PCI for STEMI

Ari de la Hera, M.D.

ED physician activates the Cath Lab Single call to activate the Cath Lab Cath Lab operational within 20 minutes of activation Real time data feedback for case review Having attending cardiologist always on site Prehospital ECG to activate Cath Lab while patient is en route

N Engl J Med 2006;355:2308-2320

Meta-analysis: Facilitated PCI vs Primary PCI

1.03(0.15-7.13)

3.07(0.18-52.0)

1.43(1.01-2.02)

1.03

(0.49-2.17)

Mortality Reinfarction Major Bleeding

Fac. PCIBetter

PPCIBetter

Fac. PCIBetter

PPCIBetter

Fac. PCIBetter

PPCIBetter

Keeley E, et al. Lancet 2006;367:579.

0.1 1 10 0.1 1 10 0.1 1 10

1.38 (1.01-1.87)

1.71 (1.16 - 2.51)

1.51 (1.10 - 2.08 )

Lytic alone N=2953

IIb/IIIa alone N=1148

Lytic +IIb/IIIaN=399

All (N=4500)

1.40 (0.49-3.98)

1.81

(1.19-2.77)

• Acetaminophen, ASA, tramadol, narcotic analgesics (short term)

• COX-2 Selective NSAIDs

• Nonacetylated salicylates

• Non COX-2 selective NSAIDs

• NSAIDs with some COX-2 activity

Stepped Care Approach To Pharmacologic Therapy for Musculoskeletal Symptoms with Known Cardiovascular Disease or Risk Factors for

Ischemic Heart Disease

Select patients at low riskof thrombotic events

Prescribe lowest doserequired to control symptoms

Add ASA 81 mg and PPI to patients at increased risk of thrombotic events *

• Regular monitoring for sustained hypertension or worsening of prior blood pressure control), edema, worsening renal function, or gastrointestinal bleeding.

• If these events occur, consider reduction of the dose or discontinuation of the offending drug, a different drug, or alternative therapeutic modalities, as dictated by clinical circumstances.

* Addition of ASA may not be sufficient protection against thrombotic eventsAntman EM, et al. J Am Coll Cardiol 2008. Published ahead of print on December 10, 2007. Available at http://content.onlinejacc.org/cgi/content/full/j.jacc.2007.10.001.