Aderenza alle Linee Guida internazionali nei pazienti con Sindrome Coronarica Acuta Antonio Manari Key points: • 1‐ Linee Guida STEMI e NSTEMI • 2‐ Razionale delle indicazioni delle Linee Guida • 3‐ Risultati nella pratica clinica (aspetti logistici)
39
Embed
Aderenza alle Linee Guida internazionali nei pazienti con ...tigulliocardio.com/slide/Manari.pdf · Aderenza alle Linee Guida internazionali nei pazienti con Sindrome Coronarica Acuta
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Aderenza alle Linee Guida internazionali nei pazienti con Sindrome Coronarica Acuta
Antonio Manari
Key points:
• 1‐ Linee Guida STEMI e NSTEMI• 2‐ Razionale delle indicazioni delle Linee Guida• 3‐ Risultati nella pratica clinica (aspetti logistici)
Hospital Link Between Overall Guidelines Adherence and Mortality
Peterson et al, JAMA 2006;295:1863-1912
Every 10% ↑ in guidelines adherence →10% ↓ in mortality (OR=0.90, 95% CI: 0.84-0.97)
ESC Up-dated Guidelines STEMI 2008
Reperfusion strategy
Recommended Logistics
• Pre-hospital triage/care:● EMS
• unique telephone number• tele-consultationAmbulance• 12-ECG recorder/defibrillator• staff able to provide basic and advanced life support
• Networks:● implementation of a network of hospitals with different levels of
technology connected by an efficient ambulance service using the same protocol
• Targets:● < 10 min ECG recording/ transmission● < 120 min to first balloon inflation
ESC Guidelines STEMI 2008
Pre - Hospital ECG: NCDR (National Cardiovascular Database Registry) ACTION
EMS7,098 patients STEMI
pre - hospital ECG
1,941 (27.4%) 5,157 (72.6%)
pPCI92.1 % 86.3 %
DTB(p<0.0001)61 min 75 min
Mortality(p=0.06)6.7% 9.5%
Diercks et al, JACC 2009
Yes No
Bypassing the ER impacts outcomes in STEMI
5,13,8
12
8,37,9 8,4
16,4
13
0
5
10
15
20
All Reperfusion Rx
All Reperfusion Rx
Direct CCU
via ER
5 days 1 year
P=0.03
P=0.04
P=0.02
P=0.006
Steg et al. Heart 2006;92:1378-83
Recommended Logistics
• Pre-hospital triage/care:● EMS
• unique telephone number• tele-consultationAmbulance• 12-ECG recorder/defibrillator• staff able to provide basic and advanced life support
• Networks:● implementation of a network of hospitals with different levels of
technology connected by an efficient ambulance service using the same protocol
• Targets:● < 10 min ECG recording/ transmission● < 120 min to first balloon inflation
ESC Guidelines STEMI 2008
H= hub cardiochirurgico h= sede di emodinamica diagnostico/interventisticas= spoke: Unità Terapia Intensiva Cardiologica
h
hss
Hss H s
ss
s
sh h h
hH HH
s
s
ss
ssh H h
h hs
s
hh
h
s s s
s
s
ss
Organizzazione della rete cardiologica e cardiochirurgica Regionale
Delibera regionale 1267, del 22 luglio 2002
RIDEFINIZIONE DEI PERCORSI DI TEMPESTIVO ACCESSO AI
SERVIZI, DIAGNOSI E CURA PER PAZIENTI CON INFARTO MIOCARDICO ACUTO