Il valore aggiunto
degli anti GPIIb/IIIa
nella terapia delle SCA
Stefano Savonitto
Divisione di Cardiologia
IRCCS Arcispedale S. Maria Nuova
Reggio Emilia
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
ACS with persistent ST-segment elevation
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Time from symptom onset to reopening of the IRA
and myocardial salvage
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Silvain J. JACC 2011;57:1359
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Prasugrel vs Tirofiban HBD in PCI for STEMI
Variability of platelet inhibitory effect
30’ after drug administration
Valgimigli M, et al
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
All-Cause Mortality 1-Year
On-TIME-2
open label & double-blind, n = 1398
Ten Berg J. J Am Coll Cardiol. 2010;55:2446-55.
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Benefit of facilitated PPCI in high-risk
patients presenting at non-PCI centers
1-year mortality
A: all pts
N= 2,452
C: TRS>3
spoke site
N= 502
16.0%
13.3%
B: TRS>3
N= 1,229
6.6%
D: TRS>3
spoke site
symptom
to rand.
< 4h
N= 397
Herrmann HC. JACC Intv 2009;2:917-24
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Time from symptom onset to reopening of the IRA
and myocardial salvage
ON TIME 2
Ortolani
FINESSE
JACC Intv 2010; 3: 1292-4
“Educating the public to seek treatment at an early stage… is likely to reduce mortality to
a greater degree than pharmacological facilitation before PCI, although translation of this
goal to reality in a community setting is and will continue to be extremely difficult.”
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Reduction of early stent thrombosis with prehospital high-dose tirofiban in STEMI
Heestermans AACM
J Thrombosis Haemostasis
2009;7:1612 -8
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Acute Stent Thrombosis
Bivalirudin monotherapy
Heparin + GPIIb/IIIa inhibitor
Def/Prob Stent Thrombosis (%)
3.5
HR (95%CI) =
5.93 [2.06,17.04]
3.0
2.5
P = 0.0002
2.0
1.5
1.5%
1.0
0.5
0.3%
0.0
0
Number at risk
Bivalirudin
UFH+GPIIb/IIIa
6
12
18
24 hours
Time in Hours
1611
1591
1583
1587
1580
1584
1578
1583
1577
1583
Dangas G. ACC 2009 Scientific Sessions; March 29, 2009; Orlando, FL.
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Clopidogrel Loading in Bivalirudin pts
Stent Thrombosis 1-Day Landmark Analysis
Def/Prob Stent Thrombosis (%)
600mg Clopidogrel
300mg Clopidogrel
5
HR [95%CI] =
4 1.30 [0.54-3.16]
HR [95%CI] =2.11
[1.07,4.17]
P = 0.03
P = 0.56
3.4%
3
2
1.6%
1.5%
1
1.2%
0
0
Number at risk
600 mg
300 mg
1
30
90
180
270
365
943
474
863
430
Time in Days
1013 1009 990
519 514 497
969
486
957
480
Dangas G. ACC 2009 Scientific Sessions; March 29, 2009; Orlando, FL.
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Impaired bioavailability of clopidogrel in STEMI patients
Heestermans A, et al Thrombosis Research 2008;122:776-781
5 mmol/l ADP
20 mmol/l ADP
Comparison of changes in platelet aggregation induced between STEMI patients
(n=9) and healthy controls (n=10) after a 600 mg clopidogrel loading dose.
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Abciximab for primary PCI in STEMI
significant mortality reduction
-29%
De Luca G, et al. JAMA 2005;293:1759
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
MACE at 30 Days (%)
HORIZONS - Outcome in Patients With
Symptom Onset to Hospital ER Admission <2.2 hrs
-43%
p=0.03
EMEA. Assesement Report For Angiox. Doc. Ref No.:EMEA/724835/2009. Page 10. www.emea.europa.eu
Titolo: added value of GPIIb/IIIa RB in ACS
.
