primary pci

PRIMARY PCI(Percutaneous Coronary Intervention)

Amir Aziz AlkatiriAmir Aziz AlkatiriRS Awal Bros Pekanbaru

Primary PCI Treatment of choice for Acute MI

Definition

• Primary PCI : an emergent percutaneous catheter intervention in the setting of STEMI, without previous fibrinolytic treatment

• is the preferred reperfusion strategy in patients with STEMI

Primary PCI vs Thrombolytic

Primary PCI vs Thrombolysis

• Thrombolysis is effective in 40–60% of patients,while p-PCI is effective in > 90%.

• Thus,comparing thrombolysis vs primary PCI is comparing a semi-effective therapy vs a fully effective therapy.

• The mortality benefit derived from the primary PCI strategy is not related to the fact that the underlying stenosis is removed.

• The mortality benefit of primary PCI is caused by the simple fact that primary PCI is twice as effective as thrombolysis in opening the artery.

European Heart Journal (2010) 31, 634–636

Components of delay in STEMI

European Heart Journal (2012) 33, 2569–2619

How to Optimize Reperfusion in Acute MI

ProblemProblem SolutionSolution

Longer Delay for Presentation

(symptom onset to presentation)

Longer Delay for Presentation

(symptom onset to presentation)

Large Media Education

Large Media Education

Delay for TransportationDelay for Transportation Logistical ProtocolsLogistical Protocols

Delay for Treatment(either lytics or PCI)

Delay for Treatment(either lytics or PCI)

In-Hospital Quality of

Care

In-Hospital Quality of

Care

Prehospital and in-hospital management, and reperfusion strategies within 24 h of FMC

Primary PCI: indications and procedural aspects

Procedural aspects

• Radial approach is preferred• Drug-eluting stents (DES) reduce the risk of

repeated target vessel revascularization, compared with bare-metal stents (BMS)

• Thrombus Aspiration during Primary PCI showed improvement in indices of myocardial reperfusion (ST-segment resolution and myocardial blush) from routine use of manual thrombus aspiration before a balloon or a stent is introduced into the coronary artery

Slender Club Japan

2009.12.04

Periprocedural pharmacotherapy

• DAPT : Aspirin 160-300mg + ADP receptor blocker

(Clopidogrel/Prasugrel/Ticagrelor)• Heparin• GPIIB/IIIA inhibitor

Revascularization strategy for STEMI with multivessel disease

• Still debatable• Conservative approach• Stage revascularization approach

Contoh Kasus

• Tn.D, 71thn• Sakit dada berat sejak 6 jam SMRS disertai

keringat dingin• Fakto Risiko: DM, Dislipidemia, Hipertensi• TD 140/70, HR 60x/m• EKG: SR, ST elevasi II,III,aVF, V5-V9

• Diagnosis: Acute Inferoposterior MCI