Controversies on Primary angioplasty in STEMI
|
|
- Emerald Melton
- 5 years ago
- Views:
Transcription
1 Controversies on Primary angioplasty in STEMI 원주의대이승환
2 Case ( 51/M) CC C.C: ongoing squeezing chest pain D : for 2 hours Risk factors Current smoker ( 40 PYs) Hypercholesterolemia (+)
3 Case ( 51/M) Physical examination BP: 142 / 96 mmhg, Pulse: 68 /min Regular heart beat without murmur Stat lab. data Troponin stick negative CK-MB : 3.40 ng/ml ( upper limit 6.3 ng/ml) Troponin-I : 0.13 ng/ml ( upper limit 0.2 ng/ml)
4 EKG at arrival
5 Which is the best treatment of STEMI? The key point of decision is the feasibility of primary PCI In hospital with Cath. Lab. Thrombolysis vs Primary angioplasty In hospital without Cath. Lab. Thrombolysis vs transfer for Primary angioplasty
6 Myocardial salvage First 2 hours from pain onset is critical Presentation Delay
7 Primary PCI vs. Thrombolysis Therapy Benefit Primary PCI or Thrombolysis Risk Presentation delay Treatment delay (from Sx onset to ER) (from ER to balloon)
8 The best treatment is tailored to patient Reperfusion Option for STEMI
9 Presentation delay and 30-day mortality (Pooled Analysis)
10 Consider contraindication of thrombolysis
11 Consider age factor
12 Relationship between institutional primary PCI volume and mortality
13 Reducing PCI-related treatment delay
14 Limit of PCI related delay is 60 min
15 Reperfusion guidelines - ACC/AHA 2007 I IIa IIb III STEMI patients presenting to a hospital with PCI capability should be treated with primary PCI within 90 minutes of first medical contact. Modified recommendation I IIa IIb III STEMI patients presenting to a hospital without PCI capability and who cannot be transferred to a PCI center for intervention within 90 minutes of first medical contact should be treated with fibrinolytic therapy within 30 minutes of hospital presentation, unless contraindicated. Modified recommendation
16 Which is your choice of treatment? 51 old man with STEMI within 2 hrs of symptom onset at hospital without cath. lab. 1) Thrombolysis 2) Transfer for Primary angioplasty.
17 Initial ECG ECG ( 1 hours after thrombolytic therapy)
18 33% of patients received TT need rescue PCI
19 Initial ECG ECG ( Immediate after PCI)
20 Transfer for PPCI vs Thrombolysis DANAMI- 2
21 DANAMI - 2 Trial Referral hospitals Planned: 1,100 pts. Angioplasty centers Planned: 800 pts. No transfer Ambulance Transfer <3hr Fibrinolysis PCI Fibrinolysis PCI (front loaded tpa) y (front loaded tpa) 1,129 pts. 443 pts. Moon JC, Int J Cardiol. 2002;85:
22 DANAMI 2: Median Treatment Time (min) Moon JC, Int J Cardiol. 2002;85:
23 Primary end point within 30 Days Referral hospitals: 1, patients Primary end point: Death or reinfarction or stroke DANAMI 2 trial Moon JC, Int J Cardiol. 2002;85:
24 Thrombolysis vs transfer to primary PCI within 90 min (Maximum transport distance was 120 km) Randomized national multicentre trial--prague patients with acute STEMI presenting within <12 h to the nearest community hospital without a catheter laboratory Thrombolysis in this hospital (TL group, n = 421) Immediate transport for primary angioplasty (PCI group, n = 429). PRAGUE Study Group Investigators Eur Heart J. 2003;24:94-104
25 PRAGUE-2 study Tertiary centers are located within 100Km from home
26 Time intervals from pain onset to reperfusion PRAGUE Study Group Investigators Eur Heart J. 2003;24:94-104
27 Outcomes in AMI Treated with Local Lytic Therapy vs Transfer for Primary PCI PRAGUE Study Group Investigators Eur Heart J. 2003;24:94-104
28 Transfer for PPCI vs Lytics Mortality only
29 Transfer for PPCI vs Lytics Composite end point
30 Reperfusion guidelines - ACC/AHA 2007 I IIa IIb III STEMI patients presenting to a hospital with PCI capability should be treated with primary PCI within 90 minutes of first medical contact. Modified recommendation I IIa IIb III STEMI patients presenting to a hospital without PCI capability and who cannot be transferred to a PCI center for intervention within 90 minutes of first medical contact should be treated with fibrinolytic therapy within 30 minutes of hospital presentation, unless contraindicated. Modified recommendation
31
32 반경 25 mile(40.25 km) 이내 (30 분이내 )
