Validation of the Baveno Vi Criteria to Identify Low Risk ...
Trattamento delle Sindromi Coronariche AcuteSindromi...
Transcript of Trattamento delle Sindromi Coronariche AcuteSindromi...
Trattamento delle Sindromi Coronariche AcuteSindromi Coronariche Acute
nel paziente anziano
Stefano SavonittoDi i i di C di l i
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Divisione di CardiologiaArcispedale S. Maria Nuova
Reggio Emilia
Proportion of men and women >85 year-old registered in the Swedish National hospital discharge registry
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Rosengren A. Eur Heart J 2012;33:562
Comparing mean ages of Italian ACS registries and guideline-building trials
80-NSTEACS STEMI
75- women
70-
65-
men women
year
s
65
60-
7468 68
63
meny
55-6362 62 62 60 59 59
Eur Heart J Acute CV Care
2012
BLITZ 4Eur Heart J
Acute CV Care 2012
BLITZ 4RITA III
Lancet2002
TIMI18
NEJM2001
ICTUSNEJM2005
TRITONLancet2009
HORIZONSNEJM2008
PLATOCirculation
2011
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Average enrolment / center / monthItalian Elderly
ACS Study
313 patients / 21 centres / 29 monthsYears
y
= 0.51 patients / centre / monthYears
2008-2010JACC Intv 2012
Years2005-2007
Eur Heart J 2010
266 patients / 23 centres / 33 months
= 0.34 patients / centre / month
302 patients / 14 centres / 59 monthsYears1996-2000
TIME studyElderly pts
= 0.37 patients / centre / month1996-2000Lancet 2002 Symptomatic
Stable CAD
2220 patients / 196 centres / 24 months
= 0.55 patients / centre / month
Years1998-2000NEJM 2000
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Metanalysis of PPCI vs lysis in elderly patients
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Bueno H, EHJ 2011;32:51-60
Senior PAMI: 30-day Outcome Based on Age-Stratified Randomizationased o ge St at ed a do at o
25
PCI Lysis
22 2220
25
PCI Lysis
1715
20
%
19 2022
16 16
22
15
20
%
7,1 7,7 7,7
11,3 12
5
10
5
10
0Death Death/CVA D/CVA/reMI
Age 70-80 (n=351)
0Death Death/CVA D/CVA/reMI
Age >80 (n=130)
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Primary angioplastyPAMI pooled analysis (1990-1998)
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
De Geare et al Am J Cardiol 2000;86:30–34
12-month outcomes
C it d i t All t litComposite endpoint All-cause mortality
1.0
urvi
val
1.0
val f
ree
ofin
g st
roke Primary PCI
Thrombolysis
0.8
mul
ativ
e Su
0.8
ativ
e Su
rviv
I or d
iasb
l
0.6
Cum
m
P=0.650.6C
umm
ula
deat
h re
M
P=0.31
Follow-up (days)360300240180120600
Follow-up (days)360300240180120600
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Bueno H, EHJ 2011;32:51-60
30-day mortality in STEMI by time
Mortality %
>= 75 yr
65 – 74 yr65 74 yr
< 65 yr
Women<65 Women 65-75 Women >75 Men<65 Men 65-75 Men >75
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Men 65 Men 65 75 Men 75 Uppsala Clinical Research Centre 2005
Changes in the management of ACS in the elderly 2006 vs 2001: The Franche Comté Registry
Non-adjustedAdjusted for propensity score
STE
STE
STESTE
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Schiele F, Eur Heart J 2009;30:987
