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When PCI in NSTEMI?

When PCI in NSTEMI?. Giuseppe Biondi Zoccai, MD Department of Medico-Surgical Sciences and Biotechnologies Sapienza University of Rome gbiondizoccai@gmail.com. Emergenze cardiologiche - Marina di Ravenna 15:15-15:30 – 20 April 2012. DO YOU KNOW HOW TRAIN BRAKES WORK?.

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When PCI in NSTEMI?

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  1. When PCI in NSTEMI? Giuseppe Biondi Zoccai, MD DepartmentofMedico-SurgicalSciences and Biotechnologies Sapienza UniversityofRome gbiondizoccai@gmail.com Emergenzecardiologiche - Marina di Ravenna 15:15-15:30 – 20 April 2012

  2. DO YOU KNOW HOW TRAIN BRAKES WORK? FAIL-SAFE SYSTEMS A fail-safe or fail-secure device is one that, in the event of failure, responds in a way that will cause no harm, or at least a minimum of harm, to other devices or danger to personnel. Air brakes on railway trains are held in the "off" position by air pressure in the brake system. Should a brake line split, or a carriage become de-coupled, the air pressure will be lost and the brakes applied. http://en.wikipedia.org/wiki/Fail-safe

  3. When PCI in NSTEMI? Giuseppe Biondi Zoccai, MD DepartmentofMedico-SurgicalSciences and Biotechnologies Sapienza UniversityofRome gbiondizoccai@gmail.com Emergenzecardiologiche - Marina di Ravenna 15:15-15:30 – 20 April 2012

  4. When NOT TO PERFORM PCI in NSTEMI? Giuseppe Biondi Zoccai, MD DepartmentofMedico-SurgicalSciences and Biotechnologies Sapienza UniversityofRome gbiondizoccai@gmail.com Emergenzecardiologiche - Marina di Ravenna 15:15-15:30 – 20 April 2012

  5. LEARNING GOALS • What is NSTEMI in 2012? • What does PCI entail? • Don’ts • Take home messages

  6. LEARNING GOALS • What is NSTEMI in 2012? • What does PCI entail? • Don’ts • Take home messages

  7. DEFINITION Hamm et al, Eur Heart J 2011

  8. HS TROPONIN IN STABLE CAD Ndrepepa al, Am J Cardiol 2011

  9. LEARNING GOALS • What is NSTEMI in 2012? • What does PCI entail? • Don’ts • Take home messages

  10. KEY ASSUMPTION • Coronary angiography is not synonimous with PCI • Risk-benefit balance of angio is much higher than that of PCI • However, alternative to angio are available (e.g. imaging-based stress testing, CT coronary angiography)

  11. INCIDENCE OF PERI-PCI MI Novack et al, Arch intern Med 2012

  12. INCIDENCE OF DES THROMBOSIS very late total acute subacute late D’Ascenzo et al, submitted

  13. PREDICTORS OF STENT THROMBOSIS D’Ascenzo et al, Int J Cardiol 2011

  14. LEARNING GOALS • What is NSTEMI in 2012? • What does PCI entail? • Don’ts • Take home messages

  15. 1ST NO: PATIENT REFUSAL

  16. 2ND NO: REDUCED LIFE EXPECTANCY

  17. 3RD NO: LACK OF ACCESS SITES Biondi-Zoccai et al, Catheter Cardiovasc Interv 2011

  18. 4TH NO: HIGH BLEEDING RISK Agostoni et al, J Am Coll Cardiol 2004

  19. 5TH NO: CONTRAINDICATIONS TO DAT Sangiorgi et al, EuroIntervention 2011

  20. 6TH NO: LACK OF SIGNIFICANT LESIONS* *e.g. NSTEMI not due to CAD

  21. 6TH NO: LACK OF SIGNIFICANT LESIONS* *e.g. NSTEMI not due to CAD

  22. 7TH NO: LESION IS IRRELEVANT

  23. 7TH NO: LESION IS IRRELEVANT Tonion et al, New Eng J Med 2009

  24. 8TH NO: CABG IS INDICATED Novara et al, J Cardiovasc Med 2012

  25. 9TH NO: VALVE SURGERY IS INDICATED Colombo et al, G Ital Cardiol 2005

  26. 10TH NO: YOU CANNOT AFFORD IT Dijksman et al, Int J Cardiol 2009; de Winter et al, New Engl J Med 2005

  27. TAKE HOME MESSAGES • In the current evidence and experience context, it is safer to focus only on which patients with NSTEMI should not be offered PCI rather than the other way round • Coronary angiography and PCI should also be distinguished, as they have different scopes and safety profiles • Several absolute and relative contraindications to PCI in NSTEMI can be envisioned, requiring case by case decision-making

  28. For these and further slides on these topics please feel free to visit the metcardio.org website:http://www.metcardio.org/slides.html

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