primary pci
DESCRIPTION
Dr. Amir Aziz Alkatiri, SpJP, FIHA. 3rd Pekanbaru Cardiology Update, August 24th 2013. Pangeran Hotel Pekanbaru. Learn more at PerkiPekanbaru.comTRANSCRIPT
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