33 To reduce Door to Balloon time < 원주기독병원에서 2006 년 12 월까지 notify system> Chest pain patients (Sx < 12hrs) 현 notify 체계의문제점 Emergency room intern Internal medicine 1 st resident Cardiology 1 st resident Cardiology chief resident Cardiology staff Decision of primary PCI 각단계별로 time delay의가능성많음. ( 특히내과 1년차나 cardio 1년차의병동 job이있는경우각각윗단계로의 notify delay) 너무많은단계로인해각단계마다의시간이걸림. 2007년 1월과 2월 응급의학과와 conference를통해단계를줄이기위한 algorithm 개발을위해노력하여 2007년 3월부터시행함. PCI team recruitment
34 To reduce Door to Balloon time < 원주기독병원에서 2007 년 3 월부터바뀐 notify system> Chest pain patients (Sx < 12hrs) Notify algorithm Cardiology staff에이르는단계를 4단계에서 2단계로줄임. 목표 : 25 분이내 EM 1 st resident Cardiology chief resident SMS message By OCS activation Cardiology staff PCI team Cardiology fellow Cardiology 1 st resident 환자도착후 25분까지 thrombolysis or primary PCI 에대한cardiology의결정 환자도착시 OCS로 cardiology staff, PCI team, fellow에게로환자도착 SMS message를보내미리준비를할수있게함. ( 현재전산개발과와 system 구축중.) Cardiology staff EM 1 st resident Decision of primary PCI Cardiology fellow PCI team recruitment
35 Result <2007 년 3 월부터의 notification cascade 변화후 time change> Procedure time Phase I Phase II (in primary PCI) 2006년 3월-6월 (n=28) 2007년 3월-6월 (n=35) P value hospital arrival time (min) 360.8± ± Door to cath. Room (min) 76.4± ± cath. Room to balloon (min) 21.3± ± Door to balloon (min) 98.6± ± Total fluoro time (min) 10.6± ±
36 Regional Systems of Care to Optimize Timeliness of Reperfusion Therapy for STEMI: The Mayo Clinic Protocol Henry H. Ting, MD, MBA Associate Professor of Medicine Mayo Clinic College of Medicine Division of Cardiovascular Diseases Mayo Clinic, Rochester August 14, 2007
37 Mayo Clinic STEMI Experience May 2004 to December 2006 Ting HH, et al. Circulation 2007;116:
38 N Engl J Med 2006;355: ED physician i activates t the Cath Lab Single call to activate the Cath Lab Cath Lab operational within 20 minutes of activation Real time data feedback for case review χ χ Having attending cardiologist always on site Prehospital ECG to activate Cath Lab while patient is en route
39 Saint Marys Hospital Emergency Department STEMI Patients ts Treated with Primary PCI ( ) 006) Compared with Historical Controls (2003) P = min 90 min Ting HH, et al. Circulation 2007;116:
40 Minnesota Mayo Clinic Network 28 regional hospitals s up to 150 miles away Minneapolis/ St. Paul Wisconsin Rochester Iowa Ting HH, et al. Circulation 2007;116:
41 Mayo Clinic FAST TRACK Protocol for Regional STEMI Patients Ting HH, et al. Circulation 2007;116:
42 Regional STEMI Patients Treated with Primary PCI or Fibrinolysis May 2004 to December 2006 (n=236) 25 min 71 min 116 min Ting HH, et al. Circulation 2007;116:
43 To improve myocardial salvage To reduce presentation delay Continuous education for population Improving emergent transport system Even distribution of clinics depending on territories Presentation delay is within 2hr from ongoing pain onset To reduce treatment delay Application of fast pathway approach on each hospital
44 경청해주셔서감사합니다.
Regional STEMI Transfer Systems: the Mayo and NC RACE Experiences
Regional STEMI Transfer Systems: the Mayo and NC RACE Experiences Dr. Henry H. Ting, Mayo Clinic College of Medicine Dr. James G. Jollis,, Duke University Medical Center Mayo Clinic STEMI System for Transferred
More informationThe Window for Fibrinolysis. Frans Van de Werf, MD, PhD Leuven, Belgium
The Window for Fibrinolysis Frans Van de Werf, MD, PhD Leuven, Belgium ESC STEMI Guidelines : December 2008 Reperfusion Therapy: Fibrinolytic Therapy Recommendations Class LOE In the absence of contraindications
More informationMark C. Bieniarz, MD Andrew Harrell, MD Peter Berger, MD
Mark C. Bieniarz, MD Andrew Harrell, MD Peter Berger, MD Should PCI center activate the cathlab off EMS field interpretation of ECG? Is this happening consistently in New Mexico? What is acceptable rate
More informationCritics of Thrombolytics: Is Pre-Hospital Clot-busting Actually a Bad Thing? David Persse, MD Houston Fire Department EMS
Critics of Thrombolytics: Is Pre-Hospital Clot-busting Actually a Bad Thing? David Persse, MD Houston Fire Department EMS STEMI Stuff New or Recurrent MI s in U.S.: 865,000 Acute STEMI s: 500,000 Sooner
More informationPatient Transfer. Mark de Belder The James Cook University Hospital Middlesbrough
Patient Transfer Mark de Belder The James Cook University Hospital Middlesbrough Current Management Strategies for ACS ACS No ST Elevation ST ST Elevation Elevation Early Invasive Early Conservative Fibrinolysis
More informationFacilitated Percutaneous Coronary Intervention in Acute Myocardial Infarction. Is it beneficial to patients?
