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Yeo Hans Cahyadi MD PhD FESC

Born: Jakarta, 24 August 1955


Status: Married, 3 children
Education: High school, Budi Mulia, 1973
GP, University of Indonesia, 1980
Cardiologist, Kanazawa Med University, Japan,1991
PhD, Kanazawa Medical University, Japan, 1991
Fellow of European Society of Cardiology (FESC), 2007
Employment:
Primary Health Care, Kalimantan 1980-1984
GP in Husada Hospital 1984-1986
Cardiologist, Husada Hospital 1991-now
President Director of Husada Hospital 1999-2005
Head of Depart of Cardiology, Husada Hospital 1999-now

Kegawatdaruratan Jatung
Infark Miokard Akut
Dr. Yeo Hans Cahyadi PhD, SpJP, FIHA, FESC

Normal ECG

VES (Ventricular Extra-Systole)

VES (Ventricular Extra-systole)


pada Old Antero-septal MI

Anterior-inferior STEMI

VT (Ventricular Tachycardia)

Ventricular Fibrillation

Cardiac Arrest

Defibrillator

ATHEROSCLEROSIS
INTRAPLAGUE THROMBUS

PLAGUE RUPTURE
INTRALUMINAL THROBUS

PLAGUE RUPTURE
PROPAGATION THROMBUS

The Vulnerable Plaque

Plaque Disruption

Evolution of Guidelines for ACS


1990199219941996199820002002 20042007 2009
1990
ACC/AHA
AMI
R.
Gunnar

1994
AHCPR/NHLBI
UA
E. Braunwald

1996
1999
Rev
Upd
ACC/AHA
AMI
2000
T. Ryan

2002

2007

Rev
Upd
Rev
ACC/AHA UA/NSTEMI
E. Braunwald; J.
2004
Anderson
2007
Rev

Upd

ACC/AHA STEMI

E. Antman
2009
Upd
ACC/AHA
STEMI/PCI
F. Kushner 34

Pathway: Triage and Transfer for PCI (in STEMI)


STEMI patient who is a
candidate for reperfusion
Initially seen at a
non-PCI
capable facility

Initially seen at a PCI


capable facility
Send to Cath Lab for
primary PCI
(Class I, LOE:A)

Transfer for primary


PCI
(Class I, LOE:A)

Prep antithrombotic (anticoagulant


plus antiplatelet) regimen
Diagnostic angio

Medical
therapy only

PCI

2009 STEMI Focused Update. Appendix 5

CABG

At PCI
facility,
evaluate
for timing
of
diagnostic
angio

Initial Treatment
with fibrinolytic
therapy
(Class 1, LOE:A)

HIGH RISK
Transfer to a PCI
facility is
reasonable for
early diagnostic
angio & possible
PCI or CABG
(Class IIa,
LOE:B),
High-risk
patients as
defined by 2007
STEMI Focused
Update should
undergo cath
(Class 1: LOE B)

NOT HIGH RISK


Transfer to a PCI
facility may be
considered
(Class IIb,
LOE:C),
especially if
ischemic
symptoms
persist and
failure to
reperfuse is
suspected

Mr. SS, 23-03-2011 (9 Ms post PCI)


Angina Pectoris
Cardiogenic shock, BP 85/65 mmHg
ECG

Mr. SS, ECG pre Primary PCI

Mr. SS, CAG + Primary PCI

Mr. SS, Primary PCI

Mr. SS, ECG post Primary PCI

Time is Money

Time is
Myocardium

Estimated lifetime risk of radiation-induced cancer


per 100 000 persons from a single computed
tomographic scan to assess coronary artery
calcification by age at screening

Kim,
K.restrictions
P. et al.
Copyright
mayArch
apply. Intern Med 2009;169:1188-1194.

Site-Specific Estimates of the Lifetime Risk of RadiationInduced Cancer From a Single Coronary Artery Calcification
Computed Tomographic Screen at Age 55 Years

Kim, K.
P. etmay
al.apply.
Arch
Copyright
restrictions

Intern Med 2009;169:1188-1194.

Thank you

ACC/AHA 2009 STEMI/PCI Guidelines


Focused Update
Based on the ACC/AHA Guidelines for the
Management of Patients With ST-Elevation
Myocardial Infarction (STEMI) and the
ACC/AHA/SCAI Guidelines on Percutaneous
Coronary Intervention (PCI): A Report of the
ACC/AHA Task Force on Practice Guidelines

66

Applying Classification of Recommendations


and Level of Evidence
Class I

Class IIa

Class IIb

Class III

Benefit >>> Risk

Benefit >> Risk


Additional studies with
focused objectives
needed

Benefit Risk
Additional studies with
broad objectives
needed; Additional
registry data would be
helpful

Risk Benefit
No additional studies
needed

Procedure/ Treatment
SHOULD be
performed/
administered

IT IS REASONABLE
to perform
procedure/administer
treatment

should
is recommended
is indicated
is useful/effective/
beneficial

is reasonable
can be useful/effective/
beneficial
is probably recommended
or indicated

Procedure/Treatment
MAY BE CONSIDERED

may/might be considered
may/might be reasonable
usefulness/effectiveness is
unknown /unclear/uncertain
or not well established

Procedure/Treatment
should NOT be
performed/administered
SINCE IT IS NOT
HELPFUL AND MAY BE
HARMFUL

is not recommended
is not indicated
should not
is not
useful/effective/beneficial
may be harmful

67

Applying Classification of Recommendations


and Level of Evidence
Class I

Class IIa

Class IIb

Class III

Benefit >>> Risk

Benefit >> Risk


Additional studies with
focused objectives
needed

Benefit Risk
Additional studies with
broad objectives
needed; Additional
registry data would be
helpful

Risk Benefit
No additional studies
needed

Procedure/
Treatment SHOULD
be performed/
administered

IT IS REASONABLE to
perform
procedure/administer
treatment

Procedure/Treatment
MAY BE CONSIDERED

Procedure/Treatment
should NOT be
performed/administered
SINCE IT IS NOT
HELPFUL AND MAY
BE HARMFUL

Level A:

Multiple populations evaluated; Data derived from multiple randomized clinical trials or meta-analyses

Level B:

Limited populations evaluated. Data derived from a single randomized trial or non-randomized studies

Level C:

Very limited populations evaluated. Only consensus opinion of experts, case studies, or standard-of-care.