Fibrinólisis y ATCp: de las guías clínicas al mundo real · Fibrinólisis y ATCp: de las guías clínicas al mundo real Dr. LUIS ALBERTO URNA HERBAS, MSc. Cardiología Intervencionista

Fibrinólisis y ATCp: de las guías clínicas al mundo real

Dr. LUIS ALBERTO URNA HERBAS, MSc.

Cardiología Intervencionista y Hemodinamia

Hospital San Juan de Dios – INMED Intervencionismo Médico

DECLARACIÓN DE CONFLICTOS DE INTERÉS

• Sin conflictos de interés.

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[email protected] [email protected]

ESC/EACTS GUIDELINES ON MYOCARDIAL REVASCULARIZATION

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Eur Heart J. 2014 Oct 1;35(37):2541-619. doi: 10.1093/eurheartj/ehu278. Epub 2014 Aug 29.


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Primary PCI for myocardial reperfusion in STEMI

Reperfusion therapy is indicated in all patients with time from symptom onset <12 hours duration and persistent ST- segment elevation or (presumed) new LBBB.

Primary PCI is the recommended reperfusion therapy over fibrinolysis if performed by an experienced team in a timely fashion.

In patients with time from symptom onset >12 hours, primary PCI is indicated in the presence of continuing ischaemia, life-threatening arrhythmias or if pain and ECG changes have been stuttering.


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Primary PCI for myocardial reperfusion in STEMI

Primary PCI is indicated for patients with severe acute heart failure or cardiogenic shock due to STEMI independent from time delay of symptom onset.

Reperfusion therapy with primary PCI should be considered in patients presenting late (12–48 hours) after symptom onset.

It is recommended that primary PCI-capable centres deliver a 24- hour/7-day service and ensure for primary PCI to be performed as fast as possible and at the latest within 60 minutes of hospital arrival.


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Fibrinolysis Despite its frequent contraindications, limited effectiveness in inducing reperfusion, and greater associated risk of bleeding, fibrinolytic therapy—preferably administered as a pre-hospital treatment— remains an adjunct to mechanical revascularization if the latter cannot The incremental benefit of primary PCI over timely fibrinolysis is diminished when PCI-related delay exceeds 120 minutes, depending on patient age, duration of symptoms, and infarct location. Fibrinolysis is discussed in detail in the ESC Guidelines on STEMI.

CONSENSO SAC DE IAM CON ELEVACIÓN DEL SEGMENTO ST

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Rev. Argent. Cardiol. Vo. 83 Supl. 4 Octubre 2015 ISSN version electronica 1850-3748


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Recomendaciones para angioplastia primaria


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Recomendaciones para el uso de fibrinolíticos


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Recomendaciones para trombolisis prehospitalaria o en centros de baja complejidad sin acceso a angioplastia primaria

APPROPRIATE USE CRITERIA FOR CORONARY REVASCULARIZATION IN PATIENTS WITH ACS

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J Am Coll Cardiol. 2017 Feb 7;69(5):570-591. doi: 10.1016/j.jacc.2016.10.034. Epub 2016 Dec 21.

STEMI—Immediate Revascularization by PCI


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STEMI—Initial Treatment by Fibrinolytic Therapy


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STEMI—Revascularization of Nonculprit Artery During the Initial Hospitalization

TREATMENT OF AMI IN WOMEN

• STEMI reperfusion strategies:

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THROMOBLYTICS PCI

Circulation. 2016 Mar 1;133(9):916-47. doi: 10.1161/CIR.0000000000000351. Epub 2016 Jan 25

META-ANALYSES: COMPARISON OF PPCI AND FIBRINOLYTIC THERAPY IN STEMI

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Circulation. 2009 Jun 23;119(24):3101-9. doi: 10.1161/CIRCULATIONAHA.108.793745. Epub 2009 Jun 8.

Bayesian forest plot of all-cause short-term mortality rates in RCTs

Bayesian forest plot of all-cause short-term mortality rates in observational studies

ESTRATEGIAS DE REPERFUSION EN EL IAMCEST. VISIÓN GENERAL Y DESCRIPCION DE CONCEPTOS. SITUACION ACTUAL DE LA REPERFUSION FARMACOLOGICA EN ESPANA

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Rev Esp Cardiol Supl. 2009;09(C):3-10 - Vol. 09 Núm.Supl.C

Tipo de reperfusion utilizado en los registros espanoles PRIAMHO II (2000) y MASCARA (2004-2005) y el Second Euro Heart Survey on Acute Coronary Syndromes (EHS-ACS II)

(2004

REGISTRO RENIMA Y RENIMA II: REGISTRO NACIONAL DE INFARTO DE MIOCARDIO AGUDO EN PERÚ

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Revista Peruana de Cardiologia Vol. XXXiV No 2 Mayo - Agosto 2008 Miguel Reyes Rocha y cols. Revista Peruana de Cardiologia Vol. XXXIX No 1 Enero - Abril 2013 Miguel Reyes Rocha y cols.

