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Patrick Ohlmann
Hôpitaux Universitaires de Strasbourg France
Faculté de médecine, Université de Strasbourg
Les HôpitauxUniversitairesde STRASBOURG
Recommandations ESC 2017 STEMI
RV des urgences 30.11.2017
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ACR récupéré
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Cardiac arrest
• ST+:
direct angiography
• No ST+:
Direct angiography
Previous evaluation in ICU
• Stroke
• PE
• Non cardiogenic shock
• Respiratory failure
• Criteria of poor neurological outcome, against immediate
angio
Unwitness cardiac arrest
Late arrival for basic life support (>10 min)
Non shockable rhythm
>20 min advanced life support
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Cardiac arrest
Strasbourg Study
Zeyons 2017 Eur Heart J Acute Cardiovasc Care p103
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Cardiac arrest
Strasbourg Study
• 177 patients
• Cardiac arrest
2009-2013
• Emergent angio
• 3 groupes
AMI 42%
Chronic CAD 15%
No CAD 42 %
Zeyons 2017 Eur Heart J Acute Cardiovasc Care p103
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Cardiac arrest
Strasbourg Study
Zeyons 2017 Eur Heart J Acute Cardiovasc Care p103
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Cardiac arrest
Strasbourg Study
ECG modifications
Zeyons 2017 Eur Heart J Acute Cardiovasc Care p103
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Cardiac arrest
Strasbourg Study
Predictors of AMI
Zeyons 2017 Eur Heart J Acute Cardiovasc Care p103
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Item Number of points
ST segment elevation in any lead (aVR included)
2 pts
Chest pain before arrest 1 pt
Shockable initial rhythm 1 pt
Score in favor of AMI if ≥ 2
Cardiac arrest
Strasbourg Study
AMI score
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Results (4)
Diagnostic value of AMI score
AUC 0.79
0 1
≥2
3
4
AUC 0.85
P=0.019
- Score = 0
- 20% of our patients
- 0% AMI
- Score = 4
- 14% of our patients
- 97% AMI
PPV 65% - NPV 93%
P=0.019 ST elevation including
Avr
AMI score
- ST elevation
- Shockable rhythm
- Chest pain
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Thrombolyse: stratégie
pharmaco invasive
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OAP, choc
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Anti-thrombotiques
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• Cas cliniques
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Cas clinique 1
RUD GER
• Patient de 68 ans: admis pour SCA
• IDM en juillet 2017:
3 stents IVA: Synergy 3.0-28+2.75-38+2.5-38
2 stent CX marginale: Synergy 2.5-32 et 2.5-36
• IRC DFG=40 mL/min
• VIH +
• Lymphome en 2010
• Pneumocystose en 2012
• Ttt: Efient+Kardegic
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Cas clinique 1
RUD GER
Coro à J0
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Cas clinique 1
RUD GER
• Staff médico-chirurgical: décision de pontage IVA et marginal
• OP prévue à J4, patient sous Effient®, surveillance en USIC
• ACR en asystole à J3
• Coro en urgence sous planche à masser: occlusion du TC, thrombus
• ECMO
• Décès
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Cas clinique 1
RUD GER
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Cas clinique 2
CUR ANT
• Patient de 66 ans
• IDM inférieur inaugural, douleurs
depuis 3 jours
• Coro en urgence le 8/11/2015
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ECG
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Cas clinique 2
CUR ANT
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