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Predictors of no-reflow: the ISAR database
Variable Data are median [25th; 75th %]
or number of patients (%)
Left ventricular ejection fraction (%)
Number of narrowed coronary
arteries
1
2
3
Pre-intervention TIMI flow grade
0
1
2
3
Vessel size (mm)
Type of intervention
Stenting
Balloon angioplasty
Pre-procedural abciximab therapy
No-reflow
Reflow
P value
(n =108)
(n =1032)
48.0 [32.8; 56.9] 50.0 [42.0; 58.0] 0.028
0.57
39 (36.1)
29 (26.9)
40 (37.0)
364 (35.3)
325 (31.5)
343 (33.2)
<0.001
90 (83.3)
564 (54.6)
5 (4.6)
109 (10.6)
10 (9.3)
189 (18.3)
3 (2.8)
170 (16.5)
3.02 [2.65; 3.34] 2.93 [2.58; 3.25]
88 (81.5)
20 (18.5)
84 (77.8)
843 (81.7)
189 (18.3)
800 (77.5)
0.28
0.96
0.95
Ndrepepa J et al. Circ Cardiovasc Interv. 2010;3-27-33
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
ACS without persistent ST-segment elevation
Troponins elevated or not
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Patients judged to be at high risk for
progression to MI or death
Patients with recurrent ischemia
Recurrent chest pain
Dynamic ST-segment changes
(ST-segment depression or transient
ST segment elevation)
Early post infarction unstable
angina
Elevated troponin levels
Diabetes
Hemodynamic instability
Major arrhythmias (VF, VT)
Introduction of
GpIIB/IIIA blocker
and
Coronary angiography
ESC NSTEACS GUIDELINES YEAR 2002
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
GP IIb-IIIa Blockade Before and After PCI:
CAPTURE, PURSUIT, PRISM-PLUS
Boersma E, et al. Lancet. 2002;359:189-198.
10%
Before PCI
Post-PCI
-33%
-39%
8.0%
Death or MI
8%
6%
N=12,296
P=0.001
4%
4.9%
4.3%
2.9%
N=2754
P=0.001
2%
0%
0
+24 h
+48 h
+72 h
Placebo
GP IIb-IIIa inhibitor
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
+24 h
+48 h
PCI
Data: 9 Novembre 2012
Evento: Genova
Impact of early intervention in HR pts
With NSTEACS: the TIMACS study
Risk of Death, MI or stroke
30% of the pts
GRS >140)
Mehta SR, NEJM 2009;360:2165-75
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Time to angiography among NSTEACS pts
In hub and spoke hospitals of the Reggio Emilia province
% pts undergoing angiography
100Hub hosp (N=165)
80-
Spoke hosp (N=222)
604062
60
200-
11
<24h
20
11
>24-48h
10
15
>48-72h
10
>72h
Savonitto S et al. GIC 2012;13:157-68
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
CURE: Early Impact of Clopidogrel in UA/NSTEMI
5%
CVD/MI/Stroke
4%
RR=0.82
p=NS
3%
2%
1%
RR=0.81
p=NS
RR=0.80
p=NS
1.1
RR=0.85
p=NS
1.4
2.5
2.1
Placebo
N=6303
Clopidogrel
N=6259
1.2
0.9
0.5 0.4
0%
24 hr
48 hr
72 hr
Time From Randomization
0-7 Days
Yusuf S. Circulation 2003;107:968
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Clopidogrel Pretreatment: Events in UA/NSTEMI
Before Cardiac Catheterization
PCI-CURE (Median time to Catheterization = 10 Days)
20%
RR=0.76
95%CI (0.62-0.93)
p=0.008
15.3%
% Patients
15%
12.1%
10%
RR=0.68
95% CI (0.47-0.99)
p=0.04
5.1%
3.6%
5%
0%
n = 206
n = 159
MI or
or Refractory
MI
Refractory
Ischemia
Ischemia
Placebo
Clopidogrel
n = 68
n = 47
MI
MI
Mehta SR et al. Lancet 2001;358:527-533
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Clopidogrel Pre-Treatment and
Myocardial Damage After Elective Stenting
No Pre-Treatment
Clopidogrel Pre-Treatment (3 days)
N = 203
60
51,1
43,3
50
40
%
30
20,4
17,2
20
10
3,3
6,3
7,4
3,2
0
CK-MB > 16 (6-8 h)
CK-MB > 16 (16-24 h)
Troponin>0.2 (6-8h)
Troponin>0.2 (16-24h)
van der Heijden et al. JACC 2004; 44:20
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Tissue Level Perfusion by TMPG
pre and post-PCI
100
50
p=0.015
80
60
66.7
71
40
20
28.1
TMPG 0/1 (%)
TMPG 0/1 (%)
P= 0.0009
40
35.5
30
20
20
10
6.2
0
0
Upstream
Tirofiban
HBD
Tirofiban
Pre-PCI
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Abciximab
Upstream
Tirofiban
HBD
Tirofiban
Abciximab
Post-PCI
Bolognese L et. JACC 2006;47:522
Data: 9 Novembre 2012
Evento: Genova
Giugliano RP. N Engl J Med 2009;360:2176-90
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
What Early ACS really showed?