Facilitated Percutaneous Coronary Intervention in Acute Myocardial Infarction Is it beneficial to patients? Seung-Jea Tahk, MD. PhD. Suwon, Korea Facilitated PCI.. background Degree of coronary flow at
More informationThe Role of DHMC as an ST Elevation Myocardial Infarction Receiving Center in a Regional STEMI Care Network:
The Role of DHMC as an ST Elevation Myocardial Infarction Receiving Center in a Regional STEMI Care Network: Nathaniel Niles, MD CREST Symposium November 7th, 28 STEMI = Acute Coronary Thrombosis STEMI
More informationRecommendations for criteria for STEMI systems of care: A focus on pharmacoinvasive strategies
Recommendations for criteria for STEMI systems of care: A focus on pharmacoinvasive strategies Mohammad Zubaid, MB, ChB, FRCPC, FACC Professor of Medicine, Kuwait University Chairman, Faculty of Cardiology,
More informationREFERRAL HOSPITAL. The Importance of Door In Door Out Time DIDO
REFERRAL HOSPITAL The Importance of Door In Door Out Time DIDO Jean Skonhovd,RN,BSN,MSAS Emergency Department Director Avera Heart Hospital of South Dakota Time to Treatment is critical for STEMI patients
More informationI have no financial relationships to disclose
I have no financial relationships to disclose Networking decreases mortality Vasil Velchev,MD,PhD UH St. Anna Sofia time = myocardium = life Transfer for angioplasty vs. Immediate Thrombolysis (hospital
More informationManagement of STEMI in era of Reperfusion. Eagles Peter Moyer, MD, MPH Medical Director Boston EMS, Fire and Police
Management of STEMI in era of Reperfusion Eagles 2007 Peter Moyer, MD, MPH Medical Director Boston EMS, Fire and Police STEMI in US ST Segment Elevation Myocardial Infarction (STEMI) ~500 K per year Thrombolysis
More informationImproving STEMI outcomes in Denmark. Michael Rahbek Schmidt, MD, PhD. Aarhus University Hospital Skejby Denmark
Improving STEMI outcomes in Denmark Michael Rahbek Schmidt, MD, PhD. Aarhus University Hospital Skejby Denmark Presenter Disclosure Information Study funded by Fondation Leducq Michael Rahbek Schmidt The
More informationSanford Chest Pain Network: Improving Rural STEMI Outcomes
Sanford Chest Pain Network: Improving Rural STEMI Outcomes Naveen Rajpurohit, MD Cardiovascular Fellow Sanford Cardiovascular Institute Sanford Heart Hospital The University of South Dakota Sioux Falls,
More informationPharmaco-Invasive Approach for STEMI
Pharmaco-Invasive Approach for STEMI Michael C. Kontos, MD Medical Director, Coronary Intensive Care Unit Director, Chest Pain Evaluation Center Associate Professor Departments of Internal Medicine (Cardiology),
More informationEagles 2007 Focused Quality in EMS The Five Required Actions
Eagles 2007 Focused Quality in EMS The Five Required Actions Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Prior
More informationTreatment of ST-elevation myocardial infarction in China: Where are we?
Treatment of ST-elevation myocardial infarction in China: Where are we? Associate Professor, Yihong Sun, MD Peking University People s Hospital Beijing, China Disclosure conflict of Interest The Challenges
More informationThrombolysis in Cardiology to whom? Professor Steen D. Kristensen, MD, DMSc, FESC Department of Cardiology
Thrombolysis in Cardiology to whom? Professor Steen D. Kristensen, MD, DMSc, FESC Department of Cardiology UNIVERSITY OF AARHUS 1 COI Speakers fee: Aspen, AZ, Bayer, BMS/Pfizer Departmental research grant:
More informationSHOULD A REGIONAL STEMI CENTRE ONLY OFFER PRIMARY PCI?
SHOULD A REGIONAL STEMI CENTRE ONLY OFFER PRIMARY PCI? Kurt Huber, MD 3 Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria Disclosures DISCLOSURE
More informationDISCUSSION QUESTION - 1
CASE PRESENTATION 87 year old male No past history of diabetes, HTN, dyslipidemia or smoking Very active Medications: omeprazole for heart burn Admitted because of increasing retrosternal chest pressure
More informationCurrent Advances and Best Practices in Acute STEMI Management A pharmacoinvasive approach
Current Advances and Best Practices in Acute STEMI Management A pharmacoinvasive approach Frans Van de Werf, MD, PhD University Hospitals, Leuven, Belgium Frans Van de Werf: Disclosures Research grants
More informationAcute Coronary Syndrome (ACS) is the consequence of
Clinical Practice Pharmaco-invasive Therapy for STEMI; The Most Suitable STEMI Reperfusion Therapy for Transferred Patients in Thailand Pradub Sukhum, MD. 1 1 Division of Cardiovascular Medicine, Bangkok
More informationNEBRASKA STEMI CONFERENCE 2015 Dr. Doug Kosmicki. 2013, American Heart Association
NEBRASKA STEMI CONFERENCE 2015 Dr. Doug Kosmicki 2013, American Heart Association 1 Dr. Doug Kosmicki Reperfusion Strategies Disclosure Information Report any disclosure information of conflicts of interest.
