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ĐIỀU TRỊ TRONG HỘI CHỨNG VÀNH CẤP:
KHI NÀO NÊN CAN THIỆP MẠCH VÀNH?

GS TS BS Võ Thành Nhân
ĐH Y Dược – BV Chợ Rẫy TP HCM



Calculating GRACE Risk Score
Killip
class

Points

Systolic
BP

Points

Age

Points

I

0

≤70

66

≤30

0

0-0.39

II

17

70-89

53

30-49

10

III

34

90-109

40

50-69

IV

51

110-129

27

≥130

19

Baseline risk factors

Points

Cardiac arrest at admission

38

ST-segment deviation

18

Positive cardiac markers

14

STEMI

14

Total from clinical evaluation

Creatinine Points

Heart
rate

Points

3

≤70

10

0.4-0.9

9

70-89

15

29

1.0-1.9

32

90-109

26

70-79

56

≥2

51

110-129

32

80-89

73

130-149

24

≥90

91

150-169

16

170-199

8

≥200

0



2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes



2015 ESC Guidelines for the management of ACS
without persistent ST-segment elevation

European Heart Journal Advance Access published August 29, 2015


2015 ESC Guidelines for the management of ACS
without persistent ST-segment elevation


2015 ESC Guidelines for the management of ACS
without persistent ST-segment elevation

2015 ESC Guidelines for the management of ACS
without persistent ST-segment elevation


2015 ESC Guidelines for the management of ACS
without persistent ST-segment elevation


2015 ESC Guidelines for the management of ACS
without persistent ST-segment elevation






2013 ACCF/AHA Guideline for the
Management of ST-Elevation
Myocardial Infarction
Developed in Collaboration with American College of Emergency Physicians
and Society for Cardiovascular Angiography and Interventions
© American College of Cardiology Foundation and American Heart Association, Inc.


Primary PCI in STEMI


Indications for Transfer for Angiography After
Fibrinolytic Therapy

*Although individual circumstances will vary, clinical stability is defined by the absence of low
output, hypotension, persistent tachycardia, apparent shock, high-grade ventricular or
symptomatic supraventricular tachyarrhythmias, and spontaneous recurrent ischemia.


Indications for PCI of an Infarct Artery in Patients Who
Were Managed With Fibrinolytic Therapy or Who Did
Not Receive Reperfusion Therapy

*Although individual circumstances will vary, clinical stability is defined by the absence of low output,
hypotension, persistent tachycardia, apparent shock, high-grade ventricular or symptomatic
supraventricular tachyarrhythmias, and spontaneous recurrent ischemia.


PCI of a Noninfarct Artery Before
Hospital Discharge
I IIa IIb III

PCI is indicated in a noninfarct artery at a time
separate from primary PCI in patients who have
spontaneous symptoms of myocardial ischemia.

I IIa IIb III

PCI is reasonable in a noninfarct artery at a time
separate from primary PCI in patients with
intermediate- or high-risk findings on noninvasive
testing.

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