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Primary PCI

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Dr. Amir Aziz Alkatiri, SpJP, FIHA. 3rd Pekanbaru Cardiology Update, August 24th 2013. Pangeran Hotel Pekanbaru. Learn more at PerkiPekanbaru.com

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Primary PCI

  1. 1. PRIMARY PCI (Percutaneous Coronary Intervention) Amir Aziz AlkatiriAmir Aziz Alkatiri RS Awal Bros Pekanbaru
  2. 2. Primary PCI Treatment of choice for Acute MI
  3. 3. Definition • Primary PCI : an emergent percutaneous catheter intervention in the setting of STEMI, without previous fibrinolytic treatment • is the preferred reperfusion strategy in patients with STEMI
  4. 4. Primary PCI vs Thrombolytic
  5. 5. Primary PCI vs Thrombolysis • Thrombolysis is effective in 40–60% of patients, while p-PCI is effective in > 90%. • Thus,comparing thrombolysis vs primary PCI is comparing a semi-effective therapy vs a fully effective therapy. • The mortality benefit derived from the primary PCI strategy is not related to the fact that the underlying stenosis is removed. • The mortality benefit of primary PCI is caused by the simple fact that primary PCI is twice as effective as thrombolysis in opening the artery. European Heart Journal (2010) 31, 634–636
  6. 6. Components of delay in STEMI European Heart Journal (2012) 33, 2569–2619
  7. 7. How to Optimize Reperfusion in Acute MI ProblemProblem SolutionSolution Longer Delay for Presentation (symptom onset to presentation) Longer Delay for Presentation (symptom onset to presentation) Large Media Education Large Media Education Delay for TransportationDelay for Transportation Logistical Protocols Logistical Protocols Delay for Treatment (either lytics or PCI) Delay for Treatment (either lytics or PCI) In-Hospital Quality of Care In-Hospital Quality of Care
  8. 8. Prehospital and in-hospital management, and reperfusion strategies within 24 h of FMC
  9. 9. Primary PCI: indications and procedural aspects
  10. 10. Procedural aspects • Radial approach is preferred • Drug-eluting stents (DES) reduce the risk of repeated target vessel revascularization, compared with bare-metal stents (BMS) • Thrombus Aspiration during Primary PCI showed improvement in indices of myocardial reperfusion (ST-segment resolution and myocardial blush) from routine use of manual thrombus aspiration before a balloon or a stent is introduced into the coronary artery
  11. 11. Slender Club Japan 2009.12.04
  12. 12. Periprocedural pharmacotherapy • DAPT : Aspirin 160-300mg + ADP receptor blocker (Clopidogrel/Prasugrel/Ticagrelor) • Heparin • GPIIB/IIIA inhibitor
  13. 13. Revascularization strategy for STEMI with multivessel disease • Still debatable • Conservative approach • Stage revascularization approach
  14. 14. Contoh Kasus • Tn.D, 71thn • Sakit dada berat sejak 6 jam SMRS disertai keringat dingin • Fakto Risiko: DM, Dislipidemia, Hipertensi • TD 140/70, HR 60x/m • EKG: SR, ST elevasi II,III,aVF, V5-V9 • Diagnosis: Acute Inferoposterior MCI

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