More informationAcute Coronary Syndrome
Acute Coronary Syndrome Clinical Manifestation of CAD Silent Ischemia/asymptomatic Stable Angina Acute Coronary Syndrome (Non- STEMI/UA and STEMI) Arrhythmias Heart Failure Sudden Death Pain patterns with
More informationIdentification and pre-notification using 12-Lead. Why this so important to our STEMI System
Identification and pre-notification using 12-Lead Why this so important to our STEMI System Jim Smith, MD Great Plains Health, North Platte Chair, NE State EMS Board Medical Director, Emergency Services,
More informationST-elevation myocardial infarctions (STEMIs)
Guidelines for Treating STEMI: Case-Based Questions As many as 25% of eligible patients presenting with STEMI do not receive any form of reperfusion therapy. The ACC/AHA guidelines highlight steps to improve
More informationLevel One STEMI Connecting the Dots changing Points of Care into Systems of Care
Level One STEMI Connecting the Dots changing Points of Care into Systems of Care Myron Bloom MD MMM Medical Director Rural Healthcare Quality Network RHQN.org drmbloom@msn.com The Eastern Washington Level
More informationPrimary Percutaneous Coronary Intervention
The big 5 in PCI Primary Percutaneous Coronary Intervention W. Wijns (Aalst, BE) Disclosures Consulting Fees: on my behalf go to the Cardiovascular Research Center Aalst Contracted Research between the
More informationThe role of pre hospital thrombolysis. Aaron Frimerman Hillel Yaffe Medical Center Hadera Israel
The role of pre hospital thrombolysis Aaron Frimerman Hillel Yaffe Medical Center Hadera Israel Is thrombolysis still valid? Disclosure I am an Interventional Cardiologist STEMI is mainly a thrombotic
More informationManagement of Acute Myocardial Infarction
Management of Acute Myocardial Infarction Prof. Hossam Kandil Professor of Cardiology Cairo University ST Elevation Acute Myocardial Infarction Aims Of Management Emergency care (Pre-hospital) Early care
More informationS. CHASSAING4 P. DEQUENNE5
#10899 - OP013 Importance of delay for management of STEMI: does the helicopter HEMS is better than ground transport with MICU ambulance? Analyze of the French region Centre Registry of Acute Coronary
More informationRural Minnesota STEMI Systems of Care
CARDIOVASCULAR HEALTH UNIT Rural Minnesota STEMI Systems of Care Almost 250,000 Americans experience ST-elevation Myocardial Infarction (STEMI), the deadliest form of heart attack, each year. Of approximately
More informationThe Strategic Reperfusion Early After STEMI study Implications for clinical practice
The Strategic Reperfusion Early After STEMI study Implications for clinical practice Robert C. Welsh, MD, FRCPC Associate Professor of Medicine Director, Adult Cardiac Catheterization and Interventional
More informationFrans Van de Werf, MD, PhD Leuven, Belgium
STEMI Cases and the ESC STEMI Guidelines Frans Van de Werf, MD, PhD Leuven, Belgium The Easy Case 2/21/2011 History and Risk Factors 50-year old male patient Past medical history: Teratoma right testis
More informationDashboard and Outcomes Report with Case Studies
Dashboard and Outcomes Report with Case Studies Kim Hustler Clinical Quality Consultant, American College of Cardiology The following relationships exist: Kim Hustler: No Disclosures Section F- Procedures
More informationChapter 3 for 12 Lead Training -Precourse-
ONTARIO BASE HOSPITAL GROUP Chapter 3 for 12 Lead Training -Precourse- Ontario Base Hospital Group Education Subcommittee 2008 TIME IS MUSCLE ONTARIO BASE HOSPITAL GROUP Introduction and Purpose Introduction
More informationProf. Adel El Etriby Ain Shams Faculty of Medicine
Prof. Adel El Etriby Ain Shams Faculty of Medicine Reperfusion Options for STEMI Patients Step One: Assess Time and Risk. Time Since Symptom Onset Risk of STEMI Risk of Fibrinolysisi i Time Required for
More informationPresenters: Disclaimer. Definitions. Deanna Jones, RN, CCRN. Annmarie Keck, RN, CEN
Presenters: Deanna Jones, RN, CCRN Cardiac Level 1 Coordinator, Providence Sacred Heart Medical Center and Children s Hospital, Spokane, WA Annmarie Keck, RN, CEN Clinical Outreach Educator Northwest MedStar,
More informationThrombolysis in Acute Myocardial Infarction
CHAPTER 70 Thrombolysis in Acute Myocardial Infarction J. S. Hiremath Introduction Reperfusion of the occluded coronary artery at the earliest is the most important aim of management of STEMI. Once a flow
More informationLiterature Review and Recommendations Prehospital Fibrinolytics Administration for Acute Myocardial Infarction
Literature Review and Recommendations Prehospital Fibrinolytics Administration for Acute Myocardial Infarction EMS Bureau Protocol Review Steering Committee Background In 2009, approximately 683,000 Americans
More informationPatient and System Time Delay
Quality Indicators in the Management of ST-elevation Myocardial Infarction Patient and System Time Delay Jacob Thorsted Sorensen, MD, PhD Department of Cardiology Aarhus University Hospital, Denmark Disclosures
More informationSTEMI Network. Joseph L. Fredi, M.D., FACC. The median D2B time for patients presenting to the Vanderbilt ED was 55 minutes.
