Xử trí NMCT cấp ST chênh lên giảm tải thất trái trước hay mở thông động mạch thủ pham trước

STEMI: unload LV first or open culprit vessel first? Christoph K Naber Contilia Heart and Vascular Center Elisabeth Krankenhaus Essen Germany Conflicts of Interest Nothing to declare Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany STEMI Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany STEMI: pPCI vs Lysis Death, Reinfarction &Stroke pPCI better Lysis better Ontario Health Technology Assessment Series 2004 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany DANAMI-2 Danmark, 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 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany PCI: Facilitated vs Primary Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany PCI: Facilitated vs Primary Thiele et al JACC Interventions 2011 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany PCI: Facilitated vs Primary Thiele et al JACC Interventions 2011 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany PCI: Facilitated vs Primary Thiele et al JACC Interventions 2011 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany Mangement of STEMI Steg et al EHJ 2012 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany IABP in stable PCI N=331 Patel et al JAMA 2012 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany IABP SHOCK II trial Thiele et al Lancet 2013 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany IABP in AMI with Shock 30 day mortality Unverzagt et al Cochrane Database 2015 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany IABP in AMI: short term mortality Dan et al Medicine 2015 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany IABP in AMI: long term mortality Dan et al Medicine 2015 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany IABP in AMI Dan et al Medicine 2015 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany Hemodynamic Support Devices Werdan et al EHJ 2014 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany Mangement of Cardiogenic Shock Werdan et al EHJ 2014 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany Mangement of AMI & Shock IABP vs Medicine Romeo et al World J Cardiol 2016 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany Mangement of AMI & Shock IABP vs PLVAD Romeo et al World J Cardiol 2016 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany Mangement of AMI & Shock IABP vs IABP+ECMO Romeo et al World J Cardiol 2016 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany Mangement of STEMI Steg et al EHJ 2012 Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany SFL Mission “Reducing mortality and morbidity of patients with ACS by supporting the implementation of Guidelines on Myocardial Revascularization at national levels” - - - 21 countries from Europe, Asia, Africa and America Years Core Program Building STEMI Networks with integrated EMS Infrastructure Providing regional and national www.stentforlife.com Summary Primary PCI is first line therapy for STEMI Lysis can significantly save lives as well and should be applied where timely pPCI is not possibly Application of IABP in all STEMI patients with or without shock is of no additional benefit 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 Contilia Herz- und Gefäßzentrum, Elisabeth Krankenhaus Essen ... Core Program Building STEMI Networks with integrated EMS Infrastructure Providing regional and national www.stentforlife.com Summary Primary PCI is first line therapy for STEMI Lysis can significantly... of Interest Nothing to declare Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany STEMI Contilia Heart- and Vascular Center, Elisabeth Krankenhaus Essen, Germany STEMI: pPCI... is not possibly Application of IABP in all STEMI patients with or without shock is of no additional benefit Data on systematic use of IABP or ECMO in STEMI patients with or without shock before