Cosa è cambiato rispetto al passato nelle nuove Linee
Guida ESC 2010
Rivascolarizzazione Miocardica
Francesco Della RovereS.S. Emodinamica E.O.
Galliera
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PCI ad hoc versus
rivascolarizzazione differita
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Rivascolarizzazionenella cardiopatia
ischemica stabile
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Courage: Freedom from angina
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Risk Stratification Scores for PCI or CABG
Rivascolarizzazionenelle Sindromi
Coronariche Acute
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3-Year Mortality:Cardiac and Non Cardiac
'C
ard
iac
Mo
rtal
ity
(%)
P=0.001
3-yr HR [95%CI]=0.56 [0.40, 0.80]
2.9%
5.1%P=0.004
1-yr HR [95%CI]=
0.57 [0.38, 0.84]
0 12 15 18 21 24 27 30 33 36
Months
3 6 9N
on
-Ca
rdia
c M
ort
alit
y (
%)
P=0.62
3-yr HR [95%CI]=1.11 [0.74, 1.65]
2.8%3.1%
P=0.56
1-yr HR [95%CI]=
1.20 [0.65, 2.20]
0 12 15 18 21 24 27 30 33 36
Months
3 6 9
Time in Months
Bivalirudin alone (n=1800)Heparin + GPIIb/IIIa (n=1802)
1611
1568
16601689
1670
1800Bival 1098
1802 1643
Number at risk
H + GPI
1633
1593
1574
1525 1043
1611
1568
16601689
1670
1800Bival 1098
1802 1643
Number at risk
H + GPI
1633
1593
1574
1525 1043
0
1
6
5
4
3
2
3.8%
2.1% 1.3%
1.1%0
1
6
5
4
3
2
Stone, GW NEJM 2008 Stone, GW TCT 2010
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STEMI Antithrombotic treatment options in myocardial revascularization
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Multidisciplinary Decision & Timing of Intervention
Collaborazione tra Cardiologi Clinici, Cardiologi Interventisti e Cardiochirurghi per la gestione dell’ampio spettro della Cardiopatia Ischemica
Heart Team come approccio per una scelta più orientata al singolo paziente, con maggior spazio lasciato al momento decisionale e al consenso informato, proponendo i vantaggi di una scelta terapeutica rispetto ad un’altra e identificando il percorso migliore.
Importanza dell’ottimizzazione della terapia medica
ESC/EACTS Guidelines on myocardial revascularization
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(b) Anticoagulation
Options for anticoagulation include UFH 60 IU/kg i.v. bolus with GPIIb–IIIa inhibitor or UFH 100 IU/kg i.v. bolus without GPIIb–IIIa inhibitor, or bivalirudin 0.75 mg/kg bolus followed by 1.75 mg/kg/h.
Antithrombins can be stopped after PCI for STEMI with few exceptions (LV aneurysm and/or thrombus, AF, prolonged bed rest, deferred sheath removal).
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