>2006<2006
Changes 35-day survival in elderly pts with ACS 2001 vs 2006: The Franche Comté Registry
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Schiele F, Eur Heart J 2009;30:987
5-year death/MI in the FIR collaboration
SI= selective invasiveRI= routine invasive
>75>75y
65-74y65 74y
<65y
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Damman P et al. Heart 2012;98:207-13
5-year death/MI in the FIR collaboration according to age and genderaccording to age and gender
SI= selective invasiveRI= routine invasive
>75y
65-74y
<65y<65y
D P t l H t 2012 98 207 13
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Damman P et al. Heart 2012;98:207-13
Italian Elderly
ACS Study
Early aggressive vs initially conservative In elderly patients with NSTEACS and elevated Tn
y
Survival to primary endpoint in troponin positive patients
HR 0.43; 95% CI 0.23-0.80Logrank P=0.015
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Savonitto S. JACC Intv 2012;5:906-16
Italian Elderly
ACS Study
Kaplan Meier survival without primary endpointaccording to actual revascularization
ACS Study
Revascularization (n=119)Revascularization (n 119)Event rate 22%
No revascularization (n=194)Event rate 37%
Logrank P=0.0077
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Italian Elderly
ACS Study
All-cause and cardiac mortality inItalian Elderly ACS and PARTNER
y
30%Mean age 82 years in both cohorts Mean age 84 years
30%-
25%- 71%
All cause
Cardiac46%
20%-
15% 85%15%-
10%- 23.816 9
85%
26.8
5%-
0
13.4 11.116.9
13.0
0-Trial
N=313RegistryN=332
PARTNER (surg)N=351
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
NEJM 2012, March 28Morici N, Am J Cardiol 2013
Cumulative risk estimate of death up to 405 days of follow up
(Morici N, Am J Cardiol 2013)
Italian Elderly
ACS Study
0.20
ACS Study
0.16
0.18Cumulative incidence of Death
120/645 pts (18.6%)
Rat
e
0.12
0.14120/645 pts (18.6%)
Eve
nt R
0.080.10
Cumulative incidence of CV Death
97/645 pts (15.0%)E
0 02
0.040.06
Cumulative incidence of NCV Death
Days0 60 120 180 300 360240 4050.00
0.02 Cumulative incidence of NCV Death
23/645 pts (3.5%)
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Contribution of cardiac death to overall death in the elderly(each column represents the % of cardiac death)
100-General population Hospitalised patients
80-
menwomengeneral
81
60-
g
4149
40-
20-
41
3739 40 4039
20
0-ISTAT CDC Medicare Italian ElderlyBreastProstate HipISTAT>75y
CDCGorina Y
Aging trends 2006
Medicare>67y
Newschaffer CJJ Nat Cancer Inst 2000
Italian ElderlyNSTEACS
>75yAm J Cardiol 2013
Breast cancer>80y
J Clin Oncol 2011
Prostate cancer>65y
Newschaffer CJJ Nat Cancer Inst 2000
Hipfracture
>65yBMJ Musc.Skel Dis
2011
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Independent predictors of death at logistic regressionIn the whole study cohort (Morici N, Am J Cardiol 2013)
Italian Elderly
ACS Study
All-cause death(N° of events=120)
Ejection Fraction* 29.989
Wald χ2
HR 95% CI p-value predictiveinformation
0.952 0.935-0.969 <0.001 35%
ACS Study
Blood haemoglobin* 10.664
Age* 6.607
