scholarly journals Coronary CT Angiography untuk deteksi plak rapuh, sebagai bagian dari usaha pencegahan Sindrom Koroner Akut

2015 ◽  
pp. 59-64
Author(s):  
Sonny Hilal Wicaksono
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Early Detection ◽  
Ct Angiography ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Ct Angiography ◽  
Coronary Intervention ◽  
Coronary Ct ◽  
Percutaneous Coronary ◽  
St Elevation

Tindakan Primary Percutaneous Coronary Intervention (PPCI) untuk pasien sindrom koroner akut (SKA) dengan ST elevasi (STEMI=ST elevation myocardial infarction) telah berjasa banyak dalam menurunkan mortalitas. Namun kerusakan jaringan miokard pasca PPCI tetap terjadi, akibat iskemia yang telah berlangsung sebelum reperfusi berhasil, atau kerusakan jaringan miokard akibat cedera reperfusi. Hal tersebut menimbulkan konsekuensi morbiditas akibat SKA berupa gagal jantung. Sehingga dikhawatirkan bila SKA tidak dicegah, di masa yang akan datang akan timbul epidemi gagal jantung. Oleh sebab itu strategi pencegahan terjadinya SKA perlu menjadi pengetahuan dasar bagi seluruh dokter spesialis jantung dan pembuluh darah (SpJP) agar epidemi gagal jantung dapat dicegah.Strategi pencegahan SKA tetap memegang 5 prinsip:1. Health Promotion2. Primary Prevention3. Early Detection and Prompt Treatment4. Secondary Prevention5. RehabilitationPoin pertama dan kedua dilakukan langsung ke tengah masyarakat di luar klinik atau rumah sakit, mulai dari poin ke-tiga, yaitu deteksi dini, dilakukan dalam praktek klinik.

Optimum Therapies for ST-Elevation Myocardial Infarction Managed with Primary Percutaneous Coronary Intervention

2012 ◽  
Vol 7 (2) ◽  
pp. 81
Author(s):  
Bruce R Brodie ◽  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Great Majority ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Stent Deployment ◽  
Aspiration Thrombectomy ◽  
Percutaneous Coronary ◽  
St Elevation

This article reviews optimum therapies for the management of ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI). Optimum anti-thrombotic therapy includes aspirin, bivalirudin and the new anti-platelet agents prasugrel or ticagrelor. Stent thrombosis (ST) has been a major concern but can be reduced by achieving optimal stent deployment, use of prasugrel or ticagrelor, selective use of drug-eluting stents (DES) and use of new generation DES. Large thrombus burden is often associated poor outcomes. Patients with moderate to large thrombus should be managed with aspiration thrombectomy and patients with giant thrombus should be treated with glycoprotein IIb/IIIa inhibitors and may require rheolytic thrombectomy. The great majority of STEMI patients presenting at non-PCI hospitals can best be managed with transfer for primary PCI even with substantial delays. A small group of patients who present very early, who are at high clinical risk and have long delays to PCI, may best be treated with a pharmaco-invasive strategy.

scholarly journals Clinical characteristics and long-term mortality of patients with midrange ejection fraction undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Vratonjic ◽  
D Milasinovic ◽  
M Asanin ◽  
V Vukcevic ◽  
S Zaharijev ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ejection Fraction ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Long Term Mortality

Abstract Background Previous studies associated midrange ejection fraction (mrEF) with impaired prognosis in patients with ST-elevation myocardial infarction (STEMI). Purpose Our aim was to assess clinical profile and short- and long-term mortality of patients with mrEF after STEMI treated with primary percutaneous coronary intervention (PCI). Methods This analysis included 8148 patients admitted for primary PCI during 2009–2019, from a high-volume tertiary center, for whom echocardiographic parameters obtained during index hospitalization were available. Midrange EF was defined as 40–49%. Adjusted Cox regression models were used to assess 30-day and 5-year mortality hazard of mrEF, with the reference category being preserved EF (>50%). Results mrEF was present in 29.8% (n=2 427), whereas low ejection fraction (EF<40%) was documented in 24.7% of patients (n=2 016). mrEF was associated with a higher baseline risk as compared with preserved EF patients, but lower when compared with EF<40%, in terms of prior MI (14.5% in mrEF vs. 9.9% in preserved EF vs. 24.2% in low EF, p<0.001), history of diabetes (26.5% vs. 21.2% vs. 30.0%, p<0.001), presence of Killip 2–4 on admission (15.7% vs. 6.9% vs. 26.5%, p<0.001) and median age (61 vs. 59 vs. 64 years, p<0.001). At 30 days, mortality was comparable in mrEF vs. preserved EF group, while it was significantly higher in the low EF group (2.7% vs. 1.6% vs. 9.4%, respectively, p<0.001). At 5 years, mrEF patients had higher crude mortality rate as compared with preserved EF, but lower in comparison with low EF (25.1% vs. 17.0% vs. 48.7%, p<0.001) (Figure). After adjusting for the observed baseline differences mrEF was independently associated with increased mortality at 5 years (HR 1.283, 95% CI: 1.093–1.505, p=0.002), but not at 30 days (HR 1.444, 95% CI: 0.961–2.171, p<0.001). Conclusion Patients with mrEF after primary PCI for STEMI have a distinct baseline clinical risk profile, as compared with patients with reduced (<40%) and preserved (≥50%) EF. Importantly, mrEF did not have a significant impact on short-term mortality following STEMI, but it did independently predict the risk of 5-year mortality. Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document