1. The trial compared early vs delayed eptifibatide, rather
than GPIIB/IIIa and control
2. Only 59% of the pts underwent PCI, and drug therapy was
strikingly different between North America and Europe (prePCI clopid 50% NA, 85% Europe)
Giugliano RP. N Engl J Med 2009;360:2176-90
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
What Early ACS really showed?
PE: D+MI+ recurrent ischemia requiring
urgent revasc, or thrombotic bailout at 96 h
SE: D+MI at 30 days
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Giugliano RP. N Engl J Med 2009;360:2176-90
Data: 9 Novembre 2012
Evento: Genova
What Early ACS really showed?
PE: D+MI+ recurrent ischemia requiring
urgent revasc, or thrombotic bailout at 96 h
SE: D+MI at 30 days
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Giugliano RP. N Engl J Med 2009;360:2176-90
Data: 9 Novembre 2012
Evento: Genova
30-day Primary Efficacy Results
after shrinking the power
Early
Delayed
Eptifibatide Eptifibatide
(n=4722)
(n=4684)
OR
(95% CI)
P
death or MI
11.2 vs 12.3
0.89 (0.79–1.01) 0.079
Death
2.8 vs 2.6
1.10 (0.86–1.41) 0.46
Myocardial infarction
9.5 vs 10.6 0.88 (0.77–1.01) 0.073
Death, MI, RI req urg revasc 12.5 vs 13.8 0.89 (0.79–1.01) 0.065
RI req urg revasc
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
2.4 vs 2.9
0.80 (0.62–1.03) 0.083
Giugliano RP. N Engl J Med 2009;360:2176-90
Data: 9 Novembre 2012
Evento: Genova
30-day Death or MI
Odds Ratio for Upstream
Eptifibatide (95% CI)
Baseline Characteristic
Routine Early
Eptifibatide, %
Delayed
Provisional
Eptifibatide, %
Overall
11.2
12.3
Men
11.4
12.0
Women
10.7
13.0
Age < 75 yr
Age > 75 yr
10.2
11.6
14.0
14.6
Troponin positive
11.6
13.0
Troponin negative
8.1
8.4
Diabetes
11.7
13.8
No Diabetes
10.9
11.7
Early clopidogrel intended
No early clopidogrel intended
10.3
13.7
12.0
13.4
0.5
0.6
0.7 0.8 0.9 1
Early Eptifibatide Better
2
Delayed Provisional Eptifibatide Better
Giugliano RP. N Engl J Med 2009;360:2176-90
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Randomization
N=9406
Strategy During First
96 Hours
Medical Only
PCI
CABG
Delayed Provisional Eptifibatide (N=4680)
Total Events = 469
Early Eptifibatide (N=4718)
Total Events = 439
CABG (N=268)
Pre-CABG Events = 33
Post-CABG Events = 52
Medical Only (N=1784)
Total Events = 71
PCI (N=2723)
Pre-PCI Events = 87
Post-PCI Events = 243
Total Events on Medical Treatment = 71 + 82 +33
Group
Events Risk
Medical
186
4718
4.1%
Post PCI
201
2584
8.0%
52
235
23.4%
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
CABG (N=251)
Pre-CABG Events = 22
Post CABG Events = 46
Medical Only (N=1706)
Total Events = 71
PCI (N=2666)
Pre-PCI Events = 82
Post-PCI Events = 201
Post CABG
N=3490
N=5389
N=519
Rate
-24%
Total Events on Medical Treatment = 71 + 87 + 22
Group
Events Risk
Medical
180
4680
4.0%
Post PCI
243
2636
10.5%
46
229
20.6%
Post CABG
Rate
Data: 9 Novembre 2012
Evento: Genova
Impact of abciximab on top of
ASA and clopidogrel
20181614121086420-
Death or MI at 30 days
-28%
P=0.02
18.3
P=0.91
P=0.98
13.1
4.0
4.6
4.0