RENIMA: Tratamiento de Intervencion no Farmacologica

Recibida (n = 995)

RENIMA II: Distribucion por Tratamiento e Intervencion (n = 1609)

INFARTO AGUDO DE MIOCARDIO EN LA REPÚBLICA ARGENTINA. REGISTRO CONAREC XVII

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Rev ARgent CARdiol 2013;81:390-399. http://dx.doi.org/10.7775/rac.es.v81.i5.1391

Infarto agudo de miocardio con supradesnivel del segmento ST. Terapia de reperfusion

ATCp

GWTG-CAD REGISTRY: TEMPORAL TRENDS IN CARE AND OUTCOMES OF PATIENTS RECEIVING FIBRINOLYTIC THERAPY COMPARED TO PPCI

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J Am Heart Assoc. 2016;5:e004113 doi: 10.1161/JAHA.116.004113 pii: e004113.

TEMPORAL TRENDS OF REPERFUSION STRATEGIES AND HOSPITAL MORTALITY FOR STEMI PATIENTS IN PCI- CAPABLE HOSPITALS

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Reperfusion strategies for STEMI patients in Canada

Can J Cardiol. 2017 Apr;33(4):485-492. doi: 10.1016/j.cjca.2016.12.002. Epub 2016 Dec 8.

IMPACTO EN LA MORTALIDAD DE DIFERENTES SISTEMAS DE ASISTENCIA EN RED PARA EL TRATAMIENTO DEL IAMCEST. LA EXPERIENCIA DE ESPAÑA

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Rev Esp Cardiol. 2017;70:155-61 - Vol. 70 Núm.03 DOI: 10.1016/j.recesp.2016.07.016

Estrategias de reperfusión

ATCp

GWTG-CAD REGISTRY: TEMPORAL TRENDS IN CARE AND OUTCOMES OF PATIENTS RECEIVING FIBRINOLYTIC THERAPY COMPARED TO PPCI

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J Am Heart Assoc. 2016;5:e004113 doi: 10.1161/JAHA.116.004113 pii: e004113.

In-Hospital Outcomes Between Patients With STEMI Receiving Fibrinolysis vs PPCI

CAMI REGISTRY: THE COMPARISON OF THE OUTCOMES BETWEEN PRIMARY PCI, FIBRINOLYSIS, AND NO REPERFUSION IN PATIENTS >75 YEARS OLD WITH STEMI

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PLoS One. 2016 Nov 3;11(11):e0165672. doi: 10.1371/journal.pone.0165672. eCollection 2016.

Clinical outcomes with different reperfusion strategies

ASSOCIATION OF GUIDELINE-BASED ADMISSION TREATMENTS AND LIFE EXPECTANCY AFTER MYOCARDIAL INFARCTION IN ELDERLY MEDICARE BENEFICIARIES

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J Am Coll Cardiol. 2016 May 24;67(20):2378-91. doi: 10.1016/j.jacc.2016.03.507.

Years of Life Lost Associated With Increasing D2B and D2N Time

DIRECT ADMISSION VERSUS INTERHOSPITAL TRANSFER FOR PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

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JACC Cardiovasc Interv. 2017 Mar 13;10(5):438-447. doi: 10.1016/j.jcin.2016.11.028. Epub 2017 Feb 15.

Direct Admission and Interhospital Transfer Rates in STEMI

12-Month Mortality

INTER-FACILITY TRANSFER VS. DIRECT ADMISSION OF PATIENTS WITH STEMI UNDERGOING PPCI

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Circ J. 2016 Jul 25;80(8):1764-72. doi: 10.1253/circj.CJ-16-0204. Epub 2016 Jun 28.

CODI IAM: EARLY STEMI IN NON-CAPABLE PCI CENTRES: IN SITU FIBRINOLYSIS VS. PCI TRANSFER

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Eur Heart J. 2016 Apr 1;37(13):1034-40. doi: 10.1093/eurheartj/ehv619. Epub 2015 Nov 18.

Thirty-day mortality relative to the assigned group (transfer or fibrinolysis) and delay from first medical contact-device for transfer group in tertiles

IMPACT OF DOOR-TO-BALLOON TIME ON LONG-TERM MORTALITY IN HIGH- AND LOW-RISK PATIENTS WITH STEMI

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Int J Cardiol. 2016 Dec 1;224:72-78. doi: 10.1016/j.ijcard.2016.09.003. Epub 2016 Sep 5.

Unadjusted mortality in high-risk and low-risk STEMI stratified by door-to-balloon times

IMPROVED SURVIVAL OF PATIENTS WITH STEMI 3–6 HOURS AFTER SYMPTOM ONSET IS ASSOCIATED WITH INTER- HOSPITAL TRANSFER FOR PPCI AT A LARGE REGIONAL STEMI PROGRAM VS. IN-HOSPITAL THROMBOLYSIS IN A COMMUNITY HOSPITAL

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Med Sci Monit. 2017 Feb 27;23:1055-1063. DOI: 10.12659/MSM.902466 e-ISSN 1643-3750

Mortality level in the IHT group and inter-hospital transfer group with

PPCI at 30 days and 1 year

Thirty-day survival curves in the IHT group and interhospital transfer group

with treated with PPCI

Gracias…

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Fibrinólisis y ATCp: de las guías clínicas al mundo real · Fibrinólisis y ATCp: de las guías clínicas al mundo real Dr. LUIS ALBERTO URNA HERBAS, MSc. Cardiología Intervencionista