文档介绍：AMIStrategy HowtoAchieveDoor-to-BalloonTimesof90MinutesandWhattoDoNext?
AaronKugelmass,MD
Director,CardiacCathLab
AssocAMIStrategy HowtoAchieveDoor-to-BalloonTimesof90MinutesandWhattoDoNext?
AaronKugelmass,MD
Director,CardiacCathLab
AssociateDivisionChief
HenryFordHospital
Detroit,Michigan,USA
Overview
Introduction
TheArgumentforPrimaryPCI
OverviewoftheHenryFordProgram
ProgramSpecifics
ProcessDictatesOutcomes
AlternativeOpportunities
AcuteMI:Introduction
*
About500,000haveSTEMI
220,000diefromtheirAMI
50%ofdeathsinthefirsthour
Outlookofhospitalizedpatientsbetter
*AHA:2001Heartandstrokestatistics
AcuteMI:EarlyManagement Reperfusion
Pharmacological(Thrombolysis)
Fibrinolytics
Antithrombins
PlateletInhibitors
Mechanical(Direct/PrimaryPCI)
Angioplasty
Stent
Thrombectomy
Combined
?FacilitatedPCI
AcuteMI:DirectPCI Advantages
Rapidassessmentofanatomyandhemodynamics
TIMI-3flowrates75-95%ininfarctartery
Lowincidenceofhemorrhagicstroke
Canbedoneinpatientswithcontraindicationsforthrombolysis
Resultssuperiortothrombolyticsinrandomizedtrials
LyticsvsTransferforPCI:DANAMI
AcuteMI:DirectPCI Limitations
Only20%ofUShospitalshavecathlabsandfewerhavePTCAfacilities
Toachieveresultssimilartorandomizedtrialsthefollowinghastobemet:
PTCAwithin90minutesofpresentation
Skilledoperator(>75cases/year)
Skilledlab(>200cases/year)
Surgicalbackupnecessary
IsTimeasCriticalinPrimaryPCI?
30-daymortality
TimefromonsetofCPtorandomization
Zijlstra,EurHeartJ2002;23:550
ProcessChange
CentralizeCommunications
FocusClinicalDecisionMaking
TransferSEMIPatientsDirectlytoSiteofTherapy
EstablishTransportPathways
UniteCICU/CathLabNursingFunctions
ImproveDoortoBalloonTimes!
Door-ToBalloonTime HenryFordHospital Detroit
Door-ToBalloonTime HenryFordSystemWide 2005
HenryFordAcuteMyocardialInfarctionProgram
6EmergencyRooms
HenryFordHospital 90,000visits
HFWyandotteHospital 72,000
HFBicountyHospital 28,000
FairlaneER 47,000
WestBloomfieldER 22,000
SterlingHeightsER 21,0