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When PCI in NSTEMI?When PCI in NSTEMI?
Giuseppe Biondi Zoccai, MDGiuseppe Biondi Zoccai, MDDepartment of Medico-Surgical Sciences and BiotechnologiesDepartment of Medico-Surgical Sciences and Biotechnologies
Sapienza University of RomeSapienza University of [email protected]@gmail.com
Emergenze cardiologiche - Marina di Ravenna Emergenze cardiologiche - Marina di Ravenna 15:15-15:30 – 20 April 201215:15-15:30 – 20 April 2012
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DO YOU KNOW HOW TRAIN BRAKES WORK?
FAIL-SAFE SYSTEMSA fail-safe or fail-secure device is one that, in the event of failure, responds in a way that will cause no harm, or at least a minimum of harm, to other devices or danger to personnel.Air brakes on railway trains are held in the "off" position by air pressure in the brake system. Should a brake line split, or a carriage become de-coupled, the air pressure will be lost and the brakes applied.
http://en.wikipedia.org/wiki/Fail-safe
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When PCI in NSTEMI?When PCI in NSTEMI?
Giuseppe Biondi Zoccai, MDGiuseppe Biondi Zoccai, MDDepartment of Medico-Surgical Sciences and BiotechnologiesDepartment of Medico-Surgical Sciences and Biotechnologies
Sapienza University of RomeSapienza University of [email protected]@gmail.com
Emergenze cardiologiche - Marina di Ravenna Emergenze cardiologiche - Marina di Ravenna 15:15-15:30 – 20 April 201215:15-15:30 – 20 April 2012
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When When NOT TO PERFORM NOT TO PERFORM PCI in NSTEMI?PCI in NSTEMI?
Giuseppe Biondi Zoccai, MDGiuseppe Biondi Zoccai, MDDepartment of Medico-Surgical Sciences and BiotechnologiesDepartment of Medico-Surgical Sciences and Biotechnologies
Sapienza University of RomeSapienza University of [email protected]@gmail.com
Emergenze cardiologiche - Marina di Ravenna Emergenze cardiologiche - Marina di Ravenna 15:15-15:30 – 20 April 201215:15-15:30 – 20 April 2012
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LEARNING GOALS• What is NSTEMI in 2012?
• What does PCI entail?
• Don’ts
• Take home messages
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LEARNING GOALS• What is NSTEMI in 2012?
• What does PCI entail?
• Don’ts
• Take home messages
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DEFINITION
Hamm et al, Eur Heart J 2011
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HS TROPONIN IN STABLE CAD
Ndrepepa al, Am J Cardiol 2011
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LEARNING GOALS• What is NSTEMI in 2012?
• What does PCI entail?
• Don’ts
• Take home messages
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KEY ASSUMPTION
• Coronary angiography is not synonimous with PCI
• Risk-benefit balance of angio is much higher than that of PCI
• However, alternative to angio are available (e.g. imaging-based stress testing, CT coronary angiography)
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INCIDENCE OF PERI-PCI MI
Novack et al, Arch intern Med 2012
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total acute subacute late very late
INCIDENCE OF DES THROMBOSIS
D’Ascenzo et al, submitted
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PREDICTORS OF STENT THROMBOSIS
D’Ascenzo et al, Int J Cardiol 2011
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LEARNING GOALS• What is NSTEMI in 2012?
• What does PCI entail?
• Don’ts
• Take home messages
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1ST NO: PATIENT REFUSAL
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2ND NO: REDUCED LIFE EXPECTANCY
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3RD NO: LACK OF ACCESS SITES
Biondi-Zoccai et al, Catheter Cardiovasc Interv 2011
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4TH NO: HIGH BLEEDING RISK
Agostoni et al, J Am Coll Cardiol 2004
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5TH NO: CONTRAINDICATIONS TO DAT
Sangiorgi et al, EuroIntervention 2011
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6TH NO: LACK OF SIGNIFICANT LESIONS*
*e.g. NSTEMI not due to CAD
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6TH NO: LACK OF SIGNIFICANT LESIONS*
*e.g. NSTEMI not due to CAD
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7TH NO: LESION IS IRRELEVANT
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7TH NO: LESION IS IRRELEVANT
Tonion et al, New Eng J Med 2009
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8TH NO: CABG IS INDICATED
Novara et al, J Cardiovasc Med 2012
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9TH NO: VALVE SURGERY IS INDICATED
Colombo et al, G Ital Cardiol 2005
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10TH NO: YOU CANNOT AFFORD IT
Dijksman et al, Int J Cardiol 2009; de Winter et al, New Engl J Med 2005
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TAKE HOME MESSAGES• In the current evidence and experience context,
it is safer to focus only on which patients with NSTEMI should not be offered PCI rather than the other way round
• Coronary angiography and PCI should also be distinguished, as they have different scopes and safety profiles
• Several absolute and relative contraindications to PCI in NSTEMI can be envisioned, requiring case by case decision-making
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For these and further slides on these topics please feel free to visit the
metcardio.org website:
http://www.metcardio.org/slides.html
