Kỹ thuật nào là tốt nhất cho can thiệp mạch vành cấp

What is the Best Technology for
Primary PCI?
Adj Assoc Prof Yeo Khung Keong
Senior Consultant, Cardiology
Oct 2016

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Best Technology
Cath Lab

Stent

Balloon
Drugs

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Team!

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STEMI Guidelines
• ESC: 2012, 2014
• ACC/AHA: 2013, 2015

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Best Technology
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Drugs
Culprit vs. non-culprit PCI
Aspiration thrombectomy
DES vs. BMS


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Antiplatelet therapy

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Other Antithrombotics
• Heparin or bivalirudin
• Glycoprotein IIb/IIIa antagonist with heparin
or bivalirudin (Class IIA indication)

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Aspiration Thrombectomy

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• RCT; N=1071
• Primary endpoint: myocardial blush grade
• Aspiration better than standard
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Open label, RCT, Registry-based
N=7244
Primary end-point: all cause mortality
No significant difference

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• N=10732, RCT
• Primary: composite of CV death, MI, shock or
NYHA IV (in 180 days)
• Safety: stroke within 30 days
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Summary
• PCI of non-culprit vessel now Class IIB
• Aspiration thrombectomy no longer routine

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Practice
• Not *routine*
• But useful in large thrombus burden
• Meticulous technique

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Angiojet
• Angiojet: no proven benefit and higher
30D MACE

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Angiojet

No proven benefit for routine use
and higher 30D MACE

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DES or BMS
• No different from regular use

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DES or BMS

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