STEMI Network STEMI News By Joseph Fredi, M.D., FACC, and Carol R. Scott, B.S.N., M.S.N., coordinators, STEMI Network, Vanderbilt Heart and Vascular Institute Even with the great success our STEMI Network
More informationSTEMI Stents What next? Arshad Khan - HNE Clinical Research Fellow. Supervisors: Prof Boyle and Attia.
STEMI Stents What next? Arshad Khan - HNE Clinical Research Fellow. Supervisors: Prof Boyle and Attia. PART 1 Systems of care for STEMI. STEMI Management Coronary angiogram +/- stenting. Prehospital thrombolysis
More informationDaily practice of ACS management in the Gulf: Data from Gulf COAST
Daily practice of ACS management in the Gulf: Data from Gulf COAST Mohammad Zubaid, MB, ChB, FRCPC, FACC Professor of Medicine, Kuwait University Head, Division of Cardiology Mubarak Alkabeer Hospital
More information12/18/2009 Resting and Maxi Resting and Max mal Coronary Blood Flow 2
Coronary Artery Pathophysiology ACS / AMI LeRoy E. Rabbani, MD Director, Cardiac Inpatient Services Director, Cardiac Intensive Care Unit Professor of Clinical Medicine Major Determinants of Myocardial
More informationACTION Registry GWTG Research and Publications Update
ACTION Registry GWTG Research and Publications Update Dr. Michael Kontos Director, Coronary Intensive Care Unit Pauley Heart Center, Virginia Commonwealth University The following relationships exist:
More informationFrom interventional cardiology to cardio-neurology. A new subspeciality
From interventional cardiology to cardio-neurology. A new subspeciality in the future? Prof. Andrejs Erglis, MD, PhD Pauls Stradins Clinical University Hospital University of Latvia Riga, LATVIA Disclosure
More informationSystems of Care to Improve Timeliness of Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction During Off Hours
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 1, NO. 1, 2008 2008 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/08/$34.00 PUBLISHED BY ELSEVIER DOI: 10.1016/j.jcin.2007.10.002 Systems of Care
More informationNew Insights on Reperfusion Choices Implications of STREAM. Paul W Armstrong MD
New Insights on Reperfusion Choices Implications of STREAM ESC STEMI Satellite Symposium August 31 2014 Aligning Optimal Care to Time Place and Person Paul W Armstrong MD Disclosure Statement Paul W. Armstrong
More informationDecision for fibrinolysis or primary PCI in the prehospital phase
Decision for fibrinolysis or primary PCI in the prehospital phase Nicolas Danchin, Hôpital Européen Georges Pompidou, Paris, France Disclosures Research grants: Astrazeneca, Eli-Lilly, GSK, Merck, Novartis,
More informationTransfer in D2B. Scott D Friedman, MD FACC Medical Director, Cardiology Services Shore Health System of Maryland. The Problem
Transfer in D2B Scott D Friedman, MD FACC Medical Director, Cardiology Services Shore Health System of Maryland The Problem NRMI-5: North Carolina, July 2003- June 2004 NC Nation Guidelines N 2,738 79,927
More informationStent For Life, Egypt A Success Story. Hany Ragy MD, FSCAI NHI, Cairo,
Stent For Life, Egypt A Success Story Hany Ragy MD, FSCAI NHI, Cairo, Egypt @hragy Stent For Life Initiative in Egypt Professor Mohamed Sobhy, MD, FACC, FESC Professor of Cardiology Department, Alexandria
More information1 a) Please confirm or deny whether your Trust has admitted patients for acute myocardial infarction in 2008/09, 2009/10 or 2010/11
May 2011 1 a) Please confirm or deny whether your Trust has admitted patients for acute myocardial infarction in 2008/09, 2009/10 or 2010/11 Yes b) If confirmed please provide details on the number of
More informationThe Need for Rescue PCI after Failed Fibrinolysis: Who, When and Why.
