Il paziente con dolore toracico acuto. Come orientare la diagnosi sulla strada verso il laboratorio di Emodinamica o verso un area a bassa intensità
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1 Il paziente con dolore toracico acuto. Come orientare la diagnosi sulla strada verso il laboratorio di Emodinamica o verso un area a bassa intensità Andrea Barbieri Azienda Ospedaliero-Universitaria di Modena
2 Immediate invasive strategy in ACS 1. Lessons from STEMI services 2. Applying the lessons of STEMI services to NSTEMI?
3 Immediate invasive strategy in ACS 1. Lessons from STEMI services 2. Applying the lessons of STEMI services to NSTEMI?
4 Eur Heart J 2018;39:
5 Emerg Med Clin N Am 2006;24:91 111
6 Mayo Clin Proc 2015;90:
7 Mayo Clin Proc 2015;90:
8 Mayo Clin Proc 2015;90:
9 ECG findings for hyperkaliemia Emerg Med Clin North Am 2006;24:91 111
10 ECG criteria for LV hypertrophy Emerg Med Clin North Am 2006;24:91 111
11 Classic STEMI ECG diagnostic criteria Am Heart J 2010;160:
12 Incidence of TIMI 0/1 grade flow in trials of NSTEMI Am Heart J 2009;158:706-12
13 STEMI-equivalent Eur Heart J 2018;39:
14 ECG criteria for LBBB Emerg Med Clin North Am 2006;24:91 111
15 LM coronary occlusion pattern Am Heart J 2010;160:
16 Am Heart J 2009;158:706-12
17 Am Heart J 2009;158:706-12
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19 Physicians ECG Interpretation accuracy by specialty and experience J Am Heart Assoc 2013;2:e000268
20 Int J Cardiol 2014;172:e91-3
21 Classification of Cath Lab activation Am Heart J 2010;160:
22 ECG criteria for benign early repolarization Emerg Med Clin North Am 2006;24:91 111
23 ECG criteria for myopericarditis Emerg Med Clin North Am 2006;24:91 111
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25 Eur Heart J 2018;39:
26 Eur Heart J 2018;39:
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28 Immediate invasive strategy in ACS 1. Lessons from STEMI services 2. Applying the lessons of STEMI services to NSTEMI?
29 GRACE Registry. Nat Clin Pract Cardiovasc Med 2008;5:580-9
30 NSTEMI risk criteria: 24/7 vs 7/7 services
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33 N Engl J Med 2009; 360:
34 N Engl J Med 2009; 360:
35 N Engl J Med 2009;360:
36 Home About Web Version Help Contact Us GRACE 2.0 Risk Calculator The GRACE 2.0 ACS Risk Calculator implements the revised GRACE algorithms for predicting death or death/myocardial infarction following an initial acute coronary syndrome (ACS). WHAT'S NEW IN 2.0? - "Mini-GRACE" algorithm (for use when serum creatinine and Killip class may not be available) - New 1- and 3-year calculations - New calculations provide probabilities directly, bypassing scores - Population histograms with high-, medium- and low-risk markers - The GRACE 2.0 ACS Risk Calculator app has been defined as a medical device under the Medical Device Directive (MDD) 93/42/EEC and has been CE-marked to indicate compliance with the Directive DOWNLOAD THE MOBILE APP USE THE CALCULATOR ONLINE WEB VERSION
37 Home About Web Version Help Contact Us Calculator 1. INPUT DATA > 2. DEATH / DEATH MI RESULTS Age ( years ) Heart rate ( bpm ) Systolic blood pressure ( mmhg ) CHF ( Killip class ) ST-segment deviation Cardiac arrest at admission Elevated troponin* * Or other necrosis cardiac biomarkers Diuretic usage 1 1 Creatinine ( mg dl / μmol L ) Renal failure RESET CALCULATE
38 Home About Web Version Help Contact Us Calculator 1. INPUT DATA > 2. DEATH / DEATH MI RESULTS Death Time % Risk (Score) Histograms In hospital 8.8 Not available Number of patients by risk group for 1-year death 29% 6 months 16 (144) Not available 1 year 29 GRAPH 3 years 44 GRAPH Death/MI Time % Risk Histograms 1 year 37 GRAPH Area plot: distribution (log scale) of risk based on the entire GRACE population of 102,341 patients. EDIT INPUT NEW CALCULATION Line: risk of death or death/mi Vertical bar: individual risk of death or death/mi green = low, yellow = intermediate, red = high
39 Acute Versus Subacute Angioplasty in Patients With NON-ST-Elevation Myocardial Infarction (NONSTEMI) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT Recruitment Status! : Terminated (slow recuritment) First Posted! : July 12, 2012 Last Update Posted! : October 4, clinicaltrials.gov/ct2/show/nct [Accessed 27 March 2018]
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41 87% ACS 74% culprit lesion 64% underwent coronary revascularization (median 2.4 days early) Hospitalization reduced by 16% Eur Heart J Acute Cardiovasc Care 2017;6:
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43 Eur Heart J 2016;37:
44 J Am Heart Assoc 2014;3:e000473
45 Conclusive remarks: 24/7 services 1. STEMI 2. Very high-risk NSTEMI 3. High-risk NSTEMI? 4. Rapid triage decision with emergency echocardiography to rule-in or rule-out differential diagnoses
46 Echocardiography to rule-in and rule-out ACS and differential diagnoses: caveats 1. H24 emergency echocardiography service 2. Level C: lack of outcome studies (refine the triage/ assist in clinical decision-making)
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