XỬ TRÍ CẤP CỨU HỘI CHỨNG VÀNH CẤP, TS.BS.NGUYỄN NGỌC QUANG

Before Infarct After Infarct Lost Muscle... GISSI CASS procedure Julian Gibbon 1972 NHBPEP 1979 Coronary angioplasty developed Grüntzig 2007 Benefit of cardiac resyn- chronization th

• 

• 

• 

–  –  – 

• 

• 

• 

• 

–  –  –  – 

• 

3

Before Infarct After Infarct

Lost Muscle

V2/V3 V3R/V4R

ESC/ACCF/AHA/WHF Task Force Eur Heart J 2007; 28:2525.

GISSI CASS

procedure (Julian)

(Gibbon)

1972 NHBPEP

1979 Coronary angioplasty developed (Grüntzig)

2007 Benefit of cardiac resyn- chronization therapy in heart failure demonstrated

2002 Efficacy of drug-eluting

vs bare- metal stents determined

2002 ALLHAT

1992 SAVE

1993 Superiority of primary PCI vs

fibrinolysis in acute MI noted

1985 TIMI 1

1986

1983

and ISIS-2

1985 NCEP

1980 First implantable cardioverter-defibrillator developed (Mirowski)

1969 First description

(Favaloro)

1976 First

reductase inhibitor described (Endo)

1962

1958 Coronary

arteriography

Developed

(Sones)

1961 Risk factors defined

in early-onset

MI described

2009 Deep gene sequencing for responsiveness

to cardiovascular drugs performed

2009 Left-ventricular assist device as destination therapy

in advanced heart failure shown

to be effective

2009 Genome wide association

•  

• 

•  

• 

• 

• 

• 

• 

• 

• 

• 

• 

Ø  

• 

• 

12

patient-years Study, year

Rate ratio
 (95% CI)

Meta-analysis of anticoagulation: efficacy

Prevent 19 MIs per 1,000 pt-years

0.05 Favours warfarin

1.0 Rate
 ratio

5.0 Favours ASA

Rothberg MB, et al Ann Int Med 2005;143:241-250

Recurrent MI

patient-years Study, year

Rate ratio
 (95% CI)

1.0 Rate
 ratio

5.0 Favours ASA

Rothberg MB, et al Ann Int Med 2005;143:241-250

Novel Anticoagulants: Prime Time?

ATLASACS 2-TIMI 51 data is for rivaroxaban 2.5 mg BID in Stratum 2 (background aspirin + thienopyridine);not approved for use in the US

ARDs are approximately per year

Non-Surgical Major Bleeds:

PLATO Investigators NEJM 2009;ATLASACS 2-TIMI Investigators NEJM 2012

• 

• 

40mg

40mg

40mg

• 

• 

• 

• 

Reperfusion/

• 

phạm

Thời gian (ngày)

Cohen M, et al Am Heart J 2002; 143:63-69

Mục tiêu của Phân tầng Nguy cơ

Phân tầng Nguy cơ sớm

Tiên lượng và giải thích kỹ

Chiến lược Can

• 

• 

Tiêu chí đánh giá điều trị h/c vành cấp

2

N=1,716 Cases and 3,432 Controls

AF = attributable fraction (risk)

Revascularization Thienopyridine

31.9 10.9

19.4 to 42.4 2.3 to 9.8 Statin therapy 9.7 4.1 to 15.0 Rehabilitation referral

ACE inhibitor Glycoprotein IIb/IIIa inhibition ß-blocker

10.6 4.3 1.9 0.1

-2.4 to 21.5 -0.1 to 9.4 -1.68 to 17.3 -2.8 to 4.6

• 

•