Hera, M.D.

  2. N Engl J Med 2006;355:2308-2320 • ED physician activates the Cath Lab • Single call to activate the Cath Lab • Cath Lab operational within 20 minutes of activation • Real time data feedback for case review • Having attending cardiologist always on site • Prehospital ECG to activate Cath Lab while patient is en route

  3. Meta-analysis: Facilitated PCI vs Primary PCI Mortality Reinfarction Major Bleeding 1.81 (1.19-2.77) 1.43 (1.01-2.02) 1.03 (0.49-2.17) 1.40 (0.49-3.98) 3.07 (0.18-52.0) 1.03 (0.15-7.13) 1.38 (1.01-1.87) 1.71 (1.16 - 2.51) 1.51 (1.10 - 2.08 ) 0.1 1 10 0.1 1 10 0.1 1 10 Fac. PCIBetter PPCIBetter Fac. PCIBetter PPCIBetter Fac. PCIBetter PPCIBetter Keeley E, et al. Lancet 2006;367:579.

  4. Stepped Care Approach To Pharmacologic Therapy for Musculoskeletal Symptoms with Known Cardiovascular Disease or Risk Factors for Ischemic Heart Disease • Acetaminophen, ASA, tramadol, narcotic analgesics (short term) • Nonacetylated salicylates • Non COX-2 selective NSAIDs Select patients at low riskof thrombotic events • NSAIDs with some COX-2 activity • Regular monitoring for sustained hypertension or worsening of prior blood pressure control), edema, worsening renal function, or gastrointestinal bleeding. • If these events occur, consider reduction of the dose or discontinuation of the offending drug, a different drug, or alternative therapeutic modalities, as dictated by clinical circumstances. Prescribe lowest doserequired to control symptoms • COX-2 Selective NSAIDs Add ASA 81 mg and PPI to patients at increased risk of thrombotic events * * Addition of ASA may not be sufficient protection against thrombotic events Antman EM, et al. J Am Coll Cardiol 2008. Published ahead of print on December 10, 2007. Available athttp://content.onlinejacc.org/cgi/content/full/j.jacc.2007.10.001.

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