STEMIPCI

ACSSCDSTSTEMISTNSTEMIUA

Pathophysiology of ACS UANo ST ElevationST ElevationNSTEMIUnstable AnginaQWMINQMIMyocardial InfarctionWorking DxECGCardiac BiomarkerFinal DxThe Lancet 2001; 358: 1533-1538 and Heart 2000; 83: 361-366.Presentation

Pathophysiology of STEMIModified with permission from Libby Circulation.2001; 104: 365-372.Management Before STEMI

STEMI

PCI CABG

STEMI

STEMI:PCIPCIIAPCIIB PCI PCI1-7IA PCI (late PCI):

PCI

STEMIPCI CABG PCI LVEFPCI ASA ACT300

STEMIPCIAMI1-7PCI

STEMI:PCI (IA) Meta-analysis (TIMI 4, 9, 10B, and InTIME-II, n=20101): PCI(during hosp.) vs no PCI P In-hosp. ReMI 1.6% 4.5%

STEMIPCILate PCI

OATOccluded Artery Trial) : STEMI (2-28) + IRA + LVEF < 50% (n=2166) PCI(n=1082) vs PCI(n=1084) + ReMI + NYHA IV 417.2% 15.6% (P=0.20) ReMI 6.9% vs 5.0% (P=0.08) : IRA MI Hillis -B PCI IRA Hochman et al. NEJM 2006355(23)1-13 Hillis et al. NEJM 2006355(23)2475-2477

OAT?PCI?PCI: , ? PCI83%34% PCI

OATPCI 6-7%IRAPCI 90% 90% 70%

OATPCIPCI GPIIb/IIIa 72% TIMI III82%>95% 18% PCI 83-28 50.255

AMI (ACS) PCI+PCI EMERALD 18%

No-Reflow Phenomenon, NRF: TIM II MCE

AMI PCI11.5% 7.7%4.5%SVG4.0%PCI1-2%

No-reflow Piana etal. Circulatin 1994;89:2514-2518Abbo etal. Am J Cardiol 1995;75:778-782

AVB CV Collapse 15% 31% Ito

No-reflowAbb et al. Am J Cardiol 1995;75:778-782

No-ReflowWainstein(2001): 135/4264 (3.1%) No-ReflowMACE4(18.1% vs. 4.6%, P

EeckhoutKern:experimentalNRFMIMI reperfusionNRFangiographicNRFAMIPCIMINRFGaliutoNRF,NRF No-reflow

NETTXA25-NT NOKATP

ACSSTST AMIUAP< 2 KotaniACS PCI SVGIVUSSVGNo-reflow

1PCI(4d)452009-06-19 AMI IPW 2009-06-23 PCI2009-07-08

AMI 4D

AMI 4D

AMI 4D

2AMI 7PCI60AMI IPW 7PCI

AMI 7D

AMI 7D

PCI4IRA24PCI TIMI III>95%

CRTIIb/IIIaPCI 10%

3AMI 255AMI IPW 15AMI3RCATIMI0LAD/LCX10RCATIMI III

AMI 3dAMI 15dAMI 3d

4AMI 1PCI No-reflow46AMI IPW 11RCAPCI

AMI1

5AMI97507-3-17STEMI (IPW) , 4ECG9-

321

324

75%324

325

325

STEMIPCI 2ACS PCI Good luck!

THANK YOU!