Cosa è cambiato
rispetto al passato
nelle nuove Linee
Guida ESC 2010
Rivascolarizzazione
Miocardica
Francesco Della Rovere
S.S. Emodinamica E.O. Galliera
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PCI ad hoc
versus
rivascolarizzazione differita
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Rivascolarizzazione
nella cardiopatia
ischemica stabile
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Courage: Freedom from angina
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Risk Stratification Scores for PCI or CABG
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Rivascolarizzazione
nelle Sindromi
Coronariche Acute
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'
Time in Months
3-Year Mortality:
Cardiac and Non Cardiac
Heparin + GPIIb/IIIa (n=1802)
1-yr HR [95%CI]=
0.57 [0.38, 0.84]
P=0.004
5
3-yr HR [95%CI]=
0.56 [0.40, 0.80]
P=0.001
5.1%
4
3.8%
3
2.9%
2
2.1%
1
6
Non-Cardiac Mortality (%)
Cardiac Mortality (%)
6
Bivalirudin alone (n=1800)
3-yr HR [95%CI]=
1.11 [0.74, 1.65]
P=0.62
5
4
1-yr HR [95%CI]=
1.20 [0.65, 2.20]
P=0.56
3
3.1%
2.8%
2
1.3%
1
1.1%
0
0
0
3
6
9
12
15
18
21 24
27 30
33 36
Months
Number at risk
0
3
6
9
12
15
18 21 24
27
30
33
36
Months
Number at risk
Bival
1800
1689
1660
1633
1611
1574
1098
Bival
1800
1689
1660
1633
1611
1574
1098
H + GPI
1802
1670
1643
1593
1568
1525
1043
H + GPI
1802
1670
1643
1593
1568
1525
1043
Stone, GW NEJM 2008
Stone, GW TCT 2010
STEMI Antithrombotic treatment options
in myocardial revascularization
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Multidisciplinary Decision & Timing of Intervention
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ESC/EACTS Guidelines
on myocardial revascularization
Collaborazione tra Cardiologi Clinici, Cardiologi Interventisti
e Cardiochirurghi per la gestione dell’ampio spettro della
Cardiopatia Ischemica
Heart Team come approccio per una scelta più orientata al
singolo paziente, con maggior spazio lasciato al momento
decisionale e al consenso informato, proponendo i vantaggi
di una scelta terapeutica rispetto ad un’altra e identificando
il percorso migliore.
Importanza dell’ottimizzazione della terapia medica
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(b) Anticoagulation
Options for anticoagulation include UFH 60 IU/kg i.v. bolus
with GPIIb–IIIa inhibitor or UFH 100 IU/kg i.v. bolus without
GPIIb–IIIa inhibitor, or bivalirudin 0.75 mg/kg bolus followed
by 1.75 mg/kg/h.
Antithrombins can be stopped after PCI for STEMI with few
exceptions (LV aneurysm and/or thrombus, AF, prolonged
bed rest, deferred sheath removal).
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