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PRIMARY PCI(Percutaneous Coronary Intervention)
Amir Aziz AlkatiriAmir Aziz AlkatiriRS Awal Bros Pekanbaru
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Primary PCI Treatment of choice for Acute MI
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Definition
• Primary PCI : an emergent percutaneous catheter intervention in the setting of STEMI, without previous fibrinolytic treatment
• is the preferred reperfusion strategy in patients with STEMI
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Primary PCI vs Thrombolytic
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Primary PCI vs Thrombolysis
• Thrombolysis is effective in 40–60% of patients,while p-PCI is effective in > 90%.
• Thus,comparing thrombolysis vs primary PCI is comparing a semi-effective therapy vs a fully effective therapy.
• The mortality benefit derived from the primary PCI strategy is not related to the fact that the underlying stenosis is removed.
• The mortality benefit of primary PCI is caused by the simple fact that primary PCI is twice as effective as thrombolysis in opening the artery.
European Heart Journal (2010) 31, 634–636
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Components of delay in STEMI
European Heart Journal (2012) 33, 2569–2619
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How to Optimize Reperfusion in Acute MI
ProblemProblem SolutionSolution
Longer Delay for Presentation
(symptom onset to presentation)
Longer Delay for Presentation
(symptom onset to presentation)
Large Media Education
Large Media Education
Delay for TransportationDelay for Transportation Logistical ProtocolsLogistical Protocols
Delay for Treatment(either lytics or PCI)
Delay for Treatment(either lytics or PCI)
In-Hospital Quality of
Care
In-Hospital Quality of
Care
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Prehospital and in-hospital management, and reperfusion strategies within 24 h of FMC
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Primary PCI: indications and procedural aspects
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Procedural aspects
• Radial approach is preferred• Drug-eluting stents (DES) reduce the risk of
repeated target vessel revascularization, compared with bare-metal stents (BMS)
• Thrombus Aspiration during Primary PCI showed improvement in indices of myocardial reperfusion (ST-segment resolution and myocardial blush) from routine use of manual thrombus aspiration before a balloon or a stent is introduced into the coronary artery
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Slender Club Japan
2009.12.04
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Periprocedural pharmacotherapy
• DAPT : Aspirin 160-300mg + ADP receptor blocker
(Clopidogrel/Prasugrel/Ticagrelor)• Heparin• GPIIB/IIIA inhibitor
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Revascularization strategy for STEMI with multivessel disease
• Still debatable• Conservative approach• Stage revascularization approach
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Contoh Kasus
• Tn.D, 71thn• Sakit dada berat sejak 6 jam SMRS disertai
keringat dingin• Fakto Risiko: DM, Dislipidemia, Hipertensi• TD 140/70, HR 60x/m• EKG: SR, ST elevasi II,III,aVF, V5-V9
• Diagnosis: Acute Inferoposterior MCI
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