PCI for UA/NSTEMI or STEMI
ideally within 24 hours.
JAMA: 2018 PCI Update
Timing to PCI:
■ NSTEMI / UA：within 24-48h (< 24h if severe)
■ STEMI：within 90-120min (ideally < 60min)
early PCI 通常是在 24 小時內作.
Killip class
2018年台灣心臟學會指引: NSTEMI 除非是血行動力學不穩（SHOCK）, pulmonary edema, tachy-bradycardia, refractory angina with ECG dynamic change建議及早（<24小時)PCI外，72小時內做不影響預後（mortality）
In high-risk patients with GRACE risk score >140, an early invasive strategy lowered the risk of death, MI or stroke (HR 0.65, 95% CI 0.48–0.89). In a post hoc analysis of the ACUITY trial, a delay to PCI > 24 h was an independent predictor of 30-day and 1-year mortality. The excess of ischemic events associated with the PCI >24 h strategy was most apparent among moderate- and high-risk patients. In the NSTE-ACS patients undergoing PCI from the Taiwan ACS Full Spectrum Registry, early PCI within 24 h could not improve the primary outcome (cardiac death and recurrent MI) compared with late PCI (24–72 or > 72 h) in the low (TIMI risk score 0–2) and intermediate (TIMI risk score 3–4) risk groups. In the high risk group (TIMI risk score 5–7), patients who underwent PCI after 72 h had significantly worse primary outcomes than those who underwent PCI within 24–72 h.131
JAMA: 2018 PCI Update
Timing to PCI:
■ NSTEMI / UA：within 24-48h (< 24h if severe)
■ STEMI：within 90-120min (ideally < 60min)
early PCI 通常是在 24 小時內作.
Killip class
2018年台灣心臟學會指引: NSTEMI 除非是血行動力學不穩（SHOCK）, pulmonary edema, tachy-bradycardia, refractory angina with ECG dynamic change建議及早（<24小時)PCI外，72小時內做不影響預後（mortality）
In high-risk patients with GRACE risk score >140, an early invasive strategy lowered the risk of death, MI or stroke (HR 0.65, 95% CI 0.48–0.89). In a post hoc analysis of the ACUITY trial, a delay to PCI > 24 h was an independent predictor of 30-day and 1-year mortality. The excess of ischemic events associated with the PCI >24 h strategy was most apparent among moderate- and high-risk patients. In the NSTE-ACS patients undergoing PCI from the Taiwan ACS Full Spectrum Registry, early PCI within 24 h could not improve the primary outcome (cardiac death and recurrent MI) compared with late PCI (24–72 or > 72 h) in the low (TIMI risk score 0–2) and intermediate (TIMI risk score 3–4) risk groups. In the high risk group (TIMI risk score 5–7), patients who underwent PCI after 72 h had significantly worse primary outcomes than those who underwent PCI within 24–72 h.131
GRACE 評分系統項目
killip class
SBP
Heart rate
Age
Creatinine
cardiac arrest at admission
ST segment deviation
elevated cardiac enzyme level.
留言
張貼留言