Chiến lược tái thông mạch vành hiện nay cho NMCT cấp ST chênh lên

15th National Congress of Cardiology Hanoi, Vietnam, October 9-11, 2016 Contemporary Strategies for Percutaneous Reperfusion in STEMI 2016 Gregory W Barsness, MD, FACC, FAHA, FSCAI Consultant, Mayo Clinic Departments of Cardiovascular Diseases and Radiology Director, Mayo Clinic CICU ©2014 MFMER | Slide-1 Ischemic Heart Disease in Vietnam Growing and Costly Problem In 2011: 38% of Deaths related to CV Disease 23% of Deaths from Stroke 15% of Death attributable to Coronary Disease By 2017: 20% prevalence of CV Disease and HTN WHO Report 2011 Data from 2016 Pacific Cross Vietnam (Blue Cross Vietnam) ©2014 MFMER | Slide-2 All-Cause Long-Term Mortality in ACS 4606 AMI Pts Undergoing Angiography 70 Mortality (%) 60 NSTEMI 50 40 30 STEMI 20 10 0 Years Chan, et al Circ 2009;119 ©2014 MFMER | Slide-3 6-Month Mortality Following ACS GRACE (n=43,810) Fox, et al BMJ 2006 ©2014 MFMER | Slide-4 Guideline Adherence and Outcome In-hosp mortality (%) 5.95 6.33 5.16 5.07 4.97 Adjusted Unadjusted 4.63 4.16 4.17 Every 10%  in guidelines adherence 11%  in mortality =75% Hospital composite quality quartiles Peterson, et al ACC 2004 ©2014 MFMER | Slide-5 Hospital Performance and Outcome Mean Life Expectancy After AMI 119,735 AMI Patients in Cooperative Cardiovascular Project (1994-97) >1 Year Longer Life Expectancy! Bucholz, et al NEJM 2016;375 (14) ©2014 MFMER | Slide-6 STEMI Management Algorithm Www www.cardiosource.org ©2014 MFMER | Slide-10 35-Day Mortality Reduction with Thrombolysis 58,600 Patients in Randomized Trials 30 Mortality (%) P Hours Lysis or PPCI PPCI Risk Risk Time Time Consider Pharmaco-Invasive Approach ©2014 MFMER | Slide-18 1-Year Mortality in STREAM Pharmaco-Invasive vs PPCI (n=1892) Inclusion: Symptoms hour mm STE PreHospital lytic eligible Sinnaeve et al Circulation 2014;130:1139 ©2014 MFMER | Slide-31 Pharmaco-Invasive vs PPCI Strategy 1216 Patients in Regional STEMI System (2009-11) PharmacoInvasive PPCI % All p=NS Death/MI/CVA Death PPCI mean D2B=95 Stroke Maj Bleeding PI mean D2N=31 Rashid, et al JACC Card Int 2016;9:2014 ©2014 MFMER | Slide-32 Reperfusion Strategy No Lytic Eligible? Transfer for Primary PCI Anticipated Time from FMC to PCI Acceptable Bleeding Risk? Yes PARAMEDIC UNIT 23 Time of Symptoms