Implementing the pharmacoinvasive strategy in STEMI The Need for Rescue PCI after Failed Fibrinolysis: Who, When and Why. 7:20-7:40 Robert C. Welsh, MD, FRCPC, FESC, FAHA, FACC Professor of Medicine Director,
More informationWilliam D. Salerno, M.D. Director, Coronary Care Unit Hackensack University Medical Center Clinical Associate Professor of Medicine, UMDNJ
William D. Salerno, M.D. Director, Coronary Care Unit Hackensack University Medical Center Clinical Associate Professor of Medicine, UMDNJ PROBLEM: blood supply to the heart has been compromised and heart
More informationPolicy Register No: Status: Public. Contributes to Care Quality Commission Outcome 4
Operational Policy for Transfer of ST Elevation MI (STEMI) patients to Essex Cardiothoracic Centre (ECTC) for Primary Percutaneous Coronary Intervention Policy Register No: 09122 Status: Public Developed
More informationThe Burden & Management of Ischaemic Heart Disease in Kenya
The Burden & Management of Ischaemic Heart Disease in Kenya Dr Harun A Otieno FACC Tuesday, October 6th: Session X PASCAR & CSM Joint Congress 2015, Mauritius Disclosures With regards to this presentation,
More informationCharacteristics of Transient ST-Elevation versus ST-Elevation and Non-ST-Elevation Myocardial Infarction
Characteristics of Transient ST-Elevation versus ST-Elevation and Non-ST-Elevation Myocardial Infarction Blondheim DS, Shochat M, Asif A, Kazatsker M, Frimerman A, Vassilenko L, Abu Fane R, Neiman E, Barel
More informationGoals: Widen Your Understanding of the Wide QRS!
Goals: Widen Your Understanding of the Wide QRS! 1. Describe an approach to diagnosis of LBBB 2. Describe the predictive value of New LBBB 3. Describe the ST segment changes that are diagnostic of AMI
More informationMyocardial Infarction In Dr.Yahya Kiwan
Myocardial Infarction In 2007 Dr.Yahya Kiwan New Definition Of Acute Myocardial Infarction The term of myocardial infarction should be used when there is evidence of myocardial necrosis in a clinical setting
More informationDoor to Balloon : The Big Deal. Shaiful Azmi Yahaya,, M.D. Consultant Cardiologist Institut Jantung Negara
Door to Balloon : The Big Deal Shaiful Azmi Yahaya,, M.D. Consultant Cardiologist Institut Jantung Negara Lecture Outline Pathophysiology of ACS History Door to balloon -? The big deal Myocardial ischaemia
More informationUpdate Guidelines in STEMI Management: Focus on Logistic and System Approach to Reperfusion Therapy
March 14 th, 2018 The First Asia Forum in Emergency Medicine BNH Hospital, Bangkok, Thailand Update Guidelines in STEMI Management: Focus on Logistic and System Approach to Reperfusion Therapy Wacin Buddhari,
More informationMission: Lifeline EMS Recognition : FMC to Device < 90 Minutes Worksheet
Mission: Lifeline EMS Recognition : FMC to Device < 90 Minutes Worksheet Did Pt. Receive PCI FMC to PCI < 90 Minutes Exclusions Documented Delay after hospital arrival (Refer to Page 4 in EMS Recognition
More informationPPCI in STEMI. ESC at the 22nd Annual Conference of the Saudi Heart Association February 21th, 2011
PPCI in STEMI Dr Hassan Mhish Interventional Cardiology Consultant Cardiology Fellowship Program Director Prince Salman Heart Center King Fahd Medical City Riyadh, KSA ESC at the 22nd Annual Conference
More informationMission: Lifeline Addressing the System of STEMI Care
Mission: Lifeline Addressing the System of STEMI Care Alice K. Jacobs, M.D. Boston University Medical Center Boston, MA, USA ACC West Virginia Chapter, April 2017 Disclosure Information FINANCIAL DISCLOSURE:
More informationACUTE CORONARY SYNDROME PCI IN THE ELDERLY
ACUTE CORONARY SYNDROME PCI IN THE ELDERLY G.KARABELA MD.PhD ATHENS NAVAL HOSPITAL INTERVENTIONAL CARDIOLOGY DEPARTMENT NO CONFLICT OF INTEREST TO DECLAIRE Risk stratification in Αcute Coronary Syndrome.
More informationpresenters 2010 Sameh Sabet Ain Shams University
Guidelines for PCI in late STEMI presenters 2010 Sameh Sabet Assistant Professor of Cardiology Ain Shams University 29% of MI patients have STEMI. NRMI 4 (Fourth National Registry of Myocardial Infarction),
More informationFacilitated Percutaneous Coronary Intervention in STEMI Patients: Does It Work in Asian Patients?