Placebo Abciximab
ISAR REACT 1
4.6
Placebo Abciximab
Placebo Abciximab
ISAR REACT 2
TnT negative
ISAR REACT 2
TnT positive
Kastrati A, NEJM 2004, JAMA 2006
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Bleeding events
Early
eptifibatide
N=4722
Delayed
eptifibatide
N=4684
Giugliano RP. N Engl J Med 2009;360:2176-90
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Contemporary recommendations on
Antiplatelet therapy in NSTEACS PCI
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
ACC/AHA NSTEACS Guidelines
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
ACC/AHA NSTEACS Guidelines
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
How would you treat this patient?
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Probability of 30-D death by sum of ST depression
on the admission ECG: the GUSTO IIb ECG corelab
0,35
50-
Incidence of 3VD
and LMCA disease
by quartiles of
S ST depression
% 3-vessel disease
40-
Probability of 30-day death
0,3
% LM disease
300,25
2010-
0,2
01+2 Q
(n=2493)
0,15
3Q
4Q
(n=1366) (n=1333)
0,1
Probability of death
95% confidence limits
0,05
0
0
5
10
15
20
25
30
35
40
45
sum of ST depression (mm)
Savonitto S et al: Eur Heart J 2005;26: 2106
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
The Lipsia NSTEACS randomised trial
Thiele H. Eur Heart J 2012;33:2035
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
ACUITY: Invasive Management
UFH/Enoxaparin
+ GP IIb/IIIa
(N=4,603)
Bivalirudin
+ GP IIb/IIIa
(N=4,604)
Bivalirudin
alone
(N=4,612)
99.2%
98.8%
98.9%
19.7 (7.0-29.3)†
19.5 (7.0-28.2)†
19.8 (7.3-29.0)†
5.6 (1.6-22.5)†
5.0 (1.4-21.4)†
5.2 (1.5-22.5)†
PCI
55.6%
56.7%
56.8%
CABG
11.9%
10.8%
10.6%
Medical therapy
32.4%
32.5%
32.6%
Angiography
Adm. to angio (h)
†median (IQR)
Drug* to angio/interv (h)
Actual procedure
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Stone GW, Presented at 2006 ACC Meeting.
Available at www.Clinicaltrialsresults.org
Data: 9 Novembre 2012
Evento: Genova
Predictors of reoperation in ACS patients
undergoing CABG
Odds ratio
95% CI
P-value
Clopidogrel
<5 days
4.601
1.454-14.554
0.009
Pre-op
aspirin
0.616
0.109-3.483
0.584
Pre-op
GPI
1.825
0.504-6.613
0.360
Prior
CABG
5.299
1.050-26.734
0.043
Berger JS. JACC 2008;52:1693
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Clopidogrel loading dose and bleeding
in NSTEACS patients undergoing urgent CABG
Outcome
Major bleeding,
Re-operation for
bleeding,
300mg Loading Dose >600mg Loading Dose
(n=148)
(n=48)
70 (47%)
35 (73%)
P
0.002
7 (5%)
6 (12%)
0.09
Tamponade
4 (3%)
2 (4%)
0.64
Mean 24h Chest tube
loss
391 ± 251 mL
536 ± 354 mL
0.01
Post-operative MI
8 (5%)
5 (11%)
0.31
Post-operative CVA
6 (4%)
1 (2%)
0.34
LOS in surgical
intensive care, days
4.3 ± 4.1
5.0 ± 3.1
0.0001
In-hospital death
7 (5%)
1 (2%)
0.68
Cruden NL. Am Heart J 2011;161:404
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Transfusions from time of CABG
Characteristic
Ticagrelor Clopidogrel
(n=632)
(n=629)
p-value
Hazard/Odds Ratio (95% CI)
Transfusions within 7 days post-CABG
Any transfusion