Creatinine Clearance* 4.716
0.845 0.763-0.935 0.001 13%
1.054 1.013-1.098 0.010 8%
0.986 0.973-0.999 0.030 6%
Cardiovascular death(N° of events=97)
Ejection Fraction 27 109 0 950 0 932-0 969 <0 001 45%Ejection Fraction 27.109
Creatinine Clearance 6.215
Blood haemoglobin 3.372
0.950 0.932-0.969 <0.001 45%
0.982 0.968-0.996 0.013 10%
0.900 0.805-1.007 0.066 6%
1 032 0 986 1 079 0 174 3%
Noncardiovascular death(N° of events=23)
Age 1.844
i 18 8
1.032 0.986-1.079 0.174 3%
0 96 0 4 2 0 3 0 001 42%Blood haemoglobin 18.875
Age 13.151
Ejection Fraction 4.559
0.596 0.472-0.753 <0.001 42%
1.165 1.073-1.265 <0.001 29%
0.952 0.910-0.996 0.033 10%
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
0.5 0.6 0.7 0.8 0.9 1 1.1 1.2 1.3 1.4 1.5
Hazard Ratio (HR)
Mechanisms Leading to Pharmacokinetic Variations of Antithrombotic Drug Effects in the Elderlyg y
Capodanno & Angiolillo JACC 2010;56:1683 1692
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Capodanno & Angiolillo. JACC 2010;56:1683-1692
Safety Concerns in the Elderly with ACSBleeding Risks by Age
17,9 18,520
14,115sion
N=74.271N=74.271
10,39,710Tr
ansf
us
4,55%
RB
C T
0
%
0<65 yrs 65-75 yrs > 75 yrs
Non-CABG Overall
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
C G O
GP IIb/IIIa inhibitors in the Elderly
Pooled data from EPIC, CAPTURE, EPILOG and EPISTENT Trial
AbciximabPlacebo
AbciximabPlacebo
11,8 11,6 11,8
8
10
12
30 d
ay
poin
t(%)
6,15,35
6
7
maj
or
atio
ns (%
)
5,36,5
7,2
4
6
8
urre
nce
of 3
posi
te e
nd-p
3,1
4,43,7
3,2
,
2
3
4
urre
nce
of m
ng c
ompl
ica
0
2
<55 55 - 70 >70
Occ
uco
mp
0
1
2
<55 55 - 70 >70O
ccbl
eedi
nAge (y) Age (y)
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Mak et al, Drugs Aging 2002
30-day bleeding and one-year mortality high risk subgroups
UHF
30-day Major Bleeding UHF
One-year Mortality
Age >75 FemaleUHFpre-treat Diabetes Age >75
RenalFailure Female
UHFpre-treat DiabetesRenal
Failure
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Lincoff AM, JAMA 2004;292:696
Cangrelor in The Elderly?
Non–ST-segment elevation acute coronary syndrome in 25.7% (5.7% had unstable angina), and STEMI in 18.2%.
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Bhatt DL et al. NEJM 2013 Ahead of print
RADIAL VERSUS FEMORAL APPROACH: META-ANALYSIS OF RANDOMIZED TRIALS
Major bleeding 0.05 2.3 0.27 (0.16-0.45) <0.001D+MI+stroke 2.5 3.8 0.71 (0.49-1.01) 0.058D MI stroke 2.5 3.8 0.71 (0.49 1.01) 0.058Death 1.2 1.8 0.74 (0.42-1.30 0.29MI 2.0 2.9 0.76 (0.49-1.17) 0.21Stroke 0.1 0.5 0.39 (0.09-1.75) 0.22Access site crossover
5.9 1.4 3.82 (2.83-5.15) <0.001crossoverInability to cross the lesion
4.7 3.4 1.31 (0.87-1.96) 0.20
N= 4461
Absolute RR 1.8% (95% CI 1.0-2.5%, p= 0.001),
NNT =56 to prevent one major bleeding
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Jolly SS, Am Heart J 2009; 157:132-40
Revascularization procedures Revascularization procedures during index admissionduring index admission
ItalianItalian ElderlyElderly
ACSACS StudyStudyACSACS StudyStudy
100100--9090--8080--7070--
Early Early aggressiveaggressive
9494 9696
6060--5050-- 9696 97979797 100100
InitiallyInitiallyConservativeConservative
4040--3030-- 7070
96967878
DESDES54%54%
DESDES56%56%2020--
1010--00
54%54% 56%56%
00--Radial approachRadial approach stentingstenting Procedural Procedural
successsuccessPCIPCI
ProceduralProceduralsuccesssuccessCABGCABG
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
PCIPCI CABGCABG
Savonitto S. JACC Intv 2012; 5:906-16
Antithrombotic treatments during index admission
Italian Elderly
ACS Study
Early Aggressive (n=154)
Initially Conservative (n=159)
y
Drugs %
Aspirin 95 99Ticlopidine 4.6 1.94.6 1.9Clopidogrel 90 92
Unfractionated heparin 25 24Unfractionated heparin 25 24Enoxaparin 64 59
GPIIb/IIIa inhibitor 17 (24 in PCI) 6 (17 in PCI)Bivalirudin 3.8 1.3
Fondaparinux 8.5 8.5
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Savonitto S. JACC Intv 2012; 5:906-16
Adverse clinical events during index hospitalizationItalian Elderly
ACS Study
Early Aggressive (n=154)
Initially Conservative (n=159)
Death 8 (5 2) 5 (3 1)
py
Death 8 (5.2) 5 (3.1)Myocardial (re)infarction 3 (1.9) 5 (3.1)
N (%)
Severe recurrent ischemia 1 (0.6) 15 (9.4)Heart failure 11 (7.1) 4 (2.5)
0.0004
0.06( ) ( )Cardiac arrhythmia 3 (1.9) 3 (1.9)
Any stroke / Disabling 2 / 0 1 / 0NAny stroke / Disabling stroke
2 / 0 1 / 0TIMI major bleeding 0 1 (0.6)
N
CABG-related bleeding/transfusion
4 (2.6) 0
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Savonitto S. JACC Intv 2012; 5:906-16
Cumulative risk estimate of death up to 405 days of follow up
(Morici N, et al. Submitted)
Italian Elderly
ACS Study
0.20
ACS Study
0.16
0.18Cumulative incidence of Death
120/645 pts (18.6%)
Rat
e
0.12
0.14120/645 pts (18.6%)
Eve
nt R
0.080.10
Cumulative incidence of CV Death
97/645 pts (15.0%)E
0 02
0.040.06
Cumulative incidence of NCV Death
Days0 60 120 180 300 360240 4050.00
0.02 Cumulative incidence of NCV Death
23/645 pts (3.5%)
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Reduced platelet inhibition on clopidogrel in elderly patients (the SENIOR PLATELET study)in elderly patients (the SENIOR PLATELET study)
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Silvain J. Eur Heart J 2012; 33:1241-9
Excess of upper GI complications with low-dose aspirinDepending on previous clinical history
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Patrono C. NEJM 2005
Bleeding complications in CHARISMA
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Becker RC. Circulation 2010;121:2575
Bleeding complications in CHARISMA
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Becker RC. Circulation 2010;121:2575
Wiviott SD, NEJM 2007;357:2001
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
TIMI Major non-CABG bleedingafter day 3 for prasugrel by age
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Wiviott SD, NEJM 2007;357:2001
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Overall efficacy and safety in elderly patients
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Husted S, Circ CV Qual Outcomes 2012;5:680
Newer antiplatelet treatments compared to clopidogrel in ACS: Patients >75 y.o.
25- 25-PLATO (n=2878) TRITON (n=1809)
clopid clopid
20- 20-Adj HR 0.89(IC 0.74-1.08)
HR 0.94(CI 0.75-1.18)
ticag prasug
15- 15-
10-18.3 17.2
10-18.3 17.2
Adj HR 1.18(IC 0.73-1.59)
HR 1.36
5-
0
5-
03.4 4.2
7.1 8.3(CI 0.81-2.27)
0- 0-D+MI+stroke PLATO non-CABG
major bleedingD+MI+stroke TIMI non-CABG
major bleeding
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Husted S. Circ CV Qual Outcomes 2012;5:680 Wiviott S. N Engl J Med 2007;357:2001
Prasugrel 5 mg improves platelet inhibition in the elderly(patients on chronic treatment)
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Capranzano P. Thromb Haemost 2011; 106:1149-57
Platelet inhibition studyPrasugrel 30+5 mg vs clopidogrel 300+75 mgPrasugrel 30 5 mg vs clopidogrel 300 75 mg
G b l PA JAMA 2012 308 1785 94
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Gurbel PA. JAMA 2012;308:1785-94
Overall efficacy and safety in the elderlyOverall efficacy and safety in the elderlyFigures derived by subtraction from the main paperFigures derived by subtraction from the main paper
30-25-20
prasugrel5 mg
clopidogrel75 mg
20-15-10- 24.6 24.1
19 1
Ischemicendpoints
5-0-
CVD+MI CVD MI stroke All cause
13.5 14.5 13.8 12.73.0 2.2
17.0 19.1endpoints
CVD+MI+stroke
CVD MI stroke All-causemortality
4.0-
3.0-
2.0-Bleeding1.0-
0-GUSTO
0.8 1.3 1.8 1.80.3 0.5 0.6 0.6
2.6 3.0g
endpoints
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
GUSTO SEVERE -LT
TIMI Maj TIMI fatal stroke TIMI Maj + min
2 000 patients2 000 patients >>75 years75 yearsRCTRCT
Italian Elderly
ACS-2 Study2,000 patients 2,000 patients >>75 years75 yearswith ACS treated invasivelywith ACS treated invasively
webweb
ACS 2 y
ClopidogrelClopidogrel Pras grelPras grel
webwebrandomrandom
ClopidogrelClopidogrel300+75 mg300+75 mg
PrasugrelPrasugrel60+5 mg60+5 mg
1212--month month 1212--month month followfollow--upup followfollow--upup
PrimaryPrimary endpointendpointth itth it ff llll t litt lit di ldi l ( )( )MIMI di blidi bli t kt k ddthe composite the composite ofof allall--causecause mortalitymortality, , myocardialmyocardial (re)(re)MIMI, , disablingdisabling strokestroke and and
rere--hospitalizationhospitalization forfor cardiovascularcardiovascular causescauses or severe or severe bleedingbleeding withinwithin 12 12 monthsmonths
PI: S. Savonitto, S. De Servi
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
PI: S. Savonitto, S. De ServiCoordinating Center: IRCCS Arcispedale S. Maria Nuova, Reggio Emilia
•78 y.o. man with recurrent bladder cancer and indication to re-TURB• July 2011, NSTEACS: PCI + BMS proximal-mid LAD, heavily calcified• October 2011, NSTEACS with anterior ST depression: severe restenosis LAD and, pAntero-apical akinesia; EF 0.45; moderate mitral rigurgitation• Bypass surgery: LIMA-LAD offpump, left toracotomy.
Day 3 post-surgery
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Donna di 85 anni senza patologie di rilievo, autosufficiente e attivaI° episodio di angor con pre-sincope. Centro spoke, domenica mattina.
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Donna di 85 anni senza patologie di rilievo, autosufficiente e attivaI° episodio di angor con pre-sincope. Centro spoke, domenica mattina
Terapia con nitrato, ASA, Clopidogrel 300 mg.Regressione del dolore, invio a hubg ,
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
A centro hub: ripresa di dolore
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
A centro hub: ripresa di dolore, coronarografia immediata
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Coronarografia immediata per via radiale destra
Coronaria destrarelativamenterelativamentepiccola, con stenosi 70%
FE 0.55
Minima elevazione TnTelevazione TnT
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto
Coronarografia immediata per via radiale destra
Coronaria destrarelativamente
Stop clopidogrelInizia tirofiban
relativamentepiccola, con stenosi 70% Indicazione a
AMIs-IVA in i it t iFE 0.55
Minima elevazione TnT
minitoracotomia senza CEC+ PCI Cx
elevazione TnTPaziente stabile
Intervento rinviatoIntervento rinviatodi 48 ore per wash-out clopidogrel
Data: 10-11 maggio 2013
Evento: Novara - Baveno
Titolo: ACS Treatment elderlyAutore: Stefano Savonitto