10. Evolution of Angioplasty High success Low morbidity Dr. Don Baim, FDA Panel Meeting December 2006 0 10 20 30 40 POBA early POBA late Stent early Stent late DES Event Rate % 1977 1985 1997 1994 2003-present Failure Em CABG Restenosis Stent thrombosis VLST Innovations over time
18. Fox et al . Lancet 2002; 360 :743-751 Non STEMI (n~600)
19.
20.
21.
22.
23. Primary PCI 33 38% 3% 5% 8% Long term mortality (6-18months) 33 36% 3% 5% 8% Short term mortality (4-6weeks) PCI Thrombolysis NNT Relative RR Absolute RR Event Rate Clinical indices Advantages of primary percutaneous coronary intervention over thrombolysis. 81 When this cannot be achieved within 90 minutes of diagnosis patients should receive immediate thrombolytic therapy D Patients with an ST elevation acute coronary syndrome should be treated immediately with PPCI A Those presenting < 6hours who fail to reperfuse should be considered for rescue PCI B
24. Heart Attack Centres population 340,000 Elderly migrant population Holiday influx