55.2
55.8
0.98 (0.85, 1.14)
0.83
PRBC or whole blood*
52.7
51.2
1.03 (0.88, 1.20)
0.69
Platelets
15.3
17.3
0.88 (0.67, 1.16)
0.37
Fresh frozen plasma
25.2
24.0
1.05 (0.84, 1.31)
0.67
Transfusions post CABG-related bleeding
>4 units blood
17.9
16.2
>5 units whole blood/
PRBC (2 days)
4.9
4.0
Chest tube output >2L
(24 hours)
3.3
2.7
*Median (range) units transfused within 7 days post-CABG:
tic 3.0 (2.0–4.0) vs. clop 3.0 (2.0–4.0); p=0.86
1.12 (0.83, 1.53)
0.45
1.25 (0.70, 2.23)
0.49
1.24 (0.61, 2.52)
0.2
0.5
Ticagrelor better
1.0
0.62
2.0
Clopidogrel better
Held C, JACC 2011;57:672
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Time from CABG to CV death
Clopidogrel (n=629)
7.9
8
K-M estimated rate (%)
7
6
5
4
Ticagrelor (n=629)
4.1
3
2
1
HR: 0.52 (95% CI = 0.32–0.85), p<0.01
0
0
1
2
3
4
5
6
7
8
Months from CABG procedure
9
10
11
12
Held C, JACC 2011;57:672
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Bleeding and mortality after isolated CABG
Clopidogrel vs prasugrel
mean 12-h chest tube blood loss
(655 + 580 ml vs. 503 + 378 ml; p 0.050)
Smith PK. JACC 2012; epub ahead of print 24 May 2012
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Event rates for patient undergoing CABG in PURSUIT
(< 72 h of GP IIb/IIIa discontinuation)
33.6%
cumulative incidence (%)
35%
23.8%
25%
RRR
30%
placebo
eptifibatide
p=
0.002
15%
0
30
60
90
120
150
180
days from randomization
Marso SP et al; Circulation 2000;102:2952-8
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Caso clinico 13 settembre 2012
•Uomo di 72 anni senza precedenti cardiovascolari né rilevanti fattori di rischio.
•Maratoneta amatoriale fino a un anno fa.
• Il 12 settembre esegue nel nostro Ospedale intervento di litotrissia endovescicale
e vaporizzazione prostatica “green light laser” per calcolosi vescicale e IPB ostruente
• Lo stesso pomeriggio, lieve epigastralgia durata 15 minuti, a risoluzione spontanea
• Visita cardiologica (sintomatologia aspecifica) + ECG – richiesti enzimi cardiaci
• La mattina successiva, CKMB 75 ng/ml
• Evoluzione ECG
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova
Caso clinico 13 settembre 2012
•Uomo di 72 anni senza precedenti cardiovascolari né rilevanti fattori di rischio.
•Maratoneta amatoriale fino a un anno fa.
• Il 12 settembre esegue nel nostro Ospedale intervento di litotrissia endovescicale
e vaporizzazione prostatica “green light laser” per calcolosi vescicale e IPB ostruente
• Lo stesso pomeriggio, lieve epigastralgia durata 15 minuti, a risoluzione spontanea
• Visita cardiologica (sintomatologia aspecifica) + ECG – richiesti enzimi cardiaci
• La mattina successiva, CKMB 75 ng/ml
• Evoluzione ECG
• Flectadol 500 mg – Trasferimento in UTIC
• Eseguita coronarografia: occlusione trombotica coronaria destra distale
• Eseguita tromboaspirazione + POBA con ottimo risultato angiografico
• Tirofiban 24 ore post-procedura in vista di stenting 17 Settembre.
Titolo: added value of GPIIb/IIIa RB in ACS
Autore: Stefano Savonitto
Data: 9 Novembre 2012
Evento: Genova