Editorial Comment Acta Cardiol Sin 2014;30:292 297 Facilitated Percutaneous Coronary Intervention in STEMI Patients: Does It Work in Asian Patients? Wei-Chun Huang, 1,2,3 Cheng-Hung Chiang 1,2 and Chun-Peng
More informationSTEMI Linee guida ESC Maddalena Lettino, Italy
STEMI Linee guida ESC 2017 Maddalena Lettino, Italy Disclosure Speaker fee: Aspen, Astra Zeneca, BMS, Boehringer, Eli Lilly, DaichiiSankio, Bayer, Pfizer, Sanofi Advisory board member: Astra Zeneca, Eli
More informationSTREAM - ONE YEAR MORTALITY STRATEGIC REPERFUSION EARLY AFTER MYOCARDIAL INFARCTION. STREAM 1Y AHA 2013 P Sinnaeve
STREAM - ONE YEAR MORTALITY STRATEGIC REPERFUSION EARLY AFTER MYOCARDIAL INFARCTION PCI Hospital Ambulance/ER STREAM design STEMI
More informationThe PAIN Pathway for the Management of Acute Coronary Syndrome
2 The PAIN Pathway for the Management of Acute Coronary Syndrome Eyal Herzog, Emad Aziz, and Mun K. Hong Acute coronary syndrome (ACS) subsumes a spectrum of clinical entities, ranging from unstable angina
More informationPHYSICIAN SIGNATURE DATE TIME DRUG ALLERGIES WT: KG
Available at ALL facilities Non Categorized SUB ED Chest Pain: STEMI Protocol(SUB)* SUB ED Chest Pain: STEMI Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as
More informationCover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/21543 holds various files of this Leiden University dissertation Author: Dharma, Surya Title: Perspectives in the treatment of cardiovascular disease :
More informationSTEMI update. Vijay Krishnamoorthy M.D. Interventional Cardiology
STEMI update Vijay Krishnamoorthy M.D. Interventional Cardiology OVERVIEW Current Standard of Care in Management of STEMI Update in management of STEMI Pre-Cath Lab In the ED/Office/EMS. Cath Lab Post
More informationNova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Antiplatelet Section of the Guidelines)
Cardiovascular Health Nova Scotia Guideline Update Nova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Antiplatelet Section of the Guidelines) Authors: Dr. M. Love, Dr. I. Bata, K. Harrigan
More informationAcute Coronary Syndromes
Overview Acute Coronary Syndromes Rabeea Aboufakher, MD, FACC, FSCAI Section Chief of Cardiology Altru Health System Grand Forks, ND Epidemiology Pathophysiology Clinical features and diagnosis STEMI management
More informationSTEMI Care 2014 at the Crossroads: Taking the right road
STEMI Care 2014 at the Crossroads: Taking the right road Robert C. Welsh, MD, FRCPC, FESC, FAHA, FACC Professor of Medicine Vice President, The Canadian Association of Interventional Cardiology Director,
More information9/24/2013. Thrombolytics in 2013: Never Say Never. September 19 th, 2013 Scott M Lilly, MD PhD. Clinical Case
September 19 th, 2013 Scott M Lilly, MD PhD Thrombolytics in 2013: Never Say Never Clinical Case 2 1 Evolution of STEMI Therapy The importance of absolute rest in bed for several days is clear James B
More informationTAB 7: SUB TAB: AMI/CHEST PAIN Specifications & Paper Tools
TAB 7: SUB TAB: AMI/CHEST PAIN Specifications & Paper Tools Material inside brackets ([and]) is new to this Specifications Manual version. Hospital Outpatient Quality Measures Acute Myocardial Infarction
More informationShould All Patients Be Treated with Ace-inh /ARB after STEMI with Preserved LV Function?
Should All Patients Be Treated with Ace-inh /ARB after STEMI with Preserved LV Function? Avi Shimony, MD, FESC Cardiology Division Soroka University Medical Center Ben-Gurion University, Beer-Sheva Disclosure
More informationSTEMI Presentation and Case Discussion. Case #1
STEMI Presentation and Case Discussion Scott M Lilly MD PhD, Interventional Cardiology The Ohio State University Contemporary Multidisciplinary Cardiovascular Conference Orlando, Florida September 17 th,
More informationAcute Coronary Syndrome: Interventional Strategy
2005 Acute Coronary Syndrome: Interventional Strategy Youngkeun Ahn, MD, PhD, FACC, FSCAI Department of Cardiology Program in Gene and Cell Therapy, The Heart Center of Chonnam National University, GwangJu,,
More informationST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI): DECREASING THE TIME TO TREATMENT IN THE ED
ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI): DECREASING THE TIME TO TREATMENT IN THE ED W. Brian Gibler, MD Professor and Chairman; Department of Emergency Medicine, University of Cincinnati College
More informationConflits d intérêt Astra-Zeneca, BMS, MSD, Novartis, Pfizer, Daiichi-Sankyo, Servier, CRAM, AFSSAPS, ARH Région de Bourgogne Clos Vougeot
Conflits d intérêt Astra-Zeneca, BMS, MSD, Novartis, Pfizer, Daiichi-Sankyo, Servier, CRAM, AFSSAPS, ARH Région de Bourgogne Clos Vougeot Agrément FMC N 100 437 Popul. millions Area km2 Density inha/km2
More informationThe optimum reperfusion pathway for ST elevation acute myocardial infarction: development of a decision framework
52 PREHOSPITAL CARE The optimum reperfusion pathway for ST elevation acute myocardial infarction: development of a decision framework J Kendall... There is currently much debate about the relative roles
More informationManagement of ST-elevation myocardial infarction Update 2009 Late comers: which options?
