Tiếp cận can thiệp mạch vành ở người bệnh suy tim

14th Vietnam National Congress of Cardiology Da Nang City Vietnam 2014 PCI In Heart Failure Dr Tan Huay Cheem MBBS, M Med(Int Med) MRCP(UK), FRCP(Edinburgh), FAMS, FACC, FSCAI Director, National University Heart Centre, Singapore Associate Professor of Medicine, Yong Loo Lin School of Medicine National University of Singapore President, Asia Pacific Society of Interventional Cardiology National University Heart Centre, Singapore (NUHCS) Case Study M/46 CVRF smoking Admitted for NSTEMI 2D echo showed LVEF 20% Case Study Case Study Case Study Two-Dimensional Echocardiogram Pre-& Post-PCI Pre-PCI Months Pre-PCI LVEF improved from visual estimate 20% to 40% Myocardial Revascularisation In Chronic Heart Failure • Coronary artery disease remains the most common cause of CHF • Patients with depressed LV function remain ar risk of sudden cardiac death with or without revascularisation • Revascularisation with CABG or PCI is indicated for symptomatic relief of angina pectoris in patients with heart failure • The risk-benefit balance for revascularization in patients without angina/ischemia or viable myocardium remains uncertain PCI In Heart Failure • PCI in Heart Failure (Balloon to DES) - feasibility and safety • PCI in Heart Failure with Support • PCI vs CABG vs Medical Therapy Impact of LV Dysfunction on Hospital Mortality Among Patients Undergoing Elective PCI: New York State Registry Retrospective study of 55 709 PCI pts in 1998/1999 ≤25% 26-35% 36-45% 46-55% >55% Procedure 3.4% 7.6% 17.4% 34.4% 37.2% Hospital Mortality 2.7% 1.2% 0.6% 0.2% 0.3% P[...]... Registry: PCI In ACS Pts with Heart Failure • 1788 had HF at the time of hospital admission • Patients with HF less likely to undergo cardiac cath (46.5% vs 54.2%, p=0.0001) and PCI (26% vs 31.8%, p=0.0001) compared with pts without HF • CABG rates similar between groups • Combined risk of in-hospital and post-discharge 6-month mortality was significantly higher in pts with HF on admission (20.7% vs 5.9%,... Impact of PCI On Acute Heart Failure Among Patients Hospitalised For AMI: Long Term Outcomes A1.00 B1.00 I II III IV 0.75 Mortality, % 0.75 0.50 0.50 0.25 0.25 0.00 0.00 0 2 4 6 8 10 12 0 Time (years) A B 2 4 6 8 10 Time (years) Mortality curves of patients who underwent PCI Mortality curves of patients who did not undergo PCI Killip I Killip III Killip II Killip IV L Carvalho et al Singapore Cardiac... of MACCE at discharge • Mortality at 6 months was numerically lower in the elective (IABP) group but not statistically significant (4.6% vs 7.4%, P = 0.32) Perera D et al JAMA 2010; 304: 867-874 TandemHeart Percutaneous VAD • Removes oxygenated blood from LA via transseptal cannula inserted through the femoral vein • Returns blood via femoral artery Benefits: • Reduce preload • Reduce ventricular workload... insufficiency and heart failure syndrome , more angiograpically complex lesions and less freq received DES • Primary endpoint: 1-yr MACE all-cause death, Q-wave MI, ST and TLR • Primary endpoint significantly increase in pt with lower LVEF (9.7% for normal LVEF vs 20.6% for severely decreased LVEF, p