Barcelona aug. Riadh Al-Ani

Presentasjon om: "Barcelona aug. Riadh Al-Ani"— Utskrift av presentasjonen:

1 Barcelona 26-30 aug. Riadh Al-Ani 06.09.2017
ESC Congress Barcelona aug. Riadh Al-Ani

2 STEMI Guidlines Ingen forskjell mellom vs. eller høyre grenblokk
ST-depresjon > 1 mm i 8 eller mer avledninger pluss ST-elevasjon i aVR og/eller V1, kan være tegn til hovedstammeocclusjon eller alvorlig multikarsykdom

3 STEMI Guidlines Definisjon av ‘Tid 0’, fra FMC ( first medical contact) STEMI-diagnose, EKG-fronadringer, helst < 10 min fra FMC Tidgrense til rutinmessig åpning av en IRA (infarkt-relatert arterie) 0-12 t(Class I) ; t (Class IIa) ; > 48 t (Class III)

4 STEMI Change In Recommendations 2012-2017
Radial access IIa I DES over BMS Complete revascularization III Ila level A Thormbus aspiration III level A Enoxaparin iv IIb Ila level A Early hospital discharge Oxygen SaO2 < 95% SaO2 < 90%

5 In left and mid panels, below each recommendation, the most representative trial (acronym and reference) driving the indication is mentioned. From: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevationThe Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) Eur Heart J. Published online August 26, doi: /eurheartj/ehx393 Eur Heart J | © The European Society of Cardiology All rights reserved. For permissions please 5

6 In early presenters (i. e
In early presenters (i.e. those with STEMI diagnosis within 3 hours from symptoms onset), a primary PCI strategy is the reperfusion strategy of choice. If the anticipated time from STEMI diagnosis to PCI-mediated reperfusion is > 120 min, then immediate fibrinolysis is indicated. After 3 hours (and up to 12 hours) of symptoms onset, the later the patient presents, the more consideration should be given to a primary PCI strategy as opposed to administering fibrinolytic therapy. In evolved STEMI (12–48 hours after symptoms onset), a routine primary PCI strategy (urgent angiography and subsequent PCI if indicated) should be considered in all patients. After 48 hours (recent STEMI) angiography should be performed but routine PCI of a total occluded IRA is not recommended. Regardless of the time from symptoms onset, the presence of ongoing symptoms suggestive of ischaemia, haemodynamic instability, or lifethreatening arrhythmias is an indication for a primary PCI strategy. From: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevationThe Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) Eur Heart J. Published online August 26, doi: /eurheartj/ehx393 Eur Heart J | © The European Society of Cardiology All rights reserved. For permissions please 6

7 Table 5 Summary of important time targets                                                                                                                                                              ECG

8 COMPASS- studie Cardiovascular Outcomes for People using Anticoagulation Strategies
33 land, 602 sentrer 27,395 pasienter med stabil aterosklerotisk karsykdom Vurder effekten av liten dose rivaroxaban (Xarelto) i tillegg til ASA Randomisering i 3 grupper

9 COMPASS (forts.) Gruppe 1: Xarelto 2,5 mg x 2 pulss ASA 100 mg x 1
Gruppe 3: ASA 100 mg x 1 Endepunkt ; cardiovaskulær død, stroke eller hjerteinfarkt

10 COMPASS (forts.) Studien ble stoppet pga superioritet av Xarelto + ASA gruppe Primære endepunkt 379 (4,1%) vs. 496 (5,4%) Major blødning økt, 170 (1,9%) vs. 288 (3,1%), men ingen signifikant forskjell i intrakraniale eller fatale blødninger mellom de to grupper Død 378 (4,1%) vs. 313 (3,4%) Xarelto alene ikke bedre resultat

11 RE-DUAL PCI-studie Randomized Evaluation of Dual Antithrombotic Therapy
PCI hos pasienter med atrieflimmer 2775 pasienter randomisert Tripple antitrombotisk gruppe ( ASA+ Plavix eller Brilique + Marevan).ASA seponert etter en måned ved BMS og 3 mndr etter DES Dual behandlingsgruppe ( Plavix eller Brilique + dabigatran 110 og 150 mg) Oppfølging 14 mndr

12 RE-DUAL (forts.) Endpoint ; major eller klinisk relevant non-major blødning Vurderer noninferioriti av dual terapi i forhold til trippletreapi mht MI,stroke eller systemisk embolisering

13 RE-DUAL (forts.) Blødningsrisiko mindre ved dualterapi med primær endpoint 15,4% vs. 26,9% (ved 110 mg Pradaxa) 20,2% vs. 25,7% (ved 150 mg Pradaxa) Dual terapi var noninferior til tripple terapi mht tromboemboliske hendelser (MI,stroke, perifer embolier)

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