European Society of Cardiology Annual Session 2009 Management of ST-elevation myocardial infarction Update 2009 Late comers: which options? Antonio Abbate, MD Assistant Professor of Medicine Virginia Commonwealth
More informationOptimizing primary percutaneous coronary intervention in ST-segment elevation myocardial infarction
EDITORIAL Optimizing primary percutaneous coronary intervention in ST-segment elevation myocardial infarction In an ideal world, all patients with [ST-segment elevation myocardial infarction] would be
More informationSTEMI 2014 YAHYA KIWAN. Consultant Cardiologist Head Of Cardiology Belhoul Specialty Hospital
STEMI 2014 YAHYA KIWAN Consultant Cardiologist Head Of Cardiology Belhoul Specialty Hospital Aspiration Thrombectomy Manual aspiration thrombectomy is reasonable for patients undergoing primary PCI. I
More informationPRIMARY CORONARY ANGIOPLASTY VERSUS INTRAVENOUS THROMBOLYSIS FOR ACUTE MYOCARDIAL INFARCTION - A COMPARATIVE STUDY AT QUEEN ALIA HEART INSTITUTE
PRIMARY CORONARY ANGIOPLASTY VERSUS INTRAVENOUS THROMBOLYSIS FOR ACUTE MYOCARDIAL INFARCTION - A COMPARATIVE STUDY AT QUEEN ALIA HEART INSTITUTE Walid Sawalha MD, MBBS (Lond), MRCP(UK)* ABSTRACT Objectives:
More informationHot Topics in Cardiac Arrest. Should the patient go To the Cath Lab?
Hot Topics in Cardiac Arrest Should the patient go To the Cath Lab? Tim Russert 1950-2008 Host of NBC s Meet the Press Sudden Cardiac Arrest : Autopsy showed plaque rupture in his LAD ( per LA Times,
More informationOn admission Acute extensive anterior STEMI
Mr B 52 years old male Smoker No prior known CAD Presents with 1 hour intermittent crushing retrosternal chest pain Transferred by MICU directly to CCU (ASA, Heparin) On admission Intense pain, diaphoretic
More informationOptimal antithrombotic therapy:
Optimal antithrombotic therapy: upstream and during primary PCI. Steen D Kristensen, MD, DMSc, FESC Professor and Consultant Interventional Cardiologist Aarhus University, Denmark UNIVERSITY OF AARHUS
More informationAccess to Urgent PCI for ST Segment Elevation Myocardial Infarction
Access to Urgent PCI for ST Segment Elevation Myocardial Infarction Final Report and Recommendations Submitted to the Ontario Ministry of Health and Long-Term Care April 30, 2004 Cardiac Care Network of
More informationImproving the Outcomes of
Improving the Outcomes of STEMI Shelley Valaire, ACP; and Robert Welsh, MD, FRCPC Presented at the University of Alberta s 6th Annual Cardiology Update for General Practitioners and Internists, Edmonton,
More informationEarlier reperfusion in patients with ST-elevation Myocardial infarction by use of helicopter
Knudsen et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2012, 20:70 ORIGINAL RESEARCH Open Access Earlier reperfusion in patients with ST-elevation Myocardial infarction by
More informationReperfusion Strategy in Europe: Temporal Trends in Performance Measures for Reperfusion Therapy in ST Elevation Myocardial Infarction
Reperfusion Strategy in Europe: Temporal Trends in Performance Measures for Reperfusion Therapy in ST Elevation Myocardial Infarction F. Schiele 1, M. Hochadel 2, M. Tubaro 3, N. Meneveau 1, W. Wojakowski
More informationCardiology Department. Clinical Governance
Cardiology Department Clinical Governance Background Cardiology department has a high throughput of emergency and elective patients Two acute sites CAH and DHH Cardiac investigation department provides
More informationPost-Reteplase Evaluation of Clinical Safety & Efficacy in Indian Patients (Precise-In Study)
30 Post-Reteplase Evaluation of Clinical Safety & Efficacy in Indian Patients (Precise-In Study) RK Singh 1, A Trailokya 2, MM Naik 3 Original Article Abstract Background: ST elevated myocardial infarction
More informationThe Appropriate Management of Rural Patients with ST-Segment Elevation Myocardial Infarction When Delays are Expected Due to Long-Distance Transfers
Pacific University CommonKnowledge School of Physician Assistant Studies Theses, Dissertations and Capstone Projects Summer 8-8-2014 The Appropriate Management of Rural Patients with ST-Segment Elevation
More informationPrimary Percutaneous Coronary Interventions Network in Bosnia and Herzegovina - Sarajevo s proposal
Professional paper Primary Percutaneous Coronary Interventions Network in Bosnia and Herzegovina - Sarajevo s proposal Mehmed Kulic, Anes Sosevic, A. Tahirovic, Muhamed Spuzic, Vedad Mujacic, Majla Cibo,
More informationRural STEMI System of Care Success. Nicole Huber, PA-C Cumberland Healthcare Emergency Department
Rural STEMI System of Care Success Nicole Huber, PA-C Cumberland Healthcare Emergency Department DISCLOSURES I HAVE NO ACTUAL OR POTENTIAL CONFLICT OF INTEREST IN RELATION TO THIS PRESENTATION Ideal Process
More information