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Kegawatdaruratan Jatung
Infark Miokard Akut
Dr. Yeo Hans Cahyadi PhD, SpJP, FIHA, FESC
Normal ECG
Anterior-inferior STEMI
VT (Ventricular Tachycardia)
Ventricular Fibrillation
Cardiac Arrest
Defibrillator
ATHEROSCLEROSIS
INTRAPLAGUE THROMBUS
PLAGUE RUPTURE
INTRALUMINAL THROBUS
PLAGUE RUPTURE
PROPAGATION THROMBUS
Plaque Disruption
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
Medical
therapy only
PCI
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)
Time is Money
Time is
Myocardium
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
Thank you
66
Class IIa
Class IIb
Class III
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
Class IIa
Class IIb
Class III
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.