Death, Reinfarction &Stroke Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany Ontario Health Technology Assessment Series 2004 pPCI better Lysis better STEMI: pP
Trang 1STEMI: unload LV first or open culprit vessel first?
Christoph K Naber
Contilia Heart and Vascular Center
Trang 2Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany
Conflicts of Interest
Nothing to declare
Trang 3STEMI
Trang 4Death, Reinfarction &Stroke
Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany
Ontario Health Technology Assessment Series 2004 pPCI better Lysis better
STEMI: pPCI vs Lysis
Trang 5DANAMI-2
Danmark, 5 PCI-Centers, 24 Non-PCI Hospitals
1572 STEMI Patients (1129 transferred)
Transportation:
Median 50 km (3-150 km)
Andersen et al., N Engl J Med 2003
Trang 6PCI: Facilitated vs Primary
6
Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany
Trang 7PCI: Facilitated vs Primary
Thiele et al JACC Interventions 2011
Trang 8PCI: Facilitated vs Primary
Thiele et al JACC Interventions 2011
Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany
Trang 9PCI: Facilitated vs Primary
Thiele et al JACC Interventions 2011
Trang 10Mangement of STEMI
Steg et al EHJ 2012
Trang 11Pressure Volume Curves
Rihal et al JACC 2015
Trang 12Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany
LV unloading in AMI
Kapur et al.Circulation 2013
Trang 13Pressure Volume Curves
Rihal et al JACC 2015
Trang 14Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany
Pressure Volume Curves
Rihal et al JACC 2015
No trial so far systematically tested unloading of
the LV in AMI patients with or without cardiogenic shock before primary PCI
Trang 15IABP in stable PCI
Patel et al JAMA 2012
N=331
Trang 16Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany
IABP SHOCK II trial
Thiele et al Lancet 2013
Trang 17IABP in AMI with Shock
Unverzagt et al Cochrane Database 2015
30 day mortality
Trang 18Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany
IABP in AMI: short term mortality
Dan et al
Medicine 2015
Trang 19IABP in AMI: long term mortality
Dan et al
Medicine 2015
Trang 20Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany
IABP in AMI
Dan et al Medicine 2015
Trang 21Hemodynamic Support Devices
Werdan et al EHJ 2014
Trang 22Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany
Mangement of Cardiogenic Shock
Werdan et al EHJ 2014
Trang 23Mangement of AMI & Shock
Romeo et al World J Cardiol 2016
IABP vs Medicine
Trang 24Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany
Mangement of AMI & Shock
Romeo et al World J Cardiol 2016
IABP vs PLVAD
Trang 25Mangement of AMI & Shock
Romeo et al World J Cardiol 2016
IABP vs IABP+ECMO
Trang 26Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany
Mangement of STEMI
Steg et al EHJ 2012
Trang 27“Reducing mortality and morbidity of patients with ACS
by supporting the implementation of Guidelines on Myocardial Revascularization at national levels”
www.stentforlife.com
Trang 28Contilia Herz- und Gefäßzentrum, Elisabeth Krankenhaus Essen
Summary
1 Primary PCI is first line therapy for STEMI
2 Lysis can significantly save lives as well and should be applied where timely pPCI is not possibly
3 Application of IABP in all STEMI patients with or
without shock is of no additional benefit
4 Data on systematic use of IABP or ECMO in STEMI
patients with or without shock before pPCI are
lacking and may be difficult to achieve