SCA-NSTE SCA-NSTE Dott. Marco Tubaro Unità Coronarica – Dipartimento Cardiovascolare Ospedale San Filippo Neri – Roma MT considerazioni conclusive: considerazioni conclusive: la sintesi per una proposta razionale la sintesi per una proposta razionale
48
Embed
SCA-NSTE Dott. Marco Tubaro Unità Coronarica – Dipartimento Cardiovascolare Ospedale San Filippo Neri – Roma MT considerazioni conclusive: la sintesi per.
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
SCA-NSTESCA-NSTE
Dott. Marco Tubaro
Unità Coronarica – Dipartimento Cardiovascolare Ospedale San Filippo Neri – Roma
MT
considerazioni conclusive:considerazioni conclusive:la sintesi per una proposta razionalela sintesi per una proposta razionale
SSCA-NSTE in Lombardia, Friuli Venezia Giulia ed Emilia RomagnaCA-NSTE in Lombardia, Friuli Venezia Giulia ed Emilia Romagna
MT
proporzioneSCA-NSTE/STEMI
mortalità
STEMI
SCA-NSTE
FIC SCA-NSTE, GIC 2009
reparto di ricovero e mortalitàreparto di ricovero e mortalità
MTFIC SCA-NSTE, GIC 2009
mt
linee guida ESC: stratificazione del rischio nelle SCA NSTElinee guida ESC: stratificazione del rischio nelle SCA NSTE
elevated troponin levelsdynamic ST-T changes (symptomatic or silent)diabetesrenal dysfunction (GFR < 60 mL/min/1.73 m2)EF < 40%early post-infarction anginaprior MIPCI within 6 monthsprior CABGGRACE score: intermediate - high
GRACE risk scoreGRACE risk score
mt
routine vs selective invasive strategies in NSTEACS routine vs selective invasive strategies in NSTEACS - a metanalysis of 7 trials - a metanalysis of 7 trials - -
OR (95% CI)
outcome in hospital total
death1.60 (1.14 - 2.25)
0.92 (0.77 - 1.09)
death / MI1.36 (1.12 - 1.66)
0.82 (0.72 - 0.93)
death / MI Tn + ve
0.69 (0.55 – 0.86)
death / MI Tn –ve
0.89 (0.67 - 1.18)
Mehta SR JAMA 2005
MT
MTHirsch A. Eur Heart J 2008
ICTUS: intended invasive strategy vs actual ICTUS: intended invasive strategy vs actual revascularizationrevascularization
MT
MASCARA: early invasive strategy in NSTEACSMASCARA: early invasive strategy in NSTEACS
Ferreira-Gonzales I. Am Heart J 2008;156:946.
high risk low-intermediate risk
MTMehta SR. NEJM 2009;360:2165.
TIMACS: early vs delayed invasive intervention in ACSTIMACS: early vs delayed invasive intervention in ACS
strategies in high risk NSTEACSstrategies in high risk NSTEACS
Efficacy and Safety: Post-hoc Analysis for Age, Body Weight, Efficacy and Safety: Post-hoc Analysis for Age, Body Weight, and Prior Stroke/TIA Historyand Prior Stroke/TIA History
Adapted from Wiviott et al. NEJM 2007;357:2001-2015
Prasugreln/N (%)
Clopidogreln/N (%)
HRHR (95% CI)(95% CI)
P P valuevalue
P P InteractioInteractio
nn
At least one of: Age At least one of: Age >> 75 y, Body Weight < 60 kg, or history of prior stroke/TIA 75 y, Body Weight < 60 kg, or history of prior stroke/TIA