2014 aha/acc guideline for the management of patients with non–st-elevation acute coronary...

JACC. September 23, 2014. Accepted Manuscript

DR. JUAN CARLOS BECERRA MARTÍNEZ

Fellow en Cardiología Intervencionista, UMAE HE CMNO

ACC Fellow in-Training

Miembro ESC, EAPCI, SCAI, SOLACI, SOCIME, CCJ

2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes

JACC. September 23, 2014. Accepted Manuscript

Pathophysiology

JACC. September 23, 2014. Accepted Manuscript

Presentation

JACC. September 23, 2014. Accepted Manuscript

TIMI Risk Score

JACC. September 23, 2014. Accepted Manuscript

GRACE Risk Model

JACC. September 23, 2014. Accepted Manuscript

Early Risk Stratification

JACC. September 23, 2014. Accepted Manuscript

Cardiac Biomarkers

JACC. September 23, 2014. Accepted Manuscript

Medical Management

JACC. September 23, 2014. Accepted Manuscript

Medical Management

JACC. September 23, 2014. Accepted Manuscript

Medical Management

JACC. September 23, 2014. Accepted Manuscript

Medical Management

JACC. September 23, 2014. Accepted Manuscript

Aspirin

JACC. September 23, 2014. Accepted Manuscript

P2Y12 Inhibitors

JACC. September 23, 2014. Accepted Manuscript

GP IIb/IIIa inhibitors

JACC. September 23, 2014. Accepted Manuscript

Abciximab: better downstream

Parenteral anticoagulant

JACC. September 23, 2014. Accepted Manuscript

JACC. September 23, 2014. Accepted Manuscript

JACC. September 23, 2014. Accepted Manuscript

Strategies

JACC. September 23, 2014. Accepted Manuscript

Non-anginal pain management

JACC. September 23, 2014. Accepted Manuscript

Special patient groups

JACC. September 23, 2014. Accepted Manuscript

Special patient groups

JACC. September 23, 2014. Accepted Manuscript

Special patient groups

JACC. September 23, 2014. Accepted Manuscript

Special patient groups

JACC. September 23, 2014. Accepted Manuscript

Special patient groups

JACC. September 23, 2014. Accepted Manuscript

Special patient groups

JACC. September 23, 2014. Accepted Manuscript

Puntos a discutir…1.- Ya no usar CKMB ni mioglobina en el abordaje diagnóstico

2.- BNP es útil en estratificación

3.- Mejor ticagrelor/prasugrel que clopidogrel

4.- Prasugrel solo si se colocan stents

5.- Mejor eptifibatide/tirofibán que abciximab para terapia “upstream”

6.- Bivalirudina solo en estrategia invasiva

7.- Pacientes con fondoparinux: hacer switch a otro anticoagulante en caso de cateterismo

8.- La estrategia “conservadora inicial” ahora se llama “guiada por isquemia”

Puntos a discutir…9.- Cuatro estrategias de tratamiento:

- Guiada por isquemia (antes conservadora)

- Invasiva Inmediata (2 hrs)

- Invasiva temprana (24 hrs)

- Invasiva tardía (25-72 hrs)

10.- Se añade la pirámide invertida de analgésicos

11.- B-bloqueadores pueden desencadenar espasmo coronario en pacientes con uso reciente de cocaína / metaanfetaminas

12.- Nuevas recomendaciones sobre Takotsubo

Gracias!