powerpoint 프레젠테이션€¦ · ppt file · web view · 2015-05-19cath db 사용 안내...
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Cath DB 사용 안내
- Admission data
- AMI data
- Discharge data
- Clinical Follow-Up data
Presented by 최진호 , [email protected]
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1. 새 환자 추가
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2. 환자 인적사항 입력
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List 단추 누른 후 확인 가능
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3. Admission 단추 누른 후 데이터 입력
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Admission data
Status
Outpatient referral 외래에서 입원
Emergency department 응급실에서 입원
Transfer-Acute care facility 타병원 응급실 /CCU/ICU 에서 전원된 환자
Transfer-Non-Acute care facility 타병원 병실에서 전원된 환자
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Medication data
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History & Risk factor
각 위험인자의 정의DM: 이미 진단받거나 치료중인 경우
(fasting glucose > 140 or HbA1C > 6.5%)HT: 이미 진단받거나 치료중인 경우CRF: creatinine > 2.0 mg/dLSmoking: 현재 또는 최근 흡연하면 Current smokerDyslipidemia:Menopause:Previous chronic lung disease: 진단받거나 치료중인 만성 폐쇄성 폐질환FHx Premature CAD: male: < 45 yr, female: < 55 yr
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Clinical diagnosis
임상진단No Sx/No Angina 협심증 환자가 아니면서 관상동맥조영술 시행한 경우
( 판막질환 , pre-transplantation W/U 등 )
Atypical Chest Pain 관상동맥병변이 현저하지 않음 ( 협착정도 < 50%)Stable Angina 관상동맥에 협착병변 (>50%) 있음
ACS: Unstable Angina troponin 음성 또는 매우 낮음ACS: Non-STEMI troponin 양성ACS: STEMI troponin 양성 , ST 분절 상승
Silent ischemia 무증상이나 심근허혈이 증명된 경우
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Unstable angina classification
Severity by resting chest pain
Clinical circumstancesA B C
Secondary to extracardiac condition
primary Post-MI (< 2 wk)
I None IA IB ICII 48 hr ~ 1 month IIA IIB IICIII < 48 hr IIIA IIIB troponin (-)
IIIB troponin (+)IIIC
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Non-invasive test
결과
negative
positive
equivocal
incomplete
cf) old MI
‘ 허혈심근 양성’ 의 정의
SPECT reversible perfusion defect (+)
TMT typical ST depression or elevation
DSE reversible regional wall motion abnormality
MRI evidence of myocardial ischemia (decreased myocardial perfusion )
coronary CT significant coronary artery stenosis (>50%)
or evidence of myocardial ischemia (decreased myocardial perfusion )
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Lab data
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AMI data
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AMI data - time
Chest pain (+)
ER Cath Lab
Sx Onset Time ER arrival time Thrombolysis time(needle time)
Cath Lab Arrival Time
First balloon time
ST resolution time
Door-to-Needle time
Door-to-Balloon time
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AMI data, clinical
Killip class:1, 2, 3, 4
AMI PCI:
Primary PCI : PCI 로 reperfusion 시도
Rescue PCI : failed thrombolysis 후 PCI 로 reperfusion 시도
Facilitated PCI : 의도적으로 thrombolysis 후 PCI 로 reperfusion 시도
(Salvage PCI)
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AMI – LV data
LV data: Echo, MRI, CT, (LVG)
16 vs 17 segment
LV function: normal, hypokinesia, akinesia, dyskinesia
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Discharge status
CABGNo CABGElective pre-plannedUrgent < 24 hrEmergent immediateSalvage CPR (+)Transferred for CABG
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Clinical Follow-Up
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Definition of PCI-related terms: TVF, TVR, TLR
TVF (target vessel failure):
TVR, cardiac death, or MI not clearly attributed to a vessel other than the target vessel.
TVR (target vessel revascularization):
target vessel revascularization + non-TLR
TLR (target lesion revascularization):
clinically-driven revascularization of target lesion
Death or MI of this vessel
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How to obtain clinical follow-up
Clinical follow-up = MACE (major adverse cardiac event) 의 추적
특정 일까지 생존 / 사망 여부
revascularization(PCI/CABG) 여부
AMI, CVA 여부
MACE (major adverse cardiac event)
death MI (clinically-driven) revascularization
CVA
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How to obtain clinical follow-up
(1) 전산검색외래 방문일 , 응급실 방문일 / 사망여부 , 장례식장 방문일
(2) 통계청 사망자료 ( 매년 연말 )사망원인 ( 코드 ) 및 사망일
(3) 전화 문의 ( 